A third of COVID-19 patients have neurological problems – The Dubrovnik Times

Coronavirus not only causes fever, cough and breathing problems, but also neurological problems such as headache and dizziness, a new study has found. The study was conducted by Chinese scientists on patients in Wuhan, the origin of the pandemic, and published in JAMA Neurology.

They reported that a third of the 214 patients they examined showed signs of a virus affecting the nervous system. Earlier, there were cases where patients suffering from covid-19 lost their sense of smell and taste.

These symptoms indicate that the brain was also affected in some way, commented infectious disease specialist Bernd Salzberger of the University Hospital in Regensburg. "But there are very few studies on the effects of coronavirus on patients' brains. We are still tapping in the dark," he added.

The study from Wuhan was based solely on medical history, laboratory findings and radiological examinations of 214 patients. Neurologist Ling Mao from the Huazhong Faculty of Science and Technology wrote that 78 patients (36.4 percent) had neurological problems.

Most often it was dizziness and headache. In addition, 12 of them lost their sense of taste and 11 of them smell. Six patients also suffered a stroke. But Chinese scientists are uncertain whether these symptoms are due to the disease itself or are part of the body's response to inflammatory processes.

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A third of COVID-19 patients have neurological problems - The Dubrovnik Times

Acute Neurologic Deficit Linked to Salicylate Toxicity – MPR – Monthly Prescribing Reference

A recently published report describes the case of a 61-year-old female patient with a history of stroke that experienced an acute focal neurologic deficit due to salicylate toxicity and highlights the importance of considering this diagnosis and initiating treatment as quickly as possible.

In the emergency department (ED), the patient reported experiencing hemiparesis in her upper and lower extremities after waking up that morning. Further questioning revealed that over the past 2 weeks, the patient had been feeling generally unwell, anxious, and had experienced persistent chest pressure, which she treated with aspirin.

The patients past medical history included essential hypertension, generalized anxiety disorder, and a previous ischemic stroke with an associated seizure disorder. She stated that her seizure disorder was well controlled with diazepam and phenobarbital, however, she had not taken either medication the week prior to her ED presentation due to her illness. Additionally, the patient stated that she was not taking antiplatelet or anticoagulant drugs at the time.

After her arrival, the patient became confused and began experiencing tinnitus, shortness of breath, and blurred vision. Due to her neurologic presentation, age, and past medical history, recurrent stroke or transient ischemic attack were initially considered. After these diagnoses were excluded through further evaluation, laboratory findings revealed a mixed acid-base disorder with a wide anion gap metabolic acidosis and respiratory alkalosis.

Upon further questioning, the patient admitted to excessive use of salicylate over the previous 2 to 3 weeks. Laboratory findings revealed her initial serum salicylate level to be 78.1mg/dL (upper therapeutic limit, 19.9mg/dL).

The patient was treated with oral activated charcoal and intravenous sodium bicarbonate, potassium and dextrose. The patients symptoms completely resolved within 48 hours of her presentation to the ED.

The delay in diagnosis was a concern, considering the potentially fatal nature of salicylate toxicity and the importance of early treatment, the authors concluded, adding that physicians should maintain a high index of suspicion for salicylate toxicity in patients who present with acute neurologic symptoms, and medication history should include direct questioning for salicylate use.

Reference

Delaney TM, Helvey JT, Shiffermiller JF. A Case of Salicylate Toxicity Presenting with Acute Focal Neurologic Deficit in a 61-Year-Old Woman with a History of Stroke [published online February 15, 2020]. American Journal of Case Reports. doi: 10.12659/AJCR.920016.

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Acute Neurologic Deficit Linked to Salicylate Toxicity - MPR - Monthly Prescribing Reference

COVID-19 linked to neurological symptoms, analysis finds – Clinical Daily News – McKnight’s Long Term Care News

Neurologic problems are common in patients with COVID-19, and in some cases are the first symptoms seen, according to a new analysis of patient data.

Among 214 patients hospitalized for COVID-19 in early 2020, 34% had neurologic issues, investigators found. In addition, patients with the most severe illness had significantly more of these problems, including acute cerebrovascular events, impaired consciousness, and muscle injury, reported Bo Hu, M.D., Ph.D., from Huazhong University of Science and Technology, Wuhan, China.

Most neurologic symptoms came early in the illnesses course. Symptom categories included:

Impaired consciousness included change of consciousness level (somnolence, stupor, and coma) and consciousness content (confusion and delirium).

Notably, some patients with fever and headache were admitted to the neurology ward after COVID-19 was ruled out. Days later, they developed established COVID-19 symptoms (cough, throat pain, lower lymphocyte count and lung scan signs) and were transferred back to the isolation ward.

Full findings were published Friday in JAMA Neurology.

In other coronavirus news:

Pharmacists permitted to order and administer COVID-19 tests: Licensed pharmacists may now order and administer COVID-19 tests approved by the U.S. Food and Drug Administration, the Department of Health and Human Services announced last week. The directive aims to improve testing access.

CDC confirms: Elders and males account for more coronavirus hospitalizations: The COVID-19 hospitalization rate for people 65 and older was 13.8 per 100,000, compared to a rate of 4.6 per 100,000 overall, preliminary data from March shows. Males may be disproportionately affected by COVID-19 compared with females, and black populations might be disproportionately affected as well, the agency reported.

Face masks offer slight protection from flu-like illness: Surgical-grade face masks provide modest protection against flu-like illness, according to a new study. Researchers from the University of East Anglia say there is enough evidence to support their use by vulnerable people, including patients and care providers in high-risk situations such as healthcare settings.

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COVID-19 linked to neurological symptoms, analysis finds - Clinical Daily News - McKnight's Long Term Care News

Does Long-Term Exposure to Air Pollution Lead to a Steeper Rate of Cognitive Decline? – Newswise

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Newswise MINNEAPOLIS People who live in urban areas with higher levels of air pollution may score lower on thinking and memory tests and may also lose cognitive skills faster over time, or it is possible they also may not, according to a study published in the April 8, 2020, online issue of Neurology, the medical journal of the American Academy of Neurology. Researchers examined the association of air pollution levels and cognitive impairment and decline in participants in two large epidemiological studies. They found an association between the air pollution and cognitive decline in one study group but not in the other.

As people live longer lives and the aging population grows, age-related cognitive decline is a growing public health concern with profound social, economic and health effects, so finding ways to reduce the risk is important, said study author Erin R Kulick, Ph.D., M.P.H., of Brown University School of Public Health in Providence, R.I., and a member of the American Academy of Neurology. Air pollution can affect large populations of people because it has known cardiovascular risks, and previous research has found that it may also contribute to cognitive decline. However, the results of our research were mixed.

The study involved people living in the Northern Manhattan area of New York City who were enrolled in two larger long-term studies: 5,330 people with an average age of 75 enrolled in the Washington Heights-Inwood Community Aging Project; and 1,093 people with an average age of 70 enrolled in the Northern Manhattan Study. Both groups were ethnically and racially diverse with black, white and Hispanic participants.

All participants were given medical exams at the beginning of the study as well as cognitive tests to measure memory, language skills and executive function, which involves thinking skills like organizing, planning and completing tasks.

The group from the Washington-Heights-Inwood study of 5,330 participants was followed an average of seven years with six rounds of follow-up testing every 18 months to two years. The Northern Manhattan study group of 1,093 participants was followed for five years with one follow-up round of testing.

Researchers used the residential addresses of each participant to determine their exposures to three air pollutants. Those pollutants were nitrogen dioxide and two groups of particulate matter, particles of liquids or solids suspended in air that were less than 2.5 microns in diameter called fine particulate matter and particles that were less than 10 microns in diameter called respirable particulate matter. Average levels of air pollutants were similar for both groups of participants. In each group, participants were divided into four groups based on their air pollution exposure.

Researchers found that participants in the Washington-Heights Inwood study were exposed to a yearly average of 32 parts per billion of nitrogen dioxide, 13 micrograms per cubic meter (g/m3) of fine particulate matter and 21 g/m3 of respirable particulate matter The U.S. Environmental Protection Agency (EPA) considers up to 53 parts per billion to be a safe level of yearly average exposure to nitrogen dioxide, up to 12 g/m3 for fine particulate matter and up to 50 g/m3 for respirable particulate matter.

While the levels were in the range considered safe by the EPA, its possible that these results reflect higher levels from an earlier point in time. It also raises the question of whether the federal levels are low enough to protect peoples health, said Kulick.

The researchers found that in the Washington Heights-Inwood group, people with greater exposure to higher levels of air pollution had lower scores on the tests at the beginning of the study and more rapid rates of decline.

Exposure to nitrogen dioxide was linked to an accelerated rate of cognitive decline comparable to one year of aging. Results were similar for fine and respirable particulate matter.

In the Northern Manhattan group, researchers did not find an association between cognitive function and air pollution. Kulick says the difference in results may be because the second group was much smaller and only had one round of follow-up compared to six rounds for the first group.

A strength of our study was that we were able to analyze the rates of cognitive decline over time so it adds important findings to the growing body of scientific evidence about air pollution and its effects on the brain health of older adults, Kulick said. More research is needed to better understand our studys mixed results. The good news for public health is that air pollution can be reduced, and has been in some cities, through laws and regulation. But there are still millions of people living in areas of the United States where major air quality improvements are needed.

A limitation of the study was that while it included levels of air pollution near a persons residence, it did not account for levels of pollution at the workplace or elsewhere. Also, many participants grew up in other countries and may have had different exposures to air pollution at younger ages.

The study was supported by the National Heart, Lung, and Blood Institute, the National Institute of Environmental Health, the National Institute of Aging and the Environmental Protection Agency.

Learn more about dementia at BrainandLife.org, home of the American Academy of Neurologys free patient and caregiver magazine focused on the intersection of neurologic disease and brain health. Follow Brain & Life on Facebook, Twitter and Instagram.

The American Academy of Neurology is the worlds largest association of neurologists and neuroscience professionals, with over 36,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimers disease, stroke, migraine, multiple sclerosis, concussion, Parkinsons disease and epilepsy.

For more information about the American Academy of Neurology, visit AAN.com or find us on Facebook, Twitter, Instagram, LinkedIn and YouTube.

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Does Long-Term Exposure to Air Pollution Lead to a Steeper Rate of Cognitive Decline? - Newswise

Telemedicine Market demand to reach USD 175 Bn by 2026: Global Market Insights, Inc. – GlobeNewswire

Selbyville, Delaware, April 14, 2020 (GLOBE NEWSWIRE) --

Global Market Insights, Inc. has recently added a new report on telemedicine market which estimates the global market valuation for telemedicine will cross US$ 175 billion by 2026. Growing cases of COVID-19 infections across the globe is one of the significant factors boosting the market growth. For instance, total active COVID-19 cases have reached about 1.4 million cases across the globe.

Maintaining social distancing and self-quarantine are of key importance in containing the spread of corona virus. This have led to few countries taking stringent measures such as partial or complete lockdown. Which supports increasing adoption of telemedicine services to avail healthcare services. Also, various stringent regulations that were imposed on practicing telemedicine have also been relaxed. Such favorable government policies and growing inclination of patients towards virtual visits will propel the telemedicine market growth.

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Tele-monitoring services market accounted for revenue share of about 29% in 2019 and similar trend is expected during the analysis period. Tele-monitoring services can be used to monitor those patients that are suffering from flu-like symptoms but are negative for COVID-19 infection. Moreover, tele-monitoring reduces the overall burden on the medical fraternity, thereby increasing their access to those patients that are suffering from serious ailments.

Telehospital market will witness more than 19% growth during 2020 to 2026. As the medical and paramedical personnel are at higher risks of COVID-19 infections, the demand for telehospital services is expected to increase in the future. For instance, more than 60 doctors have died in Italy due to the COVID-19 pandemic. Thus, with increasing number of healthcare personnel getting infected by the corona virus, the need for telehospital services is likely to increase during the analysis timeframe.

Neurology segment was valued at around USD 5.5 billion in 2019 and is anticipated to witness significant growth through 2026. Increasing incidence of Parkinsons disease, Alzheimers disease, autism, and epilepsy will increase the application of telemedicine in neurology. Growing demand for tele-neurology services especially amongst the older patient population will drive the telemedicine market for neurology. Moreover, with few countries implementing partial or complete lockdown, patients suffering from various neurological disorders will increasingly adopt telemedicine services.

Browse key industry insights spread across 200 pages with 283 market data tables & 9 figures & charts from the report, Telemedicine Market Share & Forecast, 2020 2026 in detail along with the table of contents:

https://www.gminsights.com/industry-analysis/telemedicine-market

Call centers segment is forecasted to show steady expansion at 18.8% CAGR from 2020 to 2026. Increasing influence of home quarantine and social distancing will lead to a spike in number of calls received by various telemedicine call centers. Moreover, companies are expanding their capabilities to serve and cater the exponential increase in the virtual call volume. Aforementioned factors will drive the market growth.

China telemedicine market is projected to expand at a CAGR of more than 23% over the forecast period. The regional growth is attributed to the factors such as large number of COVID-19 infections and growing target geriatric population. Moreover, with implementation of partial lockdown in certain provinces of China, the patients are increasingly adopting telemedicine services. Factors such as increasing usage of smartphones and internet among the Chinese population will further drive the market growth.

Some major findings of the telemedicine market report include:

Some of the prominent players operating in the e-health market are Allscripts Healthcare Solutions Inc, AMD Global Telemedicine, American Well, BioTelemetry, Cisco Systems, Honeywell International Inc, Koninklijke Philips N.V., and Teladoc. These players adopt various strategies such as acquisitions, collaborations, mergers, partnerships, geographic expansion. For instance, in May 2018, Allscripts signed an agreement to acquire HealthGrid Holding Company. This acquisition will enable significant expansion of FollowMyHealth platform portfolio and spur revenue generation.

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Partial chapters of report table of contents (TOC):

Chapter 2. Executive Summary

2.1. Telemedicine industry 360synopsis, 2015 - 2026

2.1.1. Business trends

2.1.2. Service trends

2.1.3. Type trends

2.1.4. Specialty trends

2.1.5. Delivery mode trends

2.1.6. Regional trends

Chapter 3. Telemedicine Industry Insights

3.1. Industry segmentation

3.2. Industry landscape, 2015 2026

3.3. Industry impact forces

3.3.1. Growth drivers

3.3.1.1. Rising cases of COVID-19 infections across the globe

3.3.1.2. Increasing prevalence of chronic diseases

3.3.1.3. Growing number of smartphone users

3.3.1.4. Technological advancements related to mobile phones and internet

3.3.1.5. Greater need for cost-saving in healthcare delivery

3.3.1.6. Long waiting time in hospitals for disease treatment

3.3.1.7. Favorable government initiatives

3.3.2. Industry pitfalls & challenges

3.3.2.1. Security and privacy concerns

3.3.2.2. Lack of knowledge and trust in developing countries

3.4. Growth potential analysis

3.4.1. By service

3.4.2. By type

3.4.3. By specialty

3.4.4. By delivery mode

3.5. COVID-19 impact analysis

3.5.1. Impact of COVID-19 on major markets

3.5.1.1. Overview

3.5.1.2. U.S.

3.5.1.3. Canada

3.5.1.4. Germany

3.5.1.5. UK

3.5.1.6. France

3.5.1.7. Spain

3.5.1.8. Italy

3.5.1.9. Switzerland

3.5.1.10. China

3.5.1.11. Japan

3.5.1.12. Saudi Arabia

3.5.2. Impact of COVID-19 on industry segments, by 10 major markets (2020)

3.5.2.1. Teleconsultation

3.5.2.2. Tele-monitoring

3.5.2.3. Telehome

3.5.2.4. Mental Health

3.5.2.5. Respiratory illness

3.5.3. Impact of COVID-19 on industry competition

3.5.3.1. Strategy

3.5.3.2. Product portfolio

3.5.3.3. Business growth

3.6. Reimbursement scenario

3.6.1. U.S.

3.6.2. Europe

3.7. Telemedicine modalities

3.8. Telemedicine projects

3.9. Government initiatives

3.10. Telemedicine future trends

3.11. Analyst recommendations

3.12. Porters analysis

3.13. Competitive landscape, 2019

3.13.1. Strategy dashboard

3.14. PESTEL analysis

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About Global Market Insights

Global Market Insights, Inc., headquartered in Delaware, U.S., is a global market research and consulting service provider, offering syndicated and custom research reports along with growth consulting services. Our business intelligence and industry research reports offer clients with penetrative insights and actionable market data specially designed and presented to aid strategic decision-making. These exhaustive reports are designed via a proprietary research methodology and are available for key industries such as chemicals, advanced materials, technology, renewable energy and biotechnology.

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Telemedicine Market demand to reach USD 175 Bn by 2026: Global Market Insights, Inc. - GlobeNewswire

State accuses Alamo doctor of attempting to assist in C-section while drunk – danvillesanramon.com

byRyan J. Degan

A doctor from Alamo is at risk of having her medical license revoked after the California Medical Board alleged that she attempted to assist with childbirth surgery at San Ramon Regional Medical Center while under the influence of alcohol.

Filed on March 26 by the state board, the complaint alleges that Dr. Michele Louise Riopelle, an obstetrician and gynecologist (OB/GYN) with San Ramon Regional at the time, was called in to assist in a caesarean section and reported to the hospital for the operation despite having a blood alcohol level of 0.30%.

The complaint alleges the doctor entered the operating room in an intoxicated state but did not take part in the C-section that night.

It was not immediately clear whether Riopelle was represented by an attorney. There is no written response to the complaint, nor any other documentation provided by Riopelle's side, in the California Medical Board online public document database.

Krista Deans, a spokesperson for San Ramon Regional, told DanvilleSanRamon.com on Tuesday, "Dr. Michele Riopelle is not practicing at San Ramon Regional Medical Center."

The incident occurred at approximately midnight on the night of July 31 to Aug. 1, when Riopelle was the on-call obstetrician for the San Ramon Regional labor and delivery department.

According to the Medical Board's complaint, after receiving the call that she was needed to assist in an operation, Riopelle arrived to the hospital within 40 minutes -- even though San Ramon Regional bylaws require a 30-minute response time for C-section assistance -- during which time nursing staff noticed she was "unsteady on her feet, slurring her speech, confused and incoherent."

According to the complaint, Riopelle denied taking any medication and claimed she was fine, but she was observed having difficulty washing her hands and was unable to tie her shoes or apply her mask correctly.

While nursing staff tried to prevent her from doing so, Riopelle allegedly insisted on entering the operating room where, in the presence of the patient's husband, she attempted to put on her gown and gloves. Eventually Riopelle had to be escorted out of the operating room after attempting to approach the patient, according to the complaint.

The complaint added that the attending OB/GYN was able to complete the C-section with assistance from a pediatrician prior to Riopelle entering the operating room.

Riopelle was taken to the hospital's emergency room, where she was noted to have "altered speech and poor coordination," according to the complaint. After claiming to have taken a muscle relaxant the previous day, Riopelle denied having consumed any alcohol.

Fearing a "neurological event" the emergency room physician performed a full neurological evaluation that included a CT scan, before a blood test revealed a 0.30% blood alcohol level, according to the complaint. Riopelle was then released to the care of her husband with a diagnosis of acute alcohol intoxication.

After charging Riopelle with inappropriate conduct, the Medical Board of California can revoke her license to practice, have it suspended or place her on probation.

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State accuses Alamo doctor of attempting to assist in C-section while drunk - danvillesanramon.com

Global Pediatric Neurology Devices Market- Industry Analysis and Forecast (2020-2027) by Product Type, Service, Neurological Subspecialties,…

Global Pediatric Neurology Devices Market was valued US$ XX Bn in 2019 and is expected to reach US$ XX Bn by 2027, at a nearby CAGR of 8.7 % during a forecast period.

Market Definition

Pediatric neurology is a branch of science raising to neurological disorders in children like frequent headaches and insomnia. The prevalence of neurological disorders in children is mounting rapidly. Neurological disorders are diseases of brain, spine, and nerves that connect them.

Market Dynamics

The report contains a detailed list of factors that will drive and restrain the growth of the pediatric neurology devices market. Government of developing economies are looking forward to accepting advanced technology from the developed regions to improve the quality of life of their citizen and also support the launch of medical devices for treating and aiding children with neurological disorders. Environmental factors could provoke genetic and epigenetic mutations as well as disease-related inflammatory events such as Alzheimers disease. However, the high cost related to diagnosis and monitoring of neurological diseases may hinder market growth.

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Global Pediatric Neurology Devices Segment analysis:

The report covers the segments in the pediatric neurology devices market such as product, services, neurological subspecialties, and application. Based on service, the electroencephalography segment is expected to grow at the highest X.6 % CAGR during the forecast period. Electroencephalography (EEG) Measures electrical potentials at scalp generated by underlying neurons particularly useful at diagnosing epilepsy and coma and also it monitors record of the electrical activity of the brain. Therapists highly rely on EEG procedures and video EEG to diagnose neonatal seizures and paroxysmal events and psychogenic nonepileptic seizures (PNES) respectively.

Global Pediatric Neurology Devices Market Regional analysis

North America dominates the pediatric neurology devices market share of XX % during the forecast period because of the rising incidence of diseases such as depression, epilepsy, and migraine, high healthcare spending, and cumulative government support for research & development. The 3rd International Conference on Neurology and Brain Disorders were organized on 19-10, June 2019 at the Crowne Plaza Dublin Hotel, Dublin- Ireland helps for regional growth. Migraine is an extraordinarily prevalent neurological disease, affecting 39 million men, women and children in the U.S. and 1 billion worldwide in 2019.

According to the Neurological Alliance, estimated that there are 14.7 million neurological cases in 2019. According to a report published by UMKC School of Medicine, about 2.7 million people in the U.S are suffering by epilepsy and more than 45,000 new cases are diagnosed every year. Increasing the incidence of neurological disorders in the region, which increases the market potential for neurology drugs.

Country-wise Analysis:

Emerging economies, such as India and China, contribute to the growth of the market in APAC which will grow at a CAGR of XX%, because of increasing incidents of neurological disorders. The prevalence of neurological disorders is representing huge economic and social burden mainly in low income and developing regions where there is increased life expectancy and elevated aging populations, as well as neurological services and resources, which are rare and limited. Furthermore, factors such as the increasing demand for quality devices in the healthcare and flourishing healthcare technology is estimated to provide the drive to the market growth, which boosts the uptake of advanced equipment.

Key Development

The reports cover key developments in the pediatric neurology devices market as organic and inorganic growth strategies.

On January 2020: Abbotts has developed low dose neurostimulation for chronic pain. The Proclaim XR spinal cord stimulator can run for ten years using its internal battery, and patients can control its function using a paired iPhone. For chronic pain patients who may be helped by such therapy, it may result in a huge lifestyle improvement over many of their previous options. January 2020, The infinity Parkinsons by delivering deep brain stimulation(DBS) system, originally developed by St. Jude Medical that became part of Abbott, already has approval to stimulate the subthalamic nucleus (STN) and ventral intermediate nucleus (VIM) for the he treatment of Parkinsons, Essential Tremor, and some other movement disorders.

The objective of the report is to present a comprehensive analysis of the Global Pediatric Neurology Devices Market including all the stakeholders of the industry. The past and current status of the industry with forecasted market size and trends are presented in the report with the analysis of complicated data in simple language. The report covers all the aspects of the industry with a dedicated study of key players that includes market leaders, followers and new entrants. PORTER, SVOR, PESTEL analysis with the potential impact of micro-economic factors of the market have been presented in the report. External as well as internal factors that are supposed to affect the business positively or negatively have been analyzed, which will give a clear futuristic view of the industry to the decision-makers.The report also helps in understanding Global Pediatric Neurology Devices Market dynamics, structure by analyzing the market segments and project the Global Pediatric Neurology Devices Market size. Clear representation of competitive analysis of key players by Application, price, financial position, Product portfolio, growth strategies, and regional presence in the Global Pediatric Neurology Devices Market make the report investors guide.

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Scope of the Global Pediatric Neurology Devices Market

Global Pediatric Neurology Devices Market, By Product Type

Neurosurgery Devices Neurostimulator Cerebrospinal Fluid (CSF) Management DevicesGlobal Pediatric Neurology Devices Market, By Service

Electroencephalogram Intrathecal Baclofen Therapy Neurological Evaluations Vagal Nerve StimulationGlobal Pediatric Neurology Devices Market, By Neurological Subspecialties

Neuro-Oncology Neuromuscular Neonatal Neurology Neuroimmunology Stroke OthersGlobal Pediatric Neurology Devices Market, By Application

Hospitals Healthcare Centers Neurological Research CentersGlobal Pediatric Neurology Devices Market, by Regions

North America Europe Asia-Pacific Latin America Middle East and Africa (MEA)Key Players operating in Global Pediatric Neurology Devices Market

Abbot Elana Inova Healthcare System Medtronic The Nemours Foundation Stryker Boston Scientific B.Braun Melsungen Integra LifeSciences St. Jude Medical

MAJOR TOC OF THE REPORT

Chapter One: Pediatric Neurology Devices Market Overview

Chapter Two: Manufacturers Profiles

Chapter Three: Global Pediatric Neurology Devices Market Competition, by Players

Chapter Four: Global Pediatric Neurology Devices Market Size by Regions

Chapter Five: North America Pediatric Neurology Devices Revenue by Countries

Chapter Six: Europe Pediatric Neurology Devices Revenue by Countries

Chapter Seven: Asia-Pacific Pediatric Neurology Devices Revenue by Countries

Chapter Eight: South America Pediatric Neurology Devices Revenue by Countries

Chapter Nine: Middle East and Africa Revenue Pediatric Neurology Devices by Countries

Chapter Ten: Global Pediatric Neurology Devices Market Segment by Type

Chapter Eleven: Global Pediatric Neurology Devices Market Segment by Application

Chapter Twelve: Global Pediatric Neurology Devices Market Size Forecast (2019-2026)

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Global Pediatric Neurology Devices Market- Industry Analysis and Forecast (2020-2027) by Product Type, Service, Neurological Subspecialties,...

Severe Neurological Ailments Reported in COVID-19 Patients – The Scientist

Although respiratory distress is the predominant complication of COVID-19, there are also rare, yet serious, neurological ailments that may arise. A survey of UK hospitals found that some patients also experience strokes, dementia-like symptoms, and delirium. The findings were published on June 25 in The Lancet Psychiatry.

Throughout April, neurologists in the United Kingdom used databases to find 125 hospitalized patients who tested positive for COVID-19 and also experienced certain neurological afflictions. More than half of the patients suffered a cerebrovascular event, with 57 patients enduring an ischemic stroke, while nine had an intracerebral hemorrhage.

These relatively rare but incredibly severe complications get missed, like needles in a haystack, Benedict Michael, a neurologist at the University of Liverpool and senior author of the paper, tells Science News. Now that we know the rough idea of the scale of this, we desperately need research that gets to the disease mechanisms.

An altered mental state was the second most common neurological malady, with 39 patients experiencing new-onset psychosis, neurocognitive decline, or other conditions.

The patients from the survey ranged in age from 2394. While patients of all ages were roughly equally likely to experience an altered mental state, those over age 60 were more than four times more likely to have a cerebrovascular event than their younger counterparts were.

This actually is a direct effect, in some people, of the virus going into brains, Mark George, a psychiatrist and neurologist at the Medical University of South Carolina who was not involved with the study, tells STAT.

It isnt clear whether these symptoms of delirium are coming from the virus or if the hospitals stressful conditions are at least partially to blame. The New York Times reports that some changes aimed to minimize the spread of SARS-CoV-2 in hospitals, such as little human contact from the use of head-to-toe protective equipment for healthcare workers and the lack of visitors, have made hospitalization more stressful than normal. On top of that, fighting the virus has its own inherent challenges, including decreased oxygen intake and cumbersome attachments to machines.

Its like the perfect storm to generate delirium, it really, really is, delirium expert Sharon Inouye of the Hospital Life Elder Program tells the Times. The article recounts the case of a 31-year-old COVID-19 patient from Tennessee, not included in the survey, who experienced hospital delirium as a terrifying ordeal, hallucinating situations such as burning alive, being attacked by cats, and being experimented on in another country. Once, the visions were so vivid and scary that she ended up pulling out her ventilator tube.

Because the UK survey focused on hospitalized patients, it does not shed any light on how many people with COVID-19 might be experiencing milder neurological symptoms, such as fatigue, anxiety, or altered sensory perception. It is also unclear how long patients could expect to experience these symptoms.

Theres increased risk for temporary or even permanent cognitive deficits, psychiatrist Lawrence Kaplan tells the Times. It is actually more devastating than people realize.

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Severe Neurological Ailments Reported in COVID-19 Patients - The Scientist

Informative Report On Interventional Neurology Devices Market 2020 With keyplayer Abbott, DePuy Synthes, Medtronic, Stryker, Terumo, Acandis, Bayer,…

Interventional Neurology Devices Market Industry Forecast To 2024

Garner Insights has titled a new research report named as Interventional Neurology Devices Market 2020 to its consistently extending database. The report clarifies this through a series of channels which include data ranging from rudimentary data to an undeniable estimate. It consolidates all the fundamental factors that are foreseen to change inside the market. The information would thus be used to heighten an organizations standing in the worldwide market.

Interventional neurology refers to endovascular, catheter-based techniques using fluoroscopy and angiography to diagnose and treat vascular disease of the central nervous system. Neurointerventional procedures use imaging technology and are minimally invasive, meaning they can be accomplished through small incisions, rather than open surgery.

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Based on the industrial chain, this report mainly elaborates the definition, types, applications and major players of Interventional Neurology Devices market in details. Deep analysis about Interventional Neurology Devices market status (2014-2019), enterprise competition pattern, advantages and disadvantages of enterprise products, industry development trends (2020-2024), regional industrial layout characteristics and policies has also be included.

Major Manufacturer Detail:Abbott, DePuy Synthes, Medtronic, Stryker, Terumo, Acandis, Bayer, Boston Scientific, Biosensors International, evonos, Merit Medical Systems, MicroPort Scientific, Neurosign, Penumbra, Spiegelberg, Surtex Instruments

The Important Type Coverage:Carotid Artery Angioplasty and Stenting, Carotid Artery Stents, Embolic Protection Systems, Balloon Occlusion Devices, Aneurysm Coiling and Embolization Devices, Flow Diversion Devices, Liquid Embolic Devices, Embolic coils, Micr-Support Devices, Microcatheters

Segment by ApplicationsArteriovenous Malformation and Fistulas, Cerebral Aneurysms, Schemic Strokes, Intracranial Atherosclerotic Disease

The Interventional Neurology Devices report consists of streamlined financial data obtained from various research sources to provide specific and trustworthy analysis. Evaluation of the key market trends with a positive impact on the market over the following couple of years, including an in-depth analysis of the market segmentation, comprising of sub-markets, on a regional and global basis. The report also provides a detailed outlook of the Interventional Neurology Devices market share along with strategic recommendations, on the basis of emerging segments.

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Some Of The Major Geographies Included In This Study:

North America (U.S and Canada and Rest of North America)Europe (Germany, France, Italy and Rest of Europe)Asia-Pacific (China, Japan, India, South Korea and Rest of Asia-Pacific)LAMEA (Brazil, Turkey, Saudi Arabia, South Africa and Rest of LAMEA)

Some major points covered in this Interventional Neurology Devices Market report:

1. An overall outlook of the market that helps in picking up essential data.2. The market has been segmented on the basis of the product types, applications, end-users, as well as the industry verticals, in light of numerous factors. Considering the market segmentation, further analysis has been carried out in an effective manner. For better understanding and a thorough analysis of the market, the key segments have further been partitioned into sub-segments.3. In the next section, factors responsible for the growth of the market have been included. This data has been collected from the primary and secondary sources and has been approved by the industry specialists. It helps in understanding the key market segments and their future trends.4. The report also includes the study of the latest developments and the profiles of major industry players.5. The Interventional Neurology Devices market research report also presents an eight-year forecast on the basis of how the market is predicted to grow.

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Informative Report On Interventional Neurology Devices Market 2020 With keyplayer Abbott, DePuy Synthes, Medtronic, Stryker, Terumo, Acandis, Bayer,...

Specialty Physicians Weigh in on the State of Practice After COVID-19 – Rheumatology Network

The negative impact of the COVID-19 pandemic on specialty medical practices may lift by the start of next month, according to a new report issued by the market research company Spherix Global Insights.

"Our frontline healthcare leaders are scared, worried, and frustrated. Collectively, they estimate it being eight to nine weeks before things begin to improve and 83 percent of those surveyed last week (April 1) expect things to get worse in the next two weeks. In the words of one neurologist, "(My greatest concern is) that it will linger on to some degree for much of the year and dramatically and permanently affect people's livelihoods, relationships, and dreams," according to a statement issued by Spherix.

The company surveyed 252 rheumatologists, dermatologists, gastroenterologists, nephrologists and neurologists early this month findng that office visits are down by at least 80 percent, despite the adoption of telemedicine. Doctors, the report said, have had challenges with telemedicine and are still unclear about reimbursement policies for the use of telemedicine in place of in-office visits. "Though telemedicine consults have seen successive increases each week, it is not coming close to bridging the gap, and some specialties are having a more difficult time than others," Spherix stated.

The drop in cases has placed financial strain on office-based practices, particularly for dermatologists and gastroenterologists who rely heavily on elective procedures. Many practices have furloughed or staff or laid off works altogehter. If the lockdown and pandemic continues for another two months, some private practices may not survive. "Those in smaller practices are most concerned," the report stated.

While 23 percent of physicians belive the stimulus package will help their practice, more than one-third anticipate little to no impact from government assistance and the majority of physicians have ranked President Trump's handling of the crisis "low satisfaction."

"Drugs associated with being more targeted regarding their immunosuppression and generally considered as having favorable safety profiles may come off the least scathed: Amgen's Otezla for psoriasis and psoriatic arthritis (PsA) and Takeda's Entyvio for inflammatory bowel disease (IBD), though the latter will be counter-balanced by tempered use of infusion products. For most leading brands in the autoimmune space, there have been minimal issues with the supply chain, the exceptions being hydroxychloroquine (84% of rheumatologists report issues) and Genentech's Actemra (34% of rheumatologists report issues). Products that require administration by a healthcare professional, such as Sun Dermatology's Ilumya for psoriasis, also face a challenging scenario," the report stated.

Drug suppliers, such as AbbVie, have been in frequent communication with dermatology, gastroenterology and rheumatology specialists. "It seems that AbbVie in particular is attempting to thwart any launch setbacks for their next generation JAK inhibitor (Rinvoq), as the company was listed the most frequently by rheumatologists as continuing to provide samples via mail and engage in e-detailing platforms."

"Nephrologists have been a bit more buffered than other specialists with regard to patient volume decreases, as their dialysis population continues to require thrice weekly treatment to survive. However, their patient population immunosuppressed kidney transplant patients, elderly dialysis patients receiving care in group settings, and a patient base with chronic kidney disease that typically has multiple other co-morbidities is associated with a significantly higher risk of COVID-19 complications. Over the past two weeks, nephrologists increasingly reported having action plans in place for dealing with a COVID-19 outbreak at a dialysis unit; the vast majority are prepared. Most of those surveyed give high satisfaction ratings to dialysis organizations, such as Fresenius and DaVita, and the American Society of Nephrology, for their communication around COVID-19. Only 22% feel that the pharmaceutical industry is providing a high level of support/communication, and more than half say that increased samples, largely to help bridge patients with financial hardship, would be appreciated."

Approximatley half of neurologists are now starting fewer multiple sclerosis patients on their first disease-modifying therapy (DMT) or switching patients to new treatments, compared to prior to the COVID-19 outbreak. "While concerns related to immunosuppression are definitely a factor, access to infusion centers and delayed scheduling of next doses may also be playing an increasing role in the decreased use, as three out of five neurologists indicate that at least some patients are having difficulty getting their Ocrevus treatments (compared to only 28% for a high-efficacy oral DMT like Novartis' Gilenya)."

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Specialty Physicians Weigh in on the State of Practice After COVID-19 - Rheumatology Network

Finding Hope and Pain Relief For CRPS with Dr. Katinka van der Merwe on the True Grit and Grace Podcast – PR Web

At The Spero Clinic, instead of just treating the pain, we focus on the body as a whole, helping patients go into complete remission with non-invasive and holistic treatments, said Dr. Katinka. Our team is here to remind you that hope is alive.

FAYETTEVILLE, Ark. (PRWEB) June 24, 2020

Dr. Katinka van der Merwe, the creator of the worlds leading 12 week pain relief program, has been the most requested guest on the True Grit and Grace podcast. She explains her outside-the-box, holistic approach to treating CRPS and how important it is to have hope and knowing remission is possible.

After being diagnosed with CRPS about 10 years ago, Amberly Lago, the host of the True Grit and Grace podcast, understands the impact of chronic pain. Dubbed the suicide disease, CRPS often leads to feelings of hopelessness and depression in those suffering. In this podcast, Dr. Katinka stresses the importance of maintaining hope and having a support team during remission, along with incorporating the body, mind, and spirit into the treatment process.

At The Spero Clinic, instead of just treating the pain, we focus on the body as a whole, helping patients go into complete remission with non-invasive and holistic treatments, said Dr. Katinka. Our team is here to remind you that hope is alive.

Dr. Katinka and Amberly also touch on how chronic pain patients should practice healthy eating habits, providing helpful nutrition tips to those diagnosed with CRPS. While its essential to maintain your physical health, patients should first focus on having a resilient mindset to overcome the physical and emotional pain that comes with CRPS.

For more information on The Spero Clinics treatments and success stories, visit The Spero Clinic website.

More About The Spero Clinic At The Spero Clinic, Dr. Katinka van der Merwe and her team use a Neurologic Recovery Program to help patients who are suffering from severe chronic pain like RSD/CRPS. They focus on Neurologic Rehabilitation and restoring balance to the Autonomic Nervous System. Dr. Katinkas world leading 12 week pain relief program helps treat hopeless cases worldwide.

For more information, please visit https://thesperoclinic.com/ or call us at (479) 304-8202.

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Finding Hope and Pain Relief For CRPS with Dr. Katinka van der Merwe on the True Grit and Grace Podcast - PR Web

Global Neurology Software Market 2020: Industry Analysis by Types, Application, Growth Opportunities, Key Players Analysis & Forecast Report 2025…

The report offers detailed study of the Global Neurology Software Market. The study on Global Neurology Software Market, offers deep insights about the Neurology Software Market covering all the crucial aspects of the market. Moreover, the report provides historical information with future forecast over the forecast period. Various important factors such as market trends, revenue growth patterns market shares and demand and supply are included in almost all the market research report for every industry. Some of the important aspects analyzed in the report includes market share, production, key regions, revenue rate as well as key players.

This study covers following key players:EpicBizmaticsAthenahealthhealthfusionAllscriptsNextgenBrainlabGreenway HealthKareoPractice FusionAdvanced Data SystemsNueMD

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The study is done with the help of analysis such as SWOT analysis and PESTEL analysis. There are different marketing strategies that every marketer looks up to in order to ace the competition in the Global market. Some of the primary marketing strategies that is needed for every business to be successful are Passion, Focus, Watching the Data, Communicating the value To Your Customers, Your Understanding of Your Target Market. There is a target set in market that every marketing strategy has to reach.

One of the ways for the estimation for the growth of the market is estimation of the market share by the regions which is likely to contribute to the growth of the market in the estimated forecast period. In this, the growth and fall of the each regions is covered which is likely to boost the growth of the Neurology Software market. In addition, to determine and use precise methods, research methodology such as the qualitative and quantitative data is used for the estimation and determination of the Global Neurology Software Market. It consists of the detailed study of current market trends along with the past statistics. The past years are considered as reference to get the predicted data for the forecasted period. The report covers complete analysis of the Neurology Software Market on the basis of regional and global level. Various important factors such as market trends, revenue growth patterns market shares and demand and supply are included in almost all the market research report for every industry.

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Market segment by Type, the product can be split intoAdvanced Neurology EMR SoftwareOther

Market segment by Application, split intoHospitalsCollege & Research InstitutesOther

In addition, it also covers political and social factors which is likely to affect the growth of the market. It also covers and analysis several segments which are present in the market. A significant development has been recorded by the market of Neurology Software, in past few years. It is also for it to grow further. Various important factors such as market trends, revenue growth patterns market shares and demand and supply are included in almost all the market research report for every industry.

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Global Neurology Software Market 2020: Industry Analysis by Types, Application, Growth Opportunities, Key Players Analysis & Forecast Report 2025...

More Evidence that Tobacco Smoking May Protect Against… : Neurology Today – LWW Journals

Article In Brief

Researchers suggest smoking may reduce risk of Parkinson's disease related death, and for those who smoked longer the risk was even less.

A six-decade follow-up study of nearly 30,000 British male doctors found that those who smoked tobacco when the study began in 1951 had a 30 percent lower risk of death from Parkinson's disease (PD), while those who continued to smoke had 40 percent lower risk, according to a report published in the May 5 online edition of Neurology.

The cohort study, which was followed up for 65-years, does not prove cause and effectthat smoking tobacco protects against PDbut it adds to previous findings that suggest that tobacco smoking is beneficial when it comes to the risk of developing PD. Researchers suspect that the nicotine found in tobacco may have a protective effect.

The researchers were careful to point out that the study should not be seen as advocating for smoking. Rather, they said that there needs to be a better understanding of why smoking may reduce the risk of PD because that might help explain the causes of the disease.

Current smoking is the leading cause of premature death and disability worldwide, and any such hazards would greatly exceed any beneficial effects of smoking on risk of Parkinson's disease, said study coauthor Robert Clarke, MD, professor of epidemiology and public health medicine at the University of Oxford, in an email to Neurology Today.

Little is known about the modifiable risk factors for PD, but previous studies have reported positive associations of PD with head injury, pesticide exposure, and consumption of dairy products, and inverse associations with caffeine, serum urate, physical activity, ibuprofen, and tobacco smoking, the study authors wrote.

The authors noted that a 2015 meta-analysis of observational studies reported that current smoking was associated with 60 percent lower risk of PD, but cautioned there is substantial uncertainty about the causal relevance of this inverse association. On the other hand, the authors cited a 2014 large case-control study from Denmark that suggested that the lower risk of PD in current smokers may be due to reverse causality bias, whereby early non-motor signs of PD may include a reduced response to nicotine stimulation, prompting current smokers to quit smoking before the diagnosis of PD can be made.

The current study, led by Benjamin Mappin-Kasirer, MSc, used data collected for the British Doctors Study, a prospective cohort begun in 1951 by Sir Richard Doll to examine the effects of tobacco smoking on disease-specific mortality. The study, which started with more than 34,000 doctors, was one of the first to establish the link between smoking and lung cancer.

The doctors who participated filled out a short questionnaire on their smoking status (current, ex, or never), amount smoked and in what form (cigarette, pipe or cigar). Ex-smokers were asked the questions about the time when they did smoke and about when they quit smoking.

Surviving participants were resurveyed by mail about changes in their smoking habits on six occasions between 1958 and 1998. The researchers collected cause-specific mortality for the doctors through November 20, 2016, using national mortality registries and personal inquiries. Complete mortality information was available for 99 percent of the study participants. The long follow-up period of the study coincided with a time when cigarette smoking was declining in the British population. Among doctors aged 65 to 69, the prevalence of current smoking declined from 67 perceny in 1951 to 8 percent in 1998, the study said.

The new analysis was based on information on 29,737 doctors. There were 25.879 deaths in the group, including 283 deaths that listed PD as the underlying cause. The average age of PD death was 82 years. The unadjusted rates of PD death were lower in current smokers (30 deaths per 100,000 person-years) compared with those who never smoked at baseline (46 deaths per 100,000 person- years). After the researchers did statistical adjustments for age-at-risk, current smokers at baseline had a 30 percent lower risk of PD, and the current smokers (classified as such using updated smoking habits on sequential resurveys) had a 40 percent lower risk of PD compared with doctors who never smoked.

The risks of PD were inversely associated with the amount of tobacco smoked, the researchers reported. Also, the protective effect of current smoking versus never smoking for PD was attenuated by increasing duration since quitting smoking.

Current smoking is the leading cause of premature death and disability worldwide, and any such hazards would greatly exceed any beneficial effects of smoking on risk of Parkinson's disease.

DR. ROBERT CLARKE

The investigators concluded in contrast with previous suggestions, the present report demonstrates a causally protective effect of current smoking on risk of PD.

Dr. Clarke said that while more needs to be learned, the most likely explanation is that the nicotine content in tobacco smoke may have protective properties, possibly by stimulating the release of dopamine, but the effects of other components of tobacco cannot be excluded.

The researchers said the strengths of their study included its large size and lengthy follow-up, a high response rate to the repeated surveys, and the fact that they used several statistical models to account for changes in smoking habits, reverse causality, and age-at-risk of PDeach of which yielded consistent results.

Limitations included the fact that there were only 283 PD cases, participants were all male British doctors, and the surveys did not collect information on family history, caffeine intake or other factors.

Rodolfo Savica, MD, PhD, associate professor of neurology and epidemiology at the Mayo Clinic in Rochester, MN, said the new analysis on smoking and PD is another piece of the puzzle. There is something there, but what is not yet clear.

He said that while nicotine is often singled out, we don't know if it's nicotine. He said that some of the studies using nicotine did not yield any results in Parkinson's disease, and did not find a protective effect.

Dr. Savica, who conducts PD research, said the all-male cohort in the British study makes him question what the effect of smoking tobacco would be on a similarly large study of women, noting that Parkinson's disease can present differently in men and women. Dr. Savica was the lead author on a study published in 2016 in JAMA Neurology that found an increase in PD from 1976 to 2005. The 30-year trend was derived from data collected for the Rochester Epidemiology Project. While the study was unable to conclude why there was an increase in cases, particularly among older men, environmental changes, including less smoking, was suggested as a possible factor.

Dr. Savica said cohort studies need to be interpreted with caution. As a physician it would be criminal for me to say to my patients, Start smoking now. They would die of cancer, he said.

Susan Searles Nielsen, PhD, assistant professor of neurology and a neuroepidemiologist at Washington University in St. Louis, said the inverse association between tobacco smoking and risk of Parkinson's has been strong and very consistent in the medical literature. But she said she does not agree with the Oxford researchers that their findings clearly indicate a causally protective effect, and likewise does not believe cause-and-effect can yet be ascribed to previous such findings.

Dr. Nielsen said that although this and other studies have consistently found a protective effect of tobacco, a very plausible alternative [hypothesis] remains that individuals predisposed to PD might have a different response to nicotine that extends back as far as adolescence, when smoking typically begins.

She said smoking tobacco could, with further study, turn out to be causal, non-causal or a bit of both, in terms of risk for PD. She said a few epidemiologic studies, including one that she coauthored, have found an association between exposure to second-hand tobacco smoke and lower risk of PD.

We don't know what it is about tobacco that might decrease the risk of Parkinson's disease if the association does turn out to be causal, Dr. Nielsen said. She noted that when people smoke tobacco, there is a massive host of other chemicals that come along with the nicotine.

To test the nicotine theory, she conducted a study that collected information on the past dietary habits of newly diagnosed PD patients and non-PD controls to examine whether nicotine-containing edibles from the same botanical family as tobacco might provide any protective effect. The study, published in Annals of Neurology in 2013, suggested that eating nicotine-containing foods, particularly peppers, might be protective against PD, Dr. Nielsen said.

Iris Kim, ScD, a senior epidemiologist at Vertex Pharmaceuticals in Boston (who did post-doctoral research at the Big Data Institute of Oxford University, but did not work on this study), said the new study is noteworthy.

That the follow-up period is so long is the major strength of the study, she said, as well as the fact that it corroborates previous findings that smoking is protective. Dr. Kim said one shortcoming of the study was that it did not collect information on caffeine intake, and so authors could not take into account the participants' caffeine intake, which has been shown to be protective against PD in some studies.

Dr. Kim last year published a large cohort study of 1.3 million women in the United Kingdom that found no association between alcohol intake and PD risk, and another study in 2013 that reported that caffeine intake was associated with a lower risk of Parkinson's disease among men. Both papers were published in Movement Disorders.

She said she agreed with the British researchers that the mechanism through which smoking may be protective are not fully understood. What are the biological agents that are driving this?

Drs. Clarke, Nielsen, and Savica had no disclosures.

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More Evidence that Tobacco Smoking May Protect Against... : Neurology Today - LWW Journals

Ovid Therapeutics Announces Multiple Presentations on the 2020 American Academy of Neurology Science Highlights Platform – GlobeNewswire

NEW YORK, June 08, 2020 (GLOBE NEWSWIRE) -- Ovid Therapeutics Inc. (NASDAQ: OVID), a biopharmaceutical company committed to developing medicines that transform the lives of people with rare neurological diseases, today announced multiple presentations across its rare neurological disease platform are available on the 2020 American Academy of Neurology (AAN) Science Highlights platform. The presentations were originally slated for discussion at the AAN 72nd Annual Meeting scheduled for April 25-May 1, which was cancelled due to the COVID-19 pandemic. The abstracts were also published in the online supplement to Neurology.

The presentations available on the AAN Science Highlights online platform include the following:

Presentations on OV101 (gaboxadol) in Neurodevelopmental Disorders:

Title: The adaptation and utility of the Clinical Global Impression scale for studying treatment outcomes in neurodevelopmental conditionsTopic: Child Neurology and Developmental Neurology

Title: The pivotal Phase 3 NEPTUNE trial investigating OV101 (gaboxadol) in Angelman syndrome: study overview and rationaleTopic: Child Neurology and Developmental Neurology

Title: Evidence of pharmacodynamic tolerance during repeated daily OV101 (gaboxadol) exposure in individuals with Angelman syndrome Topic: Child Neurology and Developmental Neurology

Title: Physiologically based pharmacokinetic modeling (PBPK) for OV101 (gaboxadol) exposure in children with Angelman syndromeTopic: Child Neurology and Developmental Neurology

Title: Caregiver insight on the core domains in Angelman syndromeTopic: Child Neurology and Developmental Neurology

Title: Quality of life in adolescent and adult individuals with Angelman syndrome: Baseline results from the Phase 2 STARS studyTopic: Child Neurology and Developmental Neurology

Title: Concomitant medication in adolescent and adult individuals with Angelman syndrome: Baseline results from the Phase 2 STARS studyTopic: Child Neurology and Developmental Neurology

Title: The Phase 2a ROCKET trial investigating OV101 (gaboxadol) in adolescents and young adults with Fragile X syndromeTopic: Child Neurology and Developmental Neurology

Presentations on OV935/TAK935 (soticlestat) in Rare Developmental and Epileptic Encephalopathies (DEE):

Title: Initial data from the ongoing ENDYMION open-label extension trial of soticlestat (TAK-935/OV935) in participants with developmental and/or epileptic encephalopathies (DEE)Topic: Epilepsy/Clinical Neurophysiology (EEG)

Title: A phase 1b/2a study of soticlestat (TAK-935/OV935) as adjunctive therapy in patients with developmental and epileptic encephalopathiesTopic: Epilepsy/Clinical Neurophysiology (EEG)

About Ovid TherapeuticsOvid Therapeutics Inc. is a New York-based biopharmaceutical company using its BoldMedicine approach to develop medicines that transform the lives of patients with rare neurological disorders. Ovid has a broad pipeline of potential first-in-class medicines. The Companys most advanced investigational medicine, OV101 (gaboxadol), is currently in clinical development for the treatment of Angelman syndrome and Fragile X syndrome. Ovid is also developing OV935/TAK935 (soticlestat) in collaboration with Takeda Pharmaceutical Company Limited for the potential treatment of rare developmental and epileptic encephalopathies (DEE).

For more information on Ovid, please visit http://www.ovidrx.com/.

Contacts

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

Or

Investors: Steve KlassBurns McClellan, Inc.sklass@burnsmc.com (212) 213-0006

Media:Katie Engleman1ABkatie@1abmedia.com(919) 333-7722

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Ovid Therapeutics Announces Multiple Presentations on the 2020 American Academy of Neurology Science Highlights Platform - GlobeNewswire

The Honor Roll of US News Best Children’s Hospitals 2020-21 – WTOP

A photo tour of the 2020-21 Best Childrens Hospitals Which hospitals are best prepared to care for the sickest kids?

A photo tour of the 2020-21 Best Childrens Hospitals

Which hospitals are best prepared to care for the sickest kids? The 2020-21 U.S. News Best Childrens Hospitals rankings identify 88 hospitals with demonstrated expertise in one or more of 10 pediatric specialties. Ten hospitals earned a place on the Best Childrens Hospitals Honor Roll.

Click through the slides to view the Best Childrens Honor Roll hospitals.

10. Lucile Packard Childrens Hospital Stanford

Location: Palo Alto, California

2019-20 Honor Roll rank: Not Ranked

Number of 2020-21 Honor Roll specialties: 10

Highest-ranking specialties: Neonatology (#3), Pediatric Nephrology (#4), Pediatric Pulmonology & Lung Surgery (#7), Pediatric Neurology & Neurosurgery (#8)

See all of this hospitals rankings.

9. UPMC Childrens Hospital of Pittsburgh

Location: Pittsburgh, Pennsylvania

2019-20 Honor Roll rank: 8

Number of 2020-21 Honor Roll specialties: 10

Highest-ranking specialties: Pediatric Cardiology & Heart Surgery (#2), Pediatric Diabetes & Endocrinology (#7), Pediatric Gastroenterology & GI Surgery (#9)

See all of this hospitals rankings.

8. Nationwide Childrens Hospital

Location: Columbus, Ohio

2019-20 Honor Roll rank: 7

Number of 2020-21 Honor Roll specialties: 10

Highest-ranking specialties: Pediatric Neurology & Neurosurgery (#6), Pediatric Pulmonology & Lung Surgery (#6), Pediatric Cancer (#8), Pediatric Orthopedics (#8)

See all of this hospitals rankings.

7. Childrens National Hospital

Location: Washington, D.C.

2019-20 Honor Roll rank: 6

Number of 2020-21 Honor Roll specialties: 10

Highest-ranking specialties: Neonatology (#1), Pediatric Neurology & Neurosurgery (#3), Pediatric Cancer (#6), Pediatric Nephrology (#7)

See all of this hospitals rankings.

6. Childrens Hospital Colorado

Location: Aurora, Colorado

2019-20 Honor Roll rank: 10 (tie)

Number of 2020-21 Honor Roll specialties: 10

Highest-ranking specialties: Pediatric Gastroenterology & GI Surgery (#1), Pediatric Diabetes & Endocrinology (#4), Pediatric Pulmonology & Lung Surgery (#5), Pediatric Cardiology & Heart Surgery (#6)

See all of this hospitals rankings.

5. Childrens Hospital Los Angeles

Location: Los Angeles, California

2019-20 Honor Roll rank: 5

Number of 2020-21 Honor Roll specialties: 10

Highest-ranking specialties: Neonatology (#2), Pediatric Cardiology & Heart Surgery (#3), Pediatric Orthopedics (#4), Pediatric Cancer (#5), Pediatric Gastroenterology & GI Surgery (#6)

See all of this hospitals rankings.

4. Texas Childrens Hospital

Location: Houston, Texas

2019-20 Honor Roll rank: 3 (tie)

Number of 2020-21 Honor Roll specialties: 10

Highest-ranking specialties: Pediatric Cardiology & Heart Surgery (#1), Pediatric Nephrology (#2), Pediatric Neurology & Neurosurgery (#2), Pediatric Pulmonology & Lung Surgery (#3)

See all of this hospitals rankings.

3. Cincinnati Childrens Hospital Medical Center

Location: Cincinnati, Ohio

2019-20 Honor Roll rank: 3 (tie)

Number of 2020-21 Honor Roll specialties: 10

Highest-ranking specialties: Pediatric Cancer (#3), Pediatric Diabetes & Endocrinology (#3), Pediatric Nephrology (#3), Pediatric Orthopedics (#3)

See all of this hospitals rankings.

2. Childrens Hospital of Philadelphia

Location: Philadelphia, Pennsylvania

2019-20 Honor Roll rank: 2

Number of 2020-21 Honor Roll specialties: 10

Highest-ranking specialties: Pediatric Cancer (#1), Pediatric Diabetes & Endocrinology (#1), Pediatric Orthopedics (#1), Pediatric Pulmonology & Lung Surgery (#2)

See all of this hospitals rankings.

1. Boston Childrens Hospital

Location: Boston, Massachusetts

2019-20 Honor Roll rank: 1

Number of 2020-21 Honor Roll specialties: 10

Highest-ranking specialties: Pediatric Nephrology (#1), Pediatric Neurology & Neurosurgery (#1), Pediatric Pulmonology & Lung Surgery (#1), Pediatric Urology (#1)

See all of this hospitals rankings.

More from U.S. News

10 Concerns Parents Have About Their Kids Health

NYC Pediatrician Steps Up for Adults With COVID-19

COVID-19: Racing the Clock to Treat a New Mystery Syndrome

The Honor Roll of U.S. News Best Childrens Hospitals 2020-21 originally appeared on usnews.com

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The Honor Roll of US News Best Children's Hospitals 2020-21 - WTOP

Roche’s Ocrevus Continues to Impress in the EU with Strong Uptake in New Start and Switch Multiple Sclerosis Patient Segments, but Novartis’ Mayzent…

In the wake of the Mayzent EMA approval, neurologists expect to diagnose more patients with active secondary progressive multiple sclerosis to broaden the pool of patients eligible for the second-to-market S1P receptor modulator, according to Spherix Global Insights

EXTON, Pa., April 9, 2020 /PRNewswire/ --Driven by expanded access to and uptake of disease-modifying therapies (DMTs) to treat advanced stages of relapsing multiple sclerosis (MS), the MS market in Europe shows signs of continued expansion of the number of patients treated with DMTs. Spherix collected data from 247 EU5 neurologists surveyed between February 5th and March 3rd for the most recent semiannual report included in Spherix's RealTime Dynamix: Multiple Sclerosis (EU) service. Findings confirm that the introductions of Roche's Ocrevus, Merck KGaA's Mavenclad, and (most recently) Novartis' Mayzent have contributed to the growth in treatment rates for relapsing remitting MS (RRMS), active secondary progressive MS (SPMS), and primary progressive MS (PPMS). Ocrevus has shown tremendous ability to usurp historical mainstays just two years after its initial launches in Europe, the anti-CD20 monoclonal antibody (mAb) has replaced glatiramer acetate (GA) as one of the most preferred DMTs on the market. Generic alternatives to Copaxone could have cut back on the erosion of the GA class, but Teva's success in patent litigation and continued Copaxone brand loyalty have minimized generic disruption. Indeed, steady declines in overall GA share reveal that the first generics in the MS market have struggled to establish a foothold capable of buoying the class back to its historical level of popularity.

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Increasing use of Ocrevus in patients starting on a DMT for the first time, as well as patients switching to a different brand, are both driving Ocrevus' quickly rising reported share in MS. Within the segment of new start patients, Biogen's Tecfidera and Sanofi's Aubagio are currently the share leaders, as neurologists have become accustomed to relying on the convenience of oral DMTs for their MS patients initiating DMT treatmentespecially in France. However, with many neurologists favoring induction treatment, in which new patients are initiated on an aggressive approach with a high efficacy agent, Ocrevus is an increasingly popular option for patients starting on DMT treatment. In the UK, where induction treatment is especially common, the rise of Ocrevus use in new start patients accompanies a corresponding drop in Tecfidera use among the same group, threatening the latter DMT's dominance in early lines of therapy.

Among switch patients, Ocrevus is now the most prescribed therapy, besting Novartis' Gilenya and Biogen's Tysabri. With European Medicines Agency (EMA) restrictions placed on use of Sanofi's Lemtrada beginning in November 2019, prescribing of Lemtrada as a switch-to agent has dropped significantly, and overall preference for and reported share of the DMT have fallen. Neurologists now appear to be replacing prior use of Lemtrada with more prescribing of Ocrevus, especially in Germany, Italy, and Spain. Tecfidera, the second most frequently prescribed switch-to agent just one year ago, has also experienced a substantial contraction of reported share in France and Germany.

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Ocrevus' growth trajectory has been impressive and sustained over the past two years, but new and emerging agents are poised to abate its increasing dominance. Approved by the EMA on January 13th, just weeks before survey fielding, Novartis' Mayzent is now the only therapy, besides Bayer's Betaferon, indicated specifically for the treatment of active SPMS. Given the decline of interferon shares and the desire to use high-efficacy treatments for patients with advanced disease, neurologists expect that Mayzent's true competition will be with Ocrevus. Indeed, audit data from 1,266 charts of EU patients recently switched to a new DMT, analyzed as part of Spherix's RealWorld Dynamix: DMT Switching in Multiple Sclerosis (EU) service, showed that Ocrevus was the active SPMS switch segment leader. Early perceptions among neurologists suggest that Mayzent could become a key option for active SPMS. More than half of EU neurologists are extremely willing to prescribe Mayzent to a patient with active SPMS, and diagnosis of active SPMS is expected to increase considerably over the next two years indicating that neurologists plan to reclassify a proportion of their RRMS patients as having active SPMS in order to make them eligible for Mayzent treatment.

Along with Mayzent's ability to establish a niche in active SPMS, the other threat to Ocrevus further along the horizon may again come from Novartis, with the company's subcutaneous anti-CD20 mAb, ofatumumab. Although the agent is approximately a year away from an EMA decision, EU neurologists have high hopes for its efficacy (expected to be comparable to that of Ocrevus given its mechanistic similarities) and convenient route of administration allowing it to be administered at home. One German neurologist considers ofatumumab a "highly effective therapy concept with better controllability than [Ocrevus]."

Although optimism is high for ofatumumab's at-home administration capabilities, neurologists are accustomed to the built-in opportunities for patient monitoring that come with infusion mAbs; in reality, candidacy for ofatumumab may depend heavily on likelihood of good patient compliance and adherence. In the upcoming EU RealWorld Dynamix audit, Spherix will evaluate the impact of DMT dosing profile on brand selection during a switch. The audit will also gauge Mayzent's early performance in the active SPMS market and the brand's success in competing with current preferred DMTs for that patient segment.

About RealTime Dynamix RealTime Dynamix: Multiple Sclerosis (EU)is an independent service providing strategic guidance through rapid and comprehensive twice-yearly reports, which include market trending, launch tracking, and a fresh infusion of unique content with each wave. The 7th wave of research will publish in April 2020.

About RealWorld Dynamix RealWorld Dynamix: DMT Switching in Multiple Sclerosis (EU) is an independent, data-driven service unmasking real patient management patterns through annual reports based on chart audits of ~1,250 patients switched to a new DMT within the previous three months. The report uncovers the "why" behind treatment decisions, includes year over year trending to quantify key aspects of market evolution, and integrates specialists' attitudinal & demographic data to highlight differences between stated and actual treatment patterns. The second annual report will publish in July 2020.

About Spherix Global InsightsSpherix Global Insights is a hyper-focused market intelligence firm that leverages our own independent data and expertise to provide strategic guidance, so biopharma stakeholders make decisions with confidence. We specialize in select immunology, nephrology, and neurology markets.

Spherix was recently recognized by Philadelphia Business Journal as a 2019 Soaring 76 recipient for the fastest growing companies in the Greater Philadelphia area and by The Philadelphia Inquirer as an Entrepreneurs' Forum 2019 Philadelphia 100 Winner for the fastest growing privately-held companies in the Greater Philadelphia area.

All company, brand or product names in this document are trademarks of their respective holders.

For more information contact:Meg Stabb, Neurology Insights DirectorEmail:info@spherixglobalinsights.comwww.spherixglobalinsights.com

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Prior Head Injury Associated With Severe Parkinson’s Phenotype – Medscape

FROM AAN 2020

Head injury before the onset of Parkinson's disease is associated with more severe motor and nonmotor phenotypes,according to research presented online as part of the 2020 American Academy of Neurology Science Highlights.

Neurologists have identified various phenotypes among patients with Parkinson's disease; however, the factors that determine these phenotypes, which may include genetic and environmental variables, are poorly understood.Ethan G. Brown, MD, assistant professor of neurology at the University of California, San Francisco, and colleagues hypothesized that head injury, which is a risk factor for Parkinson's disease, would be associated with a more severe phenotype.

"Head injury is a risk factor for other conditions that involve cognitive impairment," said Dr. Brown. "The mechanisms of how head injury contributes to neurodegenerative disease are not clear, but may be related to the initiation of an inflammatory cascade that can have a long-term, chronic effect. We hypothesized that these long-term sequelae may contribute to symptoms in Parkinson's disease."

The researchers examined the relationship between head injury and clinical features by analyzing data for two cohorts of patients with Parkinson's disease. Through an online survey, the investigators elicited information about head injury and other exposures from participants in theParkinson's Progression Markers Initiative(PPMI) and theFox Insight(FI) study.

Dr. Brown and colleagues determined disease phenotypes for participants in PPMI using baseline Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) score and 5-year change in Montreal Cognitive Assessment score. For participants in FI, the researchers determined phenotypes using baseline self-reported MDS-UPDRS-II score and self-reported cognitive impairment. They used parametric and nonparametric tests as appropriate and adjusted the results for age, sex, and smoking history.

In all, 267 participants with Parkinson's disease in PPMI and 25,308 in FI submitted information about head injury. In the PPMI cohort, head injury before Parkinson's disease diagnosis was associated with greater nonmotor symptom burden at enrollment. The mean MDS-UPDRS-I score was 7.73 among participants with any injury, compared with 6.19 among participants with no injury. Similarly, the mean MDS-UPDRS-I score was 8.29 among participants with severe head injury, compared with 6.19 among participants with no injury.

Motor symptoms were worse among participants with severe injury (MDS-UPDRS-II score, 8.35). Among 110 participants who were followed for 5 years, patients who reported severe head injury before diagnosis had a decline in cognitive function. The mean change in Montreal Cognitive Assessment score was 0.60 for patients with severe head injury and 0.76 in those with no head injury.

"The improvement from baseline in the participants with Parkinson's disease but without head injury was small and not statistically significant," said Dr. Brown. The increase could have resulted from practice effect, although it is not certain, he added. "We are continuing to evaluate other, more sensitive tests of cognitive impairment to try to understand these results more completely in this population."

In the FI cohort, participants who reported a prior head injury had more motor symptoms (MDS-UPDRS-II, 14.4), compared with those without head injury (MDS-UPDRS-II, 12.1). Also, the risk of self-reported cognitive impairment was elevated in participants who reported head injury (odds ratio, 1.58).

"The results most affected by the self-reported nature of [the] FI [data] are the cognitive impairment results," said Dr. Brown. "Subjective cognitive impairment...is very different from objective cognitive impairment, which could be measured through in-person testing in the PPMI cohort. Many factors may contribute to noticing cognitive decline, some of which can be measured and controlled for, but some cannot. There may be a correlation between subjective cognitive decline and true cognitive impairment, but this has not been fully studied in Parkinson's disease."

Clarifying whether the relationship between head injury and Parkinson's disease phenotype is causal or whether falling is an early indication of worse symptoms will require more longitudinal data. "We would like to further characterize the differences between people with Parkinson's disease with and without a history of head injury," said Dr. Brown. "More detailed understanding of these phenotypic differences could point to an underlying mechanism, or whether or not other comorbid conditions are involved. We would also like to understand whether genetics plays a role."

The PPMI and FI studies are funded by the Michael J. Fox Foundation. Dr. Brown has received compensation from HiOscar, NEJM Knowledge Plus, and Rune Labs and has received research support from Gateway Institute for Brain Research.

SOURCE:Brown EG et al. AAN 2020,Abstract S17.002.

This article originally appeared on MDedge.com.

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Prior Head Injury Associated With Severe Parkinson's Phenotype - Medscape

Is There a Case for Cognitive Testing for Senior… : Neurology Today – LWW Journals

Article In Brief

The article revisits the controversy around policies at some academic medical centers that require older neurologists to undergo cognitive testing for recredentialing.

Aging is known to be associated with cognitive decline. Is that reason enough to test more senior neurologists and other physicians for potential cognitive deficits that might cause a patient-care problem?

A growing number of health systems say yes and are implementing policies that require cognitive and other screenings when physicians reach a certain age. But the policies are controversial: One state passed legislation prohibiting the practice, although the ban was reversed the next year; most recently, the Equal Employment Opportunity Commission (EEOC) filed a lawsuit that argues one health system's mandatory-examination policy is illegal.

Physician demographics suggest the controversy will not go away soon. There are currently about 150,000 practicing physicians age 65 and older in the US, up from about 95,000 in 2013, according to the American Medical Association.

Proponents of age-based screenings say evidence shows they are needed. At Yale New Haven Hospital, the teaching hospital for Yale School of Medicine, physicians age 70 or older must complete a neuropsychological assessment; of the first 141 to undergo the assessment, nearly 13 percent demonstrated cognitive deficits that were likely to impair their ability to practice independently, according to a January 14 report in JAMA.

Meanwhile, about 70 older physicians from across the country have undergone a late-career health screening through the University of California-San Diego (UCSD) Physician Assessment and Clinical Education program and roughly 20 percent have been referred for further evaluation, said David Bazzo, MD, director of the UCSD Fitness for Duty program.

Opponents disagree with the idea of age-based screening. Scott E. Hirsch, MD, a neuropsychiatristboard-certified in neurology and psychiatryat NYU Langone Health, who evaluates physicians on behalf of the New York State Office of Professional Medical Conduct, is one of them. Dr. Hirsch pointed out that maintenance of certification exams require physicians to demonstrate mastery of the knowledge needed to practice.

The tests are fairly challenging and I don't think you can do well on them if you have an underlying cognitive problem, he said. We are already doing so much to stay credentialed. I don't see how cognitive screening adds anything.

A number of neurology leaders contacted for this story declined to be interviewed, but those who did agree to be interviewed had mixed opinions about mandated cognitive screening.

Policies mandating routine age-based screening started emerging about a decade ago, Dr. Bazzo said. In 2011, his UCSD program and the Coalition for Physician Enhancement convened a range of professionalsphysician-evaluators conducting assessments on behalf of state medical boards investigating complaints; geriatricians; administrative law judges who preside over physicians' disciplinary hearings; and prosecutors and defense attorneys involved in physician disciplinary casesto discuss the aging physician workforce.

In addition to educational sessions and a review of age-based physician screening commonly conducted in Canada, conference participants were surveyed on the issue. The majority favored age-based screening for physicians, starting at age 70, that includes assessments of physical and mental health and a cognitive screen, according to a report in the Journal of Medical Regulation.

That sort of started the ball rolling, Dr. Bazzo said.

Since then, many organizationsranging from huge systems like Scripps Health to community hospitals like Sinai Hospital in Baltimorehave implemented age-based screening policies. In 2014, the University of Pittsburgh Medical Center (UPMC) became one of the first to implement a policy to assess physical and cognitive abilities, said Donald M. Yealy, MD, senior medical director of the system's health services division.

Dr. Yealy and colleagues drafted the policy for two reasons. First, they recognized that some other fieldscommercial aviation, for examplehave age-related thresholds that trigger a professional re-evaluation or practice change to optimize safety.

At the same time, we also realized that we had some reported safety concerns in which we wondered, but were never certain, if a more scheduled and proactive approach might have helped us avert a patient care issue, Dr. Yealy said.

The UPMC policy applies to advanced practice providers as well as physicians. The UPMC medical staff accepted the policy, which follows steps similar to those used with other physicians when a concern arises, without much controversy.

We learned that having a set policy creates a natural and non-threatening opportunity for any physician to personally re-evaluate, he said. We have had many who, at their 70th birthday, have altered what privileges they request or shifted into a different type of practice.

By contrast, Intermountain Healthcare, a large system based in Utah, had a very different experience. That system had a mandatory retirement age of 72 for medical staff in 2013, when neuropsychologist Kelly Garrett, PhD, was asked to help plan a late-career physician program.

Our credentialing committees were giving exemptions, allowing physicians to practice beyond age 72, but they felt that they did not have enough data in order to be able to grant these extensions with much degree of confidence, Dr. Garrett said.

In 2014, Intermountain's medical staff approved a policy that required late-career physicians to complete a history and physical, including sensory and cognitive screenings. Four years later, the Utah State Legislature prohibited mandatory age-based screenings for physicians. In 2019, the ban was reversed but the new law dictates some principles that must be followed.

Intermountain has been reticent to return to business as usual and is now exploring reorganizing the program such that at least the cognitive screening part would be a voluntary program available to physicians regardless of age, Dr. Garrett said.

In February, the EEOC filed suit against Yale New Haven Hospital saying its policy requiring neuropsychological and eye examinations before physicians can obtain or renew staff privileges violates the Age Discrimination in Employment Act.

For some neurology leaders, age-based screening smacks of ageism. The idea of screening to make sure a physician's cognitive skills are adequate for the job does not alarm S. Andrew Josephson, MD, FAAN, professor and chair of neurology at the UCSF Weill Institute for Neurosciences. But age-based screening bothers him.

I would worry that, if we set some arbitrary age cutoff, we are not really focusing on the problem we should be concerned about, which is identifying physicians who have cognitive impairment from a variety of issues, whether it be a neurodegenerative process, substance abuse issues, or some other problem, he said.

Richard P. Mayeux, MD, MSc, FAAN, professor of neurology, psychiatry and epidemiology and chair of neurology at Columbia University College of Physicians and Surgeons, also gives age-based screening a thumbs-down.

It's illegal to do it as part of job credentialing based on age, said Dr. Mayeux, co-director of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain at Columbia University Medical Center. Our strategy is to single out and test only people who have demonstrated some impairment of some sort. Impaired physicians, I have no problem evaluatingbut evaluating people simply because they're old, I think is inappropriate.

Neil A. Busis, MD, FAAN, associate chair for technology and innovation in the neurology department at New York University Grossman School of Medicine, said it's important to balance the twin goals of maintaining a robust neurology workforce and protecting patients. Screening for potential impairment might be a way of striking that balance, he said. Commercial airline pilots older than 40 years must have a first-class medical certificate renewed every six months.

I think well thought-out processes from other industries can be applicable to medicine, he said. Certain kinds of health screening seem like a reasonable thing to do.

That said, if protecting patient safety is the reason for screening, singling out physicians might not be justified. If you're going to mandate screening for physicians, how about nurses and everybody else who works at the hospital? Dr. Busis said.

There is no standard approach to age-based screening or assessment programs, which vary considerably on at least three variables.

There is no cut-off score that determines that a provider is competent to practice independently, Dr. Bazzo said. Rather, neuropsychologist (and AAN member) William Perry, PhD, vice chair of the UCSD department of psychiatry, reviews and interprets each neurocognitive screening report to determine whether more in-depth testing for diagnostic purposes is recommended.

At UPMC, by contrast, physicians and advanced practice practitioners covered by the age-based screening policy must notify the credentialing committee who will be conducting the physical examination and cognitive assessment they obtain on their own. Obviously, that would give us an opportunity to make sure that the person who is going to do any part of the assessment was qualified and did not have any conflicts, Dr. Yealy said.

The credentialing committee requires a specific tool for the cognitive assessment. The physical examination must look for physical impairment that might impact an ability to function in whatever type of physician you are, whether it's a cognitive specialty and/or procedural specialty, Dr. Yealy said.

Dr. Perry and other neuropsychologists who are most active in late-career physician screening convened last year to discuss the tools available and agreed that the MicroCog is the best option because it has been normed on physicians. Acknowledging that the instrument has some limitations, Dr. Perry said it is not used to diagnose a specific condition, but rather to determine whether a more in-depth evaluation is needed.

The idea is not to use the MicroCog to remove people from practice, he said. The idea is to catch something before it's extreme and problematic because then a physician is able to make changes to their practice.

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Is There a Case for Cognitive Testing for Senior... : Neurology Today - LWW Journals

Neurologic Symptoms and COVID-19: What’s Known, What Isn’t – Medscape

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Since the Centers for Disease Control and Prevention (CDC) confirmed the first US case of novel coronavirus infection on January 20, much of the clinical focus has naturally centered on the virus' prodromal symptoms and severe respiratory effects.

However, US neurologists are now reporting that COVID-19 symptoms may also could include encephalopathy, ataxia, and other neurologic signs.

"I am hearing about strokes, ataxia, myelitis, etc," Stephan Mayer, MD, a neurointensivist in Troy, Michigan, posted on Twitter on March 26.

Other possible signs and symptoms include subtle neurologic deficits, severe fatigue, trigeminal neuralgia, complete/severe anosmia, and myalgia as reported by clinicians who responded to the tweet.

Last week, as reported by by Medscape Medical News, the first presumptive case of encephalitis linked to COVID-19 was documented in a 58-year-old woman treated at Henry Ford Health System in Detroit.

Physicians who reported the acute necrotizing hemorrhagic encephalopathy case in the journal Radiology counseled neurologists to suspect the virus in patients presenting with altered levels of consciousness.

Researchers in China also reported the first presumptive case of Guillain-Barre syndrome associated with COVID-19. A 61-year-old woman initially presented with signs of the autoimmune neuropathy GBS, including leg weakness, and severe fatigue after returning from Wuhan, China. She did not initially present with the common COVID-19 symptoms of fever, cough, or chest pain.

Her muscle weakness and distal areflexia progressed over time. On day 8, the patient developed more characteristic COVID-19 signs, including 'ground glass' lung opacities, dry cough, and fever. She was treated with antivirals, immunoglobulins, and supportive care, recovering slowly until discharge on day 30.

"Our single-case reportonly suggests a possible associationbetween GBS andSARS-CoV-2 infection. It may or may not havecausal relationship. More caseswith epidemiological data are necessary," senior author Sheng Chen, MD, PhD, told Medscape Medical News.

However, "we still suggest physicians who encounter acute GBS patients from pandemic areas protect themselves carefully and test for the virus on admission. If the results are positive, the patient needs to be isolated," added Chen, a neurologist at Shanghai Ruijin Hospital and Shanghai Jiao Tong University School of Medicine in China.

Neurologic presentations ofCOVID-19 "are not common, but could happen," Chen added. Headache, muscle weakness and myalgias have been documented in other patients in China, he said.

We know almost nothing about the potential interactions between COVID-19 and the nervous system. Dr Robert Stevens, Johns Hopkins School of Medicine, Baltimore

Despite this growing number of anecdotal reports and observational data documenting neurologic effects, the majority of patients with COVID-19 do not present with such symptoms.

"Most COVID-19 patients we have seen have a normal neurological presentation. Abnormal neurological findings we have seen include loss of smell and taste sensation, and states of altered mental status including confusion, lethargy, and coma," Robert Stevens, MD, who focuses on neuroscience critical care at the Johns Hopkins School of Medicine in Baltimore, Maryland, told Medscape Medical News.

Other groups are reporting seizures, spinal cord disease, and brain stem disease. It has been suggested that brain stem dysfunction may account for the loss of hypoxic respiratory drive seen in a subset of patients with severe COVID-19 disease, he added.

However, Stevens, who plans to track neurologic outcomes in COVID-19 patients, also cautioned that it's still early and these case reports are preliminary.

"An important caveat is that our knowledge of the different neurological presentations reported in association with COVID-19 is purely descriptive. We know almost nothing about the potential interactions between COVID-19 and the nervous system," he noted.

He added it's likely that some of the neurologic phenomena in COVID-19 are not causally related to the virus.

"This is why we have decided to establish a multisite neuro-COVID-19 data registry, so that we can gain epidemiological and mechanistic insight on these phenomena," he said.

Nevertheless, in an online report February 27 in the Journal of Medical Virology, Yan-Chao Li, MD, and colleagues write that "increasing evidence shows that coronaviruses are not always confined to the respiratory tract and that they may also invade the central nervous system, inducing neurological diseases."

Li is affiliated with the Department of Histology and Embryology, College of Basic Medical Sciences, Norman Bethune College of Medicine, Jilin University, Changchun, China.

Scientists observed SARS-CoV in the brains of infected people and animals, particularly the brainstem, they note. Given the similarity of SARS-CoV to SARS-CoV2, also known as COVID-19, the researchers suggest a similar invasive mechanism could be occurring in some patients.

Although it hasn't been proven, Li and colleagues suggest COVID-19 could act beyond receptors in the lungs, traveling via "a synapseconnected route to the medullary cardiorespiratory center" in the brain. This action, in turn, could add to the acute respiratory failure observed in many people with COVID-19.

Other neurologists tracking and monitoring case reports of neurologic symptoms potentially related to COVID-19 include Mayer and Amelia Boehme, PhD, MSPH, an epidemiologist at Columbia University specializing in stroke and cardiovascular disease.

Boehme suggested on Twitter that the neurology community conduct a multicenter study to examine the relationship between the virus and neurologic symptoms/sequelae.

Medscape Medical News interviewed Michel Dib, MD, a neurologist at the Piti Salptrire hospital in Paris, who said primary neurologic presentations of COVID-19 occur rarely and primarily in older adults. As other clinicians note, these include confusion and disorientation. He also reports cases of encephalitis and one patient who initially presented with epilepsy.

Initial reports also came from neurologists in countries where COVID-19 struck first. For example, stroke, delirium, epileptic seizures and more are being treated by neurologists at the University of Brescia in Italy in a dedicated unit designed to treat both COVID-19 and neurologic syndromes, Alessandro Pezzini, MD, reported in Neurology Today, a publication of the American Academy of Neurology.

Pezzini notes that the mechanisms behind the observed increase in vascular complications warrant further investigation. He and colleagues are planning a multicenter study in Italy to dive deeper into the central nervous system effects of COVID-19 infection.

Clinicians in China also report neurologic symptoms in some patients. A study of 221 consecutive COVID-19 patients in Wuhan revealed 11 patients developed acute ischemic stroke, one experienced cerebral venous sinus thrombosis, and another experienced cerebral hemorrhage.

Older age and more severe disease were associated with a greater likelihood for cerebrovascular disease, the authors report.

Chen and Li have disclosed no relevant financial relationships.

Follow Damian McNamara on Twitter: @MedReporter. For more Medscape Neurology news, join us on Facebook and Twitter.

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Neurologic Symptoms and COVID-19: What's Known, What Isn't - Medscape

A Blood Test for Tau Is Consistent with PET and CSF… : Neurology Today – LWW Journals

Article In Brief

Researchers found in two different studies that blood tests, which indicated abnormally high levels of a tau protein closely linked to dementia due to Alzheimer's disease (AD), distinguished AD from frontotemporal lobar degeneration. In one study, it also predicted which patients who were cognitively normal or had mild cognitive impairment upon initial evaluation would later develop Alzheimer's dementia.

A blood test for Alzheimer's disease (AD) pathology appears to be as accurate as more invasive measures and equally well correlated with AD dementia, according to two studies published simultaneously in the March issue of Nature Medicine.

The studies measured plasma phosphorylated-tau-181 (p-tau181), a form of the tau protein, and found that abnormally high levels are as closely linked to dementia due to AD as are PET scans of amyloid protein and measures of p-tau181 in cerebrospinal fluid.

Not only did a high level of plasma p-tau181 distinguish AD from frontotemporal lobar degeneration, but in one of the studies it also predicted which patients who were cognitively normal or had mild cognitive impairment (MCI) upon initial evaluation would later develop Alzheimer's dementia.

While neurologists and officials at the National Institutes of Health (NIH) applauded the findings, they emphasized that the results need to be replicated and the p-tau181 test further investigated before it can be made available in the neurology clinic.

I think we are still a few years away from having this sort of test available to the general neurologist in a clinic setting or in their office, said Eliezer Masliah, MD, director of the neuroscience at NIH's National Institute on Aging. But they and their patients should know that these less expensive, less invasive tests are coming. We are hopeful that they will be approved in the near future by the FDA.

A longtime AD researcher called the findings a triumph.

I've been in this field since 1980 and having a blood test for Alzheimer's has been one of the holy grails, said Steven T. DeKosky, MD, FAAN, the Aerts-Cosper Professor of Alzheimer's Research at the University of Florida College of Medicine, and associate director of the Florida Alzheimer's Disease Research Center. This is a remarkable accomplishment. Right now, I'm sure all of us who do PET scan studies would love to be able to use this plasma test as a screen.

The principal investigator of one of the two studies told Neurology Today that his group is already working to validate plasma p-tau181 in a primary-care setting and to develop a clinical-grade test that could be used in any laboratory.

The test could be used in patients with either dementia or MCI to improve the diagnostic work-up, especially at specialized clinics and in patients where lumbar puncture or amyloid PET imaging cannot be done, said Oskar Hansson, MD, PhD, professor in the department of clinical memory research at Lund University in Sweden.

Dr. Hansson's group measured plasma p-tau181 levels in three cohorts comprising a total of 589 individuals. The first group included 64 participants who were cognitively unimpaired (with or without a positive amyloid-beta scan), 28 who had MCI, 38 who had AD dementia, and 52 with non-AD neurodegenerative disease. The second cohort, which was followed up for eight years to track conversion to AD dementia, included 219 cognitively unimpaired participants (42 percent of whom were positive for amyloid-beta), and 125 with MCI (65 percent of whom were amyloid-beta positive). A third cohort included pathology from post-mortem tests on 33 individuals:16 had confirmed AD dementia and 47 were non-AD.

The study found a clear association between plasma and CSF levels of p-tau181 in both cohorts one and two (p<0.001). In 174 participants from cohort one, plasma P-tau181 levels predicted positive tau PET scans (area under the curve (AUC) = 0.87-0.91 for different brain regions). Increased plasma p-tau181 was also associated with increased amyloid-beta PET (using a global cortical composite measure) in both cohort one and two (p< 0.001).

In the autopsy-confirmed cohort three, plasma p-tau181 distinguished AD dementia from non-AD neurodegenerative diseases as accurately as did tau PET and CSF p-tau181 (AUC = 0.94-0.98).

The results show that plasma p-tau181 may be increased early in AD, potentially even in some A+ cognitively unimpaired individuals (preclinical AD), the paper reported. Plasma p-tau181 then increased further during the symptomatic (prodromal and dementia) stages of AD. In contrast, plasma p-tau181 was not increased in non-AD. These characteristics mark out plasma p-tau181 as a promising biomarker to track disease progression in AD and to differentiate AD from non-AD conditions, with utility for patient management in clinical practice, research and trials.

In cognitively unimpaired and MCI subjects, a level of p-tau181 above 1.81 pg mL1 at baseline was associated with a dramatically increased risk of future AD dementia (p< 0.001). None of the other plasma biomarkers analyzed in the study, including total tau, amyloid-beta42/amyloid-beta 40 and neurofilament light protein, were independently related to risk of AD dementia.

The second study in Nature Medicine, part of the ongoing Advancing Research and Treatment for Frontotemporal Lobar Degeneration study, was led by Adam L. Boxer, MD, PhD, professor and director of the Alzheimer's Disease and Frontotemporal Degeneration Clinical Trials Program at the University of California, San Francisco, Memory and Aging Center. The cohort of 362 participants includes 69 healthy controls, 47 people with MCI, 56 with clinically diagnosed AD, and the remainder with various forms of frontotemporal lobar degeneration.

Dr. Boxer and colleagues found that plasma p-tau181 was increased by 3.5-fold in AD compared with controls and differentiated AD from both clinically diagnosed (AUC = 0.894) and autopsy-confirmed frontotemporal lobar degeneration (AUC = 0.878). The measure also identified individuals who were amyloid-beta positive on PET scans regardless of clinical diagnosis and correlated with cortical tau protein deposition measured by 18F-flortaucipir PET.

As promising as the results were, Dr. Boxer told Neurology Today that his group is looking at the predictive value of other variants of phosphorylated tau.

We and others think that while plasma p-tau181 seems to be very useful, it's possible there may be other epitopes that may be even slightly more accurate, he said.

Both papers credited a 2018 study published in Alzheimer's & Dementia as the first to find that plasma p-tau181 increases with AD clinical severity and is associated with tau- and amyloid-PET scans. The first author of that study said that she still wants to see the results replicated in more diverse cohorts before the test becomes available outside of research trials.

The fact that these two studies both nicely complement each other and replicate our findings is really promising, said Michelle M. Mielke, PhD, professor of epidemiology and neurology at the Mayo Clinic. But I would like to see more replication in community-based studies rather than just in studies from memory clinics.

Her 2018 study, part of the ongoing Mayo Clinic Study of Aging, is now looking not only at plasma p-tau181 but also at plasma p-tau217.

Previously there weren't the technologies available to look at [p-tau] 217, she said. Historically, p-tau181 was the first to come out, and so that tended to be the focus. Which one is more accurate is still to be determined. And other phosphorylated tau fragments are also being looked at as well.

Two studies, which were published last year, analyzed data from the Framingham Heart Study and found that total tau in serum is a biomarker not only for dementia but also for stroke risk.

We wanted to also look at phosphorylated tau in plasma but at the time the measures were not sensitive enough, said the senior author of both studies, Sudha Seshadri, MD, FAAN, professor of neurology at Boston University School of Medicine and founding director of the Glenn Biggs institute for Alzheimer's & Neurodegenerative Diseases at UT Health San Antonio.

Total tau was a very good marker in our hands for all types of dementia and stroke risk. But it does seem that total tau is sensitive but perhaps not as specific. It seems to go up with a variety of insults to the brain.

Based on the two new papers, she said, plasma P-tau181 looks to be more specific for AD dementia.

Dr. Seshadri will be measuring plasma p-tau181 in the Framingham Study to see how it compares in a community setting. I would also like to see how it works in Hispanics in south Texas, in the African-American population, and in other groups, she said.

While the new studies involved hundreds of patients, the results still need to be replicated in far larger groups, Dr. Masliah said. NIA, which supported both studies in part, will likely fund such follow-up studies in its consortium of 32 AD centers.

What we're looking into is pulling samples from all those centers so they can be tested and verified by other technologies and then followed longitudinally, Dr. Masliah said. These are very, very exciting results, very important results, something we need to follow up on. If replicated in larger, more diverse cohorts, the plasma ptau181 test could be a game changer for clinical trials, he said.

Dr. Hansson has received research support (for his institution) from Roche, GE Healthcare, Biogen, AVID Radiopharmaceuticals, and Euroimmun. He has received consultancy/speaker fees from Biogen and Roche. Dr. Boxer has served as a consultant for Aeton, Abbvie, Alector, AGTC, Amgen, Arkuda, Arvinas, Asceneuron, Esai, Ionis, Lundbeck, Novartis, Passage BIO, Sangamo, Samumed, Third Rock, Toyama and UCB. He has received research support from Avid, Biogen, BMS, C2N, Cortice, Eisai, Eli Lilly, Forum, Genentech, Janssen, Novartis, Pfizer, Roche, and TauRx.

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