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Welcome to the Advanced Center for Neurology and Headache – Magazine of Santa Clarita

Posted on December 28, 2019 by Danzig

At Advanced Center for Neurology and Headache it is our mission to provide our patients with the most advanced medical treatment and expert care. We feature a diversely qualified team of board-certified medical specialists, with expertise in Pain Management, Sports Medicine, Neurology, Plastic and Reconstructive Surgery, Spine Surgery, Podiatry and Internal Medicine. Our teams combined expertise offers patients the benefit of immediate cohesive diagnostics and solutions all in one office. Our medical practitioners are at the forefront of the field and are among the most highly regarded.Yuvraj Grewal, M.D. earned his medical degree at Ross University School of Medicine, Portsmouth, Dominica and completed his internship at United Health Services, Johnson City, New York. He then went on to the University of Arizona, in Tucson where he completed his neurology training as well as served as Chief Resident. He pursued a fellowship subspecializing in Clinical Neurophysiology emphasizing in epilepsy and nerve conditions.He is board certified in Neurology and a member of the American Academy of Neurology and the American Association of Neuromuscular and Electro-diagnostic Medicine.Dr. Grewal is committed to providing high quality medical care to his patients and to determining the best course of treatment based on the individual case. He truly listens to his patients with a compassionate heart and combines the best of evidence based and state-of-the-art medicine to serve each individual patient. To schedule a consultation with Dr. Yuvraj Grewal, please call 661-888-1099 or email: referral@myACNH.com. The office is located at 23861 McBean Parkway, Suite A-4 in Valencia. You can visit online at http://www.myACNH.com.

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Welcome to the Advanced Center for Neurology and Headache - Magazine of Santa Clarita

Neurologist in Asheville | Asheville Neurology Specialists

Posted on October 4, 2019 by Danzig

At Asheville Neurology, our Board Certified Neurologists Dr. Armstrong, Dr. Patton and Dr. Engelbrecht work with our Physician Assistants to ensure that we are providing quality, evidence based care to our patients and their loved ones. With a newly created Department of Patient Experience, we focus on quality improvement and patient feedback, which we then use to continuously improve. Our office environment is gentle and welcoming, and designed with our patients and their loved ones experiences in mind.

Our team based care approach begins the moment we receive a new referral, when we began to triage and make sure that we believe that the diagnosis is within the scope of our practice. Once the referral has been accepted, new patients receive a call from our scheduler. During this phone call, we make sure that our patients are aware of the resources available to them, including accessing our Patient Portal and pre-registering for their appointments. Because of our pre-registration process, we are able to get valuable updated clinical and demographic information prior to our patients appointment, which allows us to spend more time during the visit focusing on what you want to talk about.

Meet Our Team

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Neurologist in Asheville | Asheville Neurology Specialists

The subject of sleep – Eureka Times-Standard

Posted on November 3, 2019 by Danzig

Instructor Barry Evans will teach a course called Sleep Perchance to Dream Tuesday from 1:30 to 3:30 p.m. through Humboldt State Universitys Osher Lifelong Learning Institute, a program designed for folks 50 and older.

This is about as interesting a topic as Ive ever taught for OLLI, said Evans, a former civil engineer as well as a local columnist and published author.

Sleep, he said, is the ultimate elephant in the room. Its vitally important but for something that takes up 25 or 30 years of a typical life its mostly ignored by our culture, except as a problem. For some, sleep is an enemy to be minimized, perhaps not realizing that adequate sleep is essential to our health and well-being. Others struggle with insomnia, worried theyre not getting enough sleep, popping pills or sedating themselves with alcohol. So, I wanted to give a balanced perspective, that is, an overview of the history, culture and neurology of sleep.

Sleep will cover a wide array of topics, including why people sleep and how much sleep one needs; sleep patterns of humans vs. other primates; sleep from a cultural and historical perspective; changing attitudes toward sleep; whats going on in peoples brains while theyre asleep; why people dream and do dreams mean anything; insomnia and how to deal with it; and the health dangers of getting too little sleep (with an emphasis on shift workers and school-age children).

Evans began studying sleep after learning that patterns today are quite different from years back.

I became fascinated with the topic when I first learned that our present sleep patterns are very different from those of our pre-artificial light forebears, he said. I was also shocked to learn how rapidly our sleep patterns are changing: 10 hours before the electric light (late 1800s), eight hours in 1950, 6.5 hours being the norm now.

To prepare for teaching the class, Evans read recent research on the neurology, health aspects and history of sleep in popular science books, Scientific American and other publications. He also watched YouTube lectures, scoured Google and Wikipedia and paid attention to his own sleeping patterns.

Im a world-class napper, Evans said, making up for my lack of nighttime sleep with daytime naps.

Sleep Perchance to Dream is taking place at the Humboldt Bay Aquatic Center in Eureka. The cost is $30 for Osher Lifelong Learning Institute members and $55 for non-members. To register, go to https://extended.humboldt.edu/olli.

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The subject of sleep - Eureka Times-Standard

Cytokinetics Announces Five Presentations at the International Symposium on ALS/MND – GlobeNewswire

Posted on November 28, 2019 by Danzig

SOUTH SAN FRANCISCO, Calif., Nov. 26, 2019 (GLOBE NEWSWIRE) -- Cytokinetics, Incorporated (Nasdaq: CYTK) today announced five poster presentations at the 30th International Symposium on ALS/MND in Perth, Australia. The posters will be presented on Thursday, December 5, 2019 and Friday, December 6, 2019.

Thursday, December 5, 2019 (All times listed below are local time in Perth)

Poster Session ATheme: Clinical Trials and Trial Design

Title: Responder and Subgroup Analyses for FORTITUDE-ALS, a Phase 2 Trial Study of Reldesemtiv in Patients with ALSPresentation Time: 10:30 11:30 AMPoster Number: CLT-21Poster Presenter: Jeremy M. Shefner, M.D., Ph.D., Lead Investigator of FORTITUDE-ALS, Professor and Chair of Neurology at Barrow Neurological Institute, and Professor and Executive Chair of Neurology at the University of Arizona, Phoenix

Title: Quality of Life and Depression Measurements in FORTITUDE-ALSPresentation Time: 10:30 11:30 AMPoster Number: CLT-22Poster Presenter: Stacy Rudnicki, M.D., Senior Medical Director, Clinical Research, Neurology, Cytokinetics

Title: Impact of ALSFRS-R progression rates on outcome measures in FORTITUDE-ALS Presentation Time: 10:30 11:30 AMPoster Number: CLT-23Poster Presenter: Stacy Rudnicki, M.D., Senior Medical Director, Clinical Research, Neurology, Cytokinetics

Title: Utilization of Durable Medical Equipment in FORTITUDE-ALSPresentation Time: 10:30 11:30 AMPoster Number: CLT-20Poster Presenter: Stacy Rudnicki, M.D., Senior Medical Director, Clinical Research, Neurology, Cytokinetics

Friday, December 6, 2019

Poster Session BTheme: Biomedical and Clinical Work in Progress

Title: People Living with ALS and Their Caregivers Input into Drug Development in EuropePresentation Time: 6:00 7:00 PMPoster Number: WP-14Poster Presenter: Miriam Galvin, Ph.D., Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin

About Cytokinetics

Cytokineticsis a late-stage biopharmaceutical company focused on discovering, developing and commercializing first-in-class muscle activators and best-in-class muscle inhibitors as potential treatments for debilitating diseases in which muscle performance is compromised and/or declining. As a leader in muscle biology and the mechanics of muscle performance, the company is developing small molecule drug candidates specifically engineered to impact muscle function and contractility.Cytokineticsis collaborating withAmgen Inc.(Amgen) to develop omecamtiv mecarbil, a novel cardiac muscle activator. Omecamtiv mecarbil is the subject of an international clinical trials program in patients with heart failure including GALACTIC-HF and METEORIC-HF.Amgenholds an exclusive worldwide license to develop and commercialize omecamtiv mecarbil with a sublicense held by Servier for commercialization inEuropeand certain other countries.Cytokineticsis collaborating withAstellas Pharma Inc.(Astellas) to develop reldesemtiv, a fast skeletal muscle troponin activator (FSTA). Astellas holds an exclusive worldwide license to develop and commercialize reldesemtiv. Licenses held byAmgenand Astellas are subject to specified co-development and co-commercialization rights ofCytokinetics.Cytokineticsis also developing CK-274, a novel cardiac myosin inhibitor that company scientists discovered independent of its collaborations, for the potential treatment of hypertrophic cardiomyopathies.Cytokineticscontinues its over 20-year history of pioneering innovation in muscle biology and related pharmacology focused to diseases of muscle dysfunction and conditions of muscle weakness.

For additional information aboutCytokinetics, visitwww.cytokinetics.com and follow us on Twitter, LinkedIn, Facebook and YouTube.

Forward-Looking Statements

This press release contains forward-looking statements for purposes of the Private Securities Litigation Reform Act of 1995 (the Act). Cytokinetics disclaims any intent or obligation to update these forward-looking statements and claims the protection of the Act's Safe Harbor for forward-looking statements. Examples of such statements include, but are not limited to, statements relating to Cytokinetics and its partners research and development activities; the Phase 2 clinical study of reldesemtiv in patients with ALS, including that such results may support progression of reldesemtiv into a potentially pivotal Phase 3 clinical trial; the potentially beneficial effects of reldesemtiv; and the properties and potential benefits of Cytokinetics other drug candidates. Such statements are based on management's current expectations, but actual results may differ materially due to various risks and uncertainties, including, but not limited to, potential difficulties or delays in the development, testing, regulatory approvals for trial commencement, progression or product sale or manufacturing, or production of Cytokinetics drug candidates that could slow or prevent clinical development or product approval; Astellas decisions with respect to the design, initiation, conduct, timing and continuation of development activities for reldesemtiv; Cytokinetics may incur unanticipated research and development and other costs or be unable to obtain additional financing necessary to conduct development of its products; standards of care may change, rendering Cytokinetics drug candidates obsolete; competitive products or alternative therapies may be developed by others for the treatment of indications Cytokinetics drug candidates and potential drug candidates may target; and risks and uncertainties relating to the timing and receipt of payments from its partners, including milestones and royalties on future potential product sales under Cytokinetics collaboration agreements with such partners. For further information regarding these and other risks related to Cytokinetics business, investors should consult Cytokinetics filings with the Securities and Exchange Commission.

Contact:CytokineticsDiane WeiserVice President, Corporate Communications, Investor Relations(650) 624-3060

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Cytokinetics Announces Five Presentations at the International Symposium on ALS/MND - GlobeNewswire

Robert M. Cain, M.D. Adult and Pediatric Neurology

Posted on October 7, 2018 by Danzig

Dr. Cain is a Neurologist who has been in private practice since 1973 in Austin, Texas.He completed his medical degree in 1966 at the Ohio State University Medical School in Columbus, Ohio. During that time, he did a three-month internship with the Evangelical Presbyterian Church in Ghana, West Africa. Dr. Cain completed an internship in surgery at the George Washington University Hospital in Washington, DC. He then worked again in Africa for the Gulf Oil Corporation in Angola, Portuguese West Africa. He then returned to the Cleveland Clinic and did a fellowship in neurology at the Cleveland Clinic. He then left the Cleveland Clinic and did a years fellowship in pediatric neurology at the National Childrens Hospital in Washington, D.C. He then went to the Childrens Hospital in Boston, Massachusetts, Harvard Service under Dr. Cesare Lombroso in the seizure unit. Dr. Cain then established practice in Austin, Texas and has been in continuous practice since that time. He has vast experience in multiple sclerosis. He is a Board member of the Lone Star Chapter of the National Multiple Sclerosis Society. He was nominated for chairman.

MEMBERSHIPS -American Board of Psychiatry and Neurology, June 1977 -Texas Neurofibromatosis Foundation Past Board Member -American Academy of Neurology Active Member and Fellow -American Society of Neuroimaging Board Certified 1986 -Texas Neurologic Societies Founding Member -American Medical Association Member -Austin Neurologic Society Member -American Association for the Study of Headache Active Member -National Multiple Sclerosis, Lone Star Chapter Board Member -Nominated for Chairman -American Society of Neuroimaging Active Member -North American Spine

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Robert M. Cain, M.D. Adult and Pediatric Neurology

Neurology Grand Rounds – University of Oklahoma Health …

Posted on April 30, 2019 by Danzig

Venue: Samis Education Center Rainbolt Family Auditorium

Topic: Cerebrovascular Aging

Speakers:

Anna Csiszar, MD, PhD

Learning Objectives:

1. Identify major structural and functional differences between young and aged cerebrovasculature.

2. Recognize the mechanisms how aging of the brains vasculature can contribute to the development of cognitive impairment.

3. Apply new interventional strategies tailored for older populations.

Professional Practice Gap:

Current State: Neither dementia research (primarily Alzheimers Disease) nor stroke research could develop a major new drug target in the last 2 decades. One of the reasons is that the current research endeavors are focused on young preclinical models with intact function and repair capacity.Desired State: New models are needed to better understand the age-dependency and complexity of chronic, age-related diseases.

Speaker Disclosures:

None

For More Information Contact:

Brigitte NettlesNeurology Grand Rounds CoordinatorTel (405) 271-4113 Ext 46023E-mail: brigitte-nettles@ouhsc.edu

Number of CE Credits: 1

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Neurology Grand Rounds - University of Oklahoma Health ...

Neurology Times

Posted on December 8, 2017 by Danzig

Dec 06, 2017

A study found that patients with AF who initiate therapy with standard dose dabigatran are at low risk of stroke and bleeding. Insights here.

Dec 06, 2017

These medical apps provided technology for caregivers to track symptoms, make appointments with doctors, monitor medications, and more.

Dec 05, 2017

Higher fish intake was linked to significantly decreased rate of episodic memory decline. More details in this study.

Dec 05, 2017

The practice of forcing left-handers to use their right hand is a long as human history and found in most societies. In fact, the words left and left-handed are synonyms for defective or sinister in almost all the worlds languages. More in this interview.

Nov 29, 2017

Despite optimism, telemedicine has been only slowly adopted as a means of health care delivery. But things are changing. Have you considered adopting telemedicine in your clinic practice?

Nov 28, 2017

The highest level of comprehensive care targets youths with epilepsy who have known comorbid psychiatric, developmental, and cognitive disorders and/or a history of nonadherence to seizure medication.

Nov 28, 2017

What percentage of opioid overdose deaths in the US are linked to prescription opioids? This question and more in our quiz.

Nov 27, 2017

Is caffeine consumption associated with risk for Parkinson disease? Is there a short-term benefit to caffeine that is sustainable over the long term? These questions and more in this quiz.

Nov 27, 2017

Can treatment of subclinical hypothyroidism help diminish frequency and severity of migraines? This study suggests that levothyroxine can do both.

Nov 27, 2017

A study that compared motor and nonmotor outcomes of DBS for Parkinson disease may show promise for patients' quality of life.

Blue Sky Neurology

Posted on March 18, 2018 by Danzig

Kirsten Bracht, M.D.

Board Certified in Neurology Fellowship Trained in Clinical Neurophysiology Special Interest in Clinical Neurophysiology, Sleep Medicine, and EpilepsyView More

Richard Clemmons, M.D.

Board Certified in Neurology, Epilepsy, and Advanced Central Clinical Neurophysiology (with added competency in Epilepsy Monitoring) Fellowship Trained in EEG and Epilepsy Special Interest in Epilepsy, Pediatric Epilepsy, EEG, and Epilepsy MonitoringView More

Aaron Haug, M.D.

Board Certified in Neurology Fellowship Trained in Movement DisordersDeep Brain Stimulation (DBS)View More

Beverly Gilder, M.D.

Board Certified in Neurology Fellowship Trained in Neuromuscular MedicineSpecial Interest in Multiple Sclerosis and MigrainesView More

Kimberly Horiuchi, M.D.

Board Certified in Neurology and Epilepsy Fellowship Trained in Epilepsy Special Interest in Seizures and EpilepsyView More

Judy Lane, M.D.

Board Certified in Headache Medicine and Neurology Residency in Neurology Special Interest in Migraine, Cluster Headache, Post-Traumatic Headache, and Head PainView More

Chuck Livsey, M.D., Ph.D.

Board Certified in Neurology and Epilepsy Fellowship Trained in Epilepsy Special Interest in EpilepsyView More

Bruce Morgenstern, M.D.

Board Certified in Neurology Fellowship Trained in Neuromuscular Disease andElectrophysiology Special Interest in Neuromuscular DiseaseView More

Ernest Nitka, M.D.

Joined our practice on October 1, 2015! Board Certified in Neurology Over 30 Years of Neurology ExperienceView More

Lyndsey Hale, M.D., M.P.H.

Joined our practice on August 17, 2015! Board Certified in Neurology Residency in NeurologyView More

Lisa Roeske-Anderson, M.D.

Board Certified in Neurology Fellowship Trained in Clinical Electrophysiology/EMG Special Interest in Concussion/Traumatic Brain InjuryView More

Michael Pearlman, M.D., Ph.D.

Board Eligible in Neurology Fellowship Trained in Neuro-Oncology Special Interest in Cancer NeurologyAdults and ChildrenView More

Jonathan Scott, M.D.

Board Certified in Neurology Fellowship Trained in Stroke Special Interest in Neurology and StrokeView More

Marc Y. Wasserman, M.D.

Board Certified in Neurology Fellowship Trained in Neurophysiology Special lnterest in migraine, seizure disorders, memory difficulties and general neurological conditionsView More

Alex Dietz, M.D.

Joins the Blue Sky Neurology Team in August 2017 Board Certified in Neurology Accepting patients at our Englewood locationView More

Nathan Kung, M.D.

Joins the Blue Sky Neurology Team in August 2017 Board Certified in Neurology Fellowship trained in Clinical Neurophysiology and Neuro-Ophthalmology Accepting patients at our Denver locationView More

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Blue Sky Neurology

Neurology & Neurosurgery | Services | University Hospitals …

Posted on March 19, 2018 by Danzig

At University Hospitals, our team of nationally-recognized neurology and neurosurgery experts is committed to providing the highest quality care for patients with neurological disorders or injuries. Headed by University Hospitals Neurological Institute, our physicians combines cutting-edge research and innovative techniques to deliver comprehensive, personalized care for a wide range of conditions.

Learn more about this service at the following locations:

University Hospitals Epilepsy Center, part of the UH Neurological Institute, is recognized as one of the leading programs in the nation for diagnosis, treatment and research of the more than 30 types of epilepsy that affect adults and children. Patients are given personalized care and access to cutting-edge treatments to help control seizures and greatly improve their quality of life. Our expert researchers also work to develop new techniques surgical procedures to treat patients with epilepsy.

Learn more about this service at the following locations:

This service is also offered at the following locations:

Interferon-Beta-Induced Headache in Patients with Multiple Sclerosis: | JPR – Dove Medical Press

Posted on March 11, 2020 by Danzig

Alaa Elmazny, Sherif M Hamdy, Maged Abdel-Naseer, Nevin M Shalaby, Hatem S Shehata, Nirmeen A Kishk, Mona A Nada, Husam S Mourad, Mohamed I Hegazy, Ahmed Abdelalim, Sandra M Ahmed, Ghada Hatem, Amr M Fouad, Hadel Mahmoud, Amr Hassan

Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt

Correspondence: Hatem S ShehataNeurology Department, Cairo University, 23 Amin Samy Street Kasr Alaini Street, Cairo, EgyptTel +2011124444179Fax +20227927795Email samirhatem@kasralainy.edu.eg

Background: Studies have shown that interferon-beta (IFN-) treatment is associated with headaches in patients with multiple sclerosis (MS). Headaches can affect quality of life and overall function of patients with MS. We examined the frequency, relationships, patterns, and characteristics of headaches in response to IFN- in patients with relapsing-remitting multiple sclerosis (RRMS).Patients and Methods: This study was a prospective, longitudinal analysis with 1-year follow-up. The study comprised 796 patients with RRMS treated with IFN- (mean age 30.84 8.98 years) at 5 tertiary referral center outpatient clinics in Egypt between January 2015 and December 2017. Headaches were diagnosed according to the International Classification of Headache Disorders ICHD-3 (beta version), and data were collected through an interviewer-administered Arabic-language-validated questionnaire with an addendum specifically designed to investigate the temporal relationship between commencement of interferon treatment, and headache onset and characteristics.Results: Twohundred seventy-six patients had pre-existing headaches, and 356 experienced de novo headaches. Of 122 patients who experienced headaches before IFN- treatment, 55 reported headaches that worsened following onset of IFN- treatment. In patients with post-IFN- headaches, 329 had headaches that persisted for > 3 months, 51 had chronic headaches, and 278 had episodic headaches, and 216 of these patients required preventive therapies. Univariate analysis showed a > 6- and an approximately 5-fold increased risk of headache among those treated with intramuscular (IM) INF--1a (OR 6.51; 95% CI: 3.73 10.01; P-value < 0.0001) and 44 g of SC INF--1a (OR 5.44; 95% CI: 3.15 9.37; P-value < 0.0001), respectively, compared with that in patients who received 22 g of SC INF--1a.Conclusion: Interferon- therapy aggravated pre-existing headaches and caused primary headaches in patients with MS. Headache risk was greater following treatment with IM INF--1a and 44 g SC INF--1a.

Keywords: headache, interferon-beta, multiple sclerosis

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

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Interferon-Beta-Induced Headache in Patients with Multiple Sclerosis: | JPR - Dove Medical Press

Smartphone Use and Headache: What’s the Link? – Clinical Advisor

Posted on March 30, 2020 by Danzig

Increased smartphoneuse was found to be associated with an increased requirement of acutemedication and less relief from medication for primary headache, but not anincrease in frequency or duration of headaches, according to research publishedin Neurology Clinical Practice.

Smartphonetechnology is advancing at a rapid rate, but excessive engagement with thesedevices is raising health concerns. In a cross-sectional study, researcherssought to determine whether smartphone use was associated with worsening ofprimary headache, including migraine, chronic migraine, and tension-typeheadaches.

The study wasconducted between June 2017 and December 2018 in India, and included patients aged14 years with primary headache. All patients underwent detailed neurologicexamination and relevant investigations; information about headache pattern,severity, frequency, duration of episodes, character, location, and associatedcomplaints were noted. Information was also obtained about new-onset headachesof >3 months.

Each patient wasrequired to answer questions regarding mobile phone use with respect to type ofcell phone, daily usage duration, and type of usage. Questions were scored as 0for no and 1 for yes, with the highest score of thequestionnaire being 11. Patients were divided into non-smartphone users (NSUs; eitherdid not use a cell phone or non-smartphone user) and smartphone users (SUs).

The primary objective was to determine the association between mobile phone usage and new-onset headache or increases severity of primary headache. Chronic migraine was defined as headache for >15 days a month for >3 months. Worsening headache was defined as 2-fold increase in severity and/or intensity. Secondary outcomes included the association of smartphone use in patients with primary headache who required medication, as well as the dosage, type of analgesic taken, pill count of acute medications per month, number of prophylactic drugs, duration of prophylactic drug use, and dosage.

A total of 400patients were included in the study (194 NSU; 206 SU). Of the 194 NSU patients,76 were not using any phone and 130 were using non-smartphones. NSU patientswere older compared with SU patients. The majority of patients with headachewere women (269/400); however, more men were in the SU group compared with theNSU group (39.3% vs 25.8%).

The most commonheadache type was migraine, followed by chronic migraine and chronictension-type headache. More patients in the SU group reported more aurascompared with the NSU group (17.5% vs 7.7%), but the course of headache wassimilar in both groups (worsened: NSUs, 71.6% vs SUs, 71.8%).

Patients in the NSU grouphad similar duration of episodes compared with SU patients, as well as thenumber of episodes of headache per month (NSU, 7.3 vs SU, 7.1). Patients in theSU group took a higher number of pills for acute treatment with a median pillintake of 8 per month compared with 5 per month in the NSU group. A higherproportion of patients in the NSU group had relief with acute medicationscompared with the SU group, but the proportions of patients taking prophylacticmedication and the median duration of prophylaxis were similar in both groups.

Although thecourse of headache, frequency of episodes, and the pain scores were similar inNSUs and SUs, the SU group had higher frequency of medications for acuteattacks with poor response to analgesics, the authors concluded.

Reference

Uttarwar P, Vibha D, Prasad K, Srivastava AK, Pandit AK, Dwivedi SN. Smartphone use and primary headache: a cross-sectional hospital-based study Neurol Clin Pract. doi:10.1212/CPJ.0000000000000816

Shared Genetic Variants Associated With Migraine and Multiple Sclerosis – Neurology Advisor

Posted on February 29, 2020 by Danzig

WEST PALM BEACH, FL Migraine prevalence was significantly higher among patients with multiple sclerosis (MS) compared with healthy controls, with several genetic variants being shared between migraine and MS, according to research presented at the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) 2020 Forum held from February 27 to 29, 2020, in West Palm Beach, Florida. Several variants were found to increase migraine risk but decrease MS risk; these findings may lead to improvements in targeted treatments and therapies.

Although symptoms and risk factors for migraine and MS often overlap, and up to 69% of patients with MS suffer migraine, it is unknown whether these 2 disorders are independent or have a common biological etiology, such as genetics. The current study used data on 1094 patients with MS and 12,176 control participants who were Kaiser Permanente Northern California Health Plan members to investigate if any genetic variants independently associated with migraine or MS could be identified from genome-wide association studies that are shared between both conditions.

Migraine status was determined via self-report and validated electronic health record algorithm. Prior genome-wide association studies of MS or migraine were used to identify variants, and after quality control, investigators analyzed 902 variants with minor allele frequency greater than 1%. Observed and permuted P for each phenotype were obtained from logistic regression and compared with identify variants associated with both phenotypes. Logistic regression models were adjusted for sex and ancestry among any variants that had significant associations with both phenotypes.

The migraine model was adjusted for a propensity score representing the probability of MS case-control status to account for potential ascertainment bias from obtaining a secondary phenotype from a case-control study.

Among the 1094 patients with MS, the mean age was 49.95 years old (SD=9.02) compared with 49.01 years old (SD=8.92) for controls. Women made up 79.98% of MS cases and 80.60% of controls. Median MS Severity Score was 3.21 (SD=2.43). Migraine incidence was significantly higher (P <.05) among MS cases (40%) compared with controls (29%). Preliminary results found 5 genetic variants (rs6677309, rs10801908, rs1335532, rs62420820, and rs17066096) that were significantly associated (P <.05) with both MS and migraine. Three of these were protective for MS (rs6677309, rs10801908, and rs1335532), and all variants increased odds of migraine.

Study investigators concluded, Results showed the prevalence of migraine was significantly higher among individuals with MS compared [with] healthy controls.Several genetic variants were shared between MS and migraine, and implicated genes include CD58, which modulates regulatory T-cells, and several immune genes (IL20RA, IL22RA2, IFNGR1 and TNFAIP3) within the 6q23 chromosomal region. Because several variants increase risk of migraine but decrease risk of MS, there may be implications for targeted therapies and treatments.

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

Reference

Horton M, Robinson S, Shao X, et al. Discovery of shared genetic variants associated with multiple sclerosis and migraine. Presented at: 5th Annual Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum; February 27-29, 2020; West Palm Beach, FL. Abstract P140.

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Shared Genetic Variants Associated With Migraine and Multiple Sclerosis - Neurology Advisor

Neurovascular or Interventional Neurology Devices Market Increasing Demand with Leading Player, Comprehensive Analysis, Forecast to 2026 – News Times

Posted on March 9, 2020 by Danzig

The report on the Neurovascular or Interventional Neurology Devices Market is a compilation of intelligent, broad research studies that will help players and stakeholders to make informed business decisions in future. It offers specific and reliable recommendations for players to better tackle challenges in the Neurovascular or Interventional Neurology Devices market. Furthermore, it comes out as a powerful resource providing up to date and verified information and data on various aspects of the Neurovascular or Interventional Neurology Devices market. Readers will be able to gain deeper understanding of the competitive landscape and its future scenarios, crucial dynamics, and leading segments of the Neurovascular or Interventional Neurology Devices market. Buyers of the report will have access to accurate PESTLE, SWOT, and other types of analysis on the Neurovascular or Interventional Neurology Devices market.

The Global Neurovascular or Interventional Neurology Devices Market is growing at a faster pace with substantial growth rates over the last few years and is estimated that the market will grow significantly in the forecasted period i.e. 2019 to 2026.

Key Players Mentioned in the Neurovascular or Interventional Neurology Devices Market Research Report:

Neurovascular or Interventional Neurology Devices Market: A Competitive Perspective

Competition is a major subject in any market research analysis. With the help of the competitive analysis provided in the report, players can easily study key strategies adopted by leading players of the Neurovascular or Interventional Neurology Devices market. They will also be able to plan counterstrategies to gain a competitive advantage in the Neurovascular or Interventional Neurology Devices market. Major as well as emerging players of the Neurovascular or Interventional Neurology Devices market are closely studied taking into consideration their market share, production, revenue, sales growth, gross margin, product portfolio, and other significant factors. This will help players to become familiar with the moves of their toughest competitors in the Neurovascular or Interventional Neurology Devices market.

Neurovascular or Interventional Neurology Devices Market: Drivers and Limitations

The report section explains the various drivers and controls that have shaped the global market. The detailed analysis of many market drivers enables readers to get a clear overview of the market, including the market environment, government policy, product innovation, development and market risks.

The research report also identifies the creative opportunities, challenges, and challenges of the Neurovascular or Interventional Neurology Devices market. The framework of the information will help the reader identify and plan strategies for the potential. Our obstacles, challenges and market challenges also help readers understand how the company can prevent this.

Neurovascular or Interventional Neurology Devices Market: Segment Analysis

The segmental analysis section of the report includes a thorough research study on key type and application segments of the Neurovascular or Interventional Neurology Devices market. All of the segments considered for the study are analyzed in quite some detail on the basis of market share, growth rate, recent developments, technology, and other critical factors. The segmental analysis provided in the report will help players to identify high-growth segments of the Neurovascular or Interventional Neurology Devices market and clearly understand their growth journey.

Ask for Discount @ https://www.marketresearchintellect.com/ask-for-discount/?rid=151352&utm_source=NT&utm_medium=888

Neurovascular or Interventional Neurology Devices Market: Regional Analysis

This section of the report contains detailed information on the market in different regions. Each region offers a different market size because each state has different government policies and other factors. The regions included in the report are North America, Europe, Asia Pacific, the Middle East and Africa. Information about the different regions helps the reader to better understand the global market.

Table of Content

1 Introduction of Neurovascular or Interventional Neurology Devices Market

1.1 Overview of the Market1.2 Scope of Report1.3 Assumptions

2 Executive Summary

3 Research Methodology of Market Research Intellect

3.1 Data Mining3.2 Validation3.3 Primary Interviews3.4 List of Data Sources

4 Neurovascular or Interventional Neurology Devices Market Outlook

4.1 Overview4.2 Market Dynamics4.2.1 Drivers4.2.2 Restraints4.2.3 Opportunities4.3 Porters Five Force Model4.4 Value Chain Analysis

5 Neurovascular or Interventional Neurology Devices Market , By Deployment Model

5.1 Overview

6 Neurovascular or Interventional Neurology Devices Market , By Solution

6.1 Overview

7 Neurovascular or Interventional Neurology Devices Market , By Vertical

7.1 Overview

8 Neurovascular or Interventional Neurology Devices Market , By Geography

8.1 Overview8.2 North America8.2.1 U.S.8.2.2 Canada8.2.3 Mexico8.3 Europe8.3.1 Germany8.3.2 U.K.8.3.3 France8.3.4 Rest of Europe8.4 Asia Pacific8.4.1 China8.4.2 Japan8.4.3 India8.4.4 Rest of Asia Pacific8.5 Rest of the World8.5.1 Latin America8.5.2 Middle East

9 Neurovascular or Interventional Neurology Devices Market Competitive Landscape

9.1 Overview9.2 Company Market Ranking9.3 Key Development Strategies

10 Company Profiles

10.1.1 Overview10.1.2 Financial Performance10.1.3 Product Outlook10.1.4 Key Developments

11 Appendix

11.1 Related Research

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TAGS: Neurovascular or Interventional Neurology Devices Market Size, Neurovascular or Interventional Neurology Devices Market Growth, Neurovascular or Interventional Neurology Devices Market Forecast, Neurovascular or Interventional Neurology Devices Market Analysis, Neurovascular or Interventional Neurology Devices Market Trends, Neurovascular or Interventional Neurology Devices Market

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Neurovascular or Interventional Neurology Devices Market Increasing Demand with Leading Player, Comprehensive Analysis, Forecast to 2026 - News Times

How a Mobile Stroke Unit Performs in the Densest of Cities : Neurology Today – LWW Journals

Posted on January 28, 2020 by Danzig

Article In Brief

Patients treated with a mobile stroke unit in New York City had significantly shorter times than patients treated with conventional care on three measures: mean dispatch-to-thrombolysis, onset-to-thrombolysis, and ambulance arrival-to-thrombolysis.

The use of a mobile stroke unit (MSU) to transport stroke patients cut time-to-thrombolysis even in the most densely populated borough of the most densely populated city in the US, New York City, a December 17, 2019 study in the Journal of the American Heart Association found.

The researcherswho compared an MSU from New York's Weill Cornell Medical Center and Columbia University Irving Medical Center to a conventional ambulance transport operating within two catchment areas in Manhattan during alternating two-week periods from October 2016 to September 2017found that the dispatch-to-thrombolysis times were significantly reduced in patients transported by the MSU.

The patients were part of the METRONOME (Metropolitan New York Mobile Stroke) registry with suspected acute ischemic stroke whose primary outcome was dispatch-to-thrombolysis time.

MSUs have gained traction in several US cities since their introduction in Houston in 2014. Yet some stroke experts have expressed skepticism about their efficacy in densely populated urban settings with large numbers of proximate dedicated stroke centers and complex traffic patterns.

In these areas, the study authors wrote, a given emergency scene location may be close to a high number of stroke-capable hospitals, resulting in shorter travel times for emergency transport vehicles. This could potentially reduce or nullify the beneficial effect of MSU care on thrombolysis time that has been demonstrated in less densely populated regions.

Lead study author Matthew E. Fink, MD, FAAN, chair of neurology at Weill Cornell Medical Center, said that of the many geographic, demographic, and logistical challenges to emergency stroke response in a location like Manhattan, the most daunting is traffic.

Conventional ambulances have to make a round trip from the hospital to the patient, then back to the hospital. That's twice as long as the one-way trip the MSU has to make, because the MSU is a primary stroke center where patients are treated at the scene, he said.

The study found longer ambulance arrival-to-hospital arrival times for the MSU because of the interval during which the vehicle remained stationary at the scene to administer CT scans and tissue plasminogen activator (tPA) thrombolytic therapy.

At the time of the study, New York City's MSU was in its first year and was the first MSU program on the east coast.

I thought that Manhattan, with its high population and large share of elderly residents, was actually a perfect location for an MSU, Dr. Fink said.

New York City's MSU program is now participating in the BEST-MSU multi-city trial of MSU operations, which runs through 2021.

Dr. Fink and his co-authors conducted a prospective cohort study of a New York Citybased MSU program that was launched in October 2016 by New York Presbyterian (NYP) Hospital and the Fire Department of New York (FDNY). A single MSU operated only in Manhattan from two separate, non-overlapping medical center catchment areasWeill Cornell Medical Center and Columbia University Irving Medical Center. The MSU was on-service within the Weill Cornell catchment area for two on-weeks; then, during the following two weeks, the on- and off-service centers switched, resulting in an alternating biweekly schedule.

All conventional ambulances in the study, including those owned by individual hospitals, operated under the city's 911 emergency medical services (EMS) system and were registered with the FDNY. The MSU, while not an official municipal ambulance unit, functioned as an institutional unit authorized by the FDNY to operate on the EMS network.

To compile the comparison group, a vascular neurologist at each of the two medical centers prospectively reviewed an FDNY database of all EMS ambulance call reports of ambulance transports to each medical center's emergency department. This review flagged all reports of transports that occurred during each campus' two off-weeks, and that were coded as an FDNY EMS call type of CVA (cerebrovascular accident, with stroke symptoms that are evaluated >5 hours from symptom onset) or CVA-C (cerebrovascular accidentcritical, with stroke symptoms that are evaluated within 5 hours of symptom onset or in whom the last known well time is unknown).

For each flagged patient, three vascular neurologists then reviewed all available history and physical examination findings to determine whether the patient would have been eligible for MSU transport had the MSU been available at the time when they were evaluated. Patients who would have been eligible for MSU care were added to the METRONOME registry as part of the conventional care group. The review team was blinded to prehospital care-related time metrics, including dispatch-to-thrombolysis time.

In total, 85 patients met the study criteria, including 66 patients transported via MSU and an additional 19 patients via conventional ambulance in the comparison group. Because seasonal weather in New York City can affect traffic and ambulance travel times, investigators conducted a post-hoc sensitivity analysis adjusting the primary analysis for the season of each patient's ambulance transport date as an additional variable.

Patients treated with MSU care had significantly shorter times than patients treated with conventional care on three measures: mean dispatch-to-thrombolysis, onset-to-thrombolysis, and ambulance arrival-to-thrombolysis times. Compared with patients in the conventional care group, patients in the MSU group had a mean decrease in dispatch-to-thrombolysis time of approximately 29.7 minutes (95% CI, 6.9-52.5).

Within the estimated difference in dispatch-to-thrombolysis time, patients in the MSU group had a mean increase in dispatch-to-ambulance arrival time of 6.5 minutes (95% CI, 2.4-10.6; p=0.002), offset by a mean decrease in ambulance arrival-to-thrombolysis time of 36.2 minutes (95% CI, 58.5 to 13.9; p=0.001). Differences in dispatch-to-thrombolysis time for patients in the MSU group also occurred despite significantly longer ambulance arrival-to-hospital arrival times (due to stationary vehicle status during CT scan and treatment) and longer distances traveled from pick-up to the accepting hospital.

Within the thrombolysis-treated population, the study encountered a higher rate of final diagnosis of stroke mimic among patients who received thrombolysis on the MSU. This was despite the fact that demographic and clinical characteristics, including rates of symptomatic intracranial hemorrhage, were not significantly different between the two groups.

Overall, the study found that fewer patients were transported by the MSU over a 12-month period than in the published accounts of other MSU programs operating in less densely populated areas. Investigators believe that the novelty of New York City's MSU, and the possibility that recognition of acute stroke by emergency dispatchers may be insufficient, could both have contributed to that discrepancy.

James C. Grotta, MD, FAAN, director of Stroke Research at the Clinical Institute for Research and Innovation at Memorial Hermann-Texas Medical Center, director of the Mobile Stroke Unit Consortium, and founder of the country's first MSU program in Houston, said the study's results were consistent with those of other MSU data, which has found that the use of mobile stroke units decreases time to thrombolysis.

This study proved that that's true even in a city like New York, that has a stroke center around the corner from almost any location, said Dr. Grotta, who is the lead investigator on the BEST-MSU trial.

Dr. Grotta noted that the structure of city EMS systems is one factor that may set New York City apart from other urban areas. Houston is more like most American cities than New York is, he said. Our MSUs can treat 10 times the number of patients that New York City can, for two reasons: We have the cooperation of all of the city's stroke centers, so we deliver to all hospital systems. And we have one citywide EMS system that we can coordinate with. Coordination between the EMS systems in New York is more complicated, since many of the hospitals have their own ambulances.

The biggest challenge to cities establishing MSU programs, both Drs. Grotta and Fink acknowledged, is moneybecause the programs save money in the long term but lose it in the near term, and, as Dr. Grotta emphasized, reimbursement is still inadequate. You need outcomes data to convince payers to pay more for an MSU transport, he said.

Peter A. Rasmussen, MD, medical director of the Distance Health Cleveland Clinic, who directed the Cleveland Clinic's mobile stroke unit program when it began operations a few weeks after Houston's opening in 2014, said that while the study highlighted only one aspect of the benefits of the mobile stroke programtime-to-thrombolysisits success points to three other benefits as well.

You're getting the benefit of a stroke expert as soon as possible; I don't know how you gauge the value of an expert eye so quickly, Dr. Rasmussen said. You get near-perfect triage, so in a city like New York, you can get patients to centers of excellence for different types of strokewhether it's hemorrhagic or ischemic stroke, whether it's a primary stroke center or a comprehensive stroke center the first time, and that reduces the subsequent cost of transport. And there's the recognition of a patient that's an interventional mechanical thrombectomy candidate and making sure that patient gets to a thrombectomy-capable center.

For Drs. Grotta and Rasmussen, though, the primary message of the New York City study was its success. Many people think that a mobile stroke unit is impractical, doesn't save time, and is hard to operate, Dr. Grotta said. Now this study has shown that you can make it work in the toughest kind of place. Even in New York City, in fact, it's extremely practical, and it does save time.

Dr Fink serves as an editor for Relias Learning. Dr. Grotta receives consulting fees from Frazer, Ltd., a manufacturer of mobile stroke units. Dr. Rasmussen reports stock holdings or proceeds from Mehana Medical, Perflow Medical, and Blockade Medical.

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Endangered panther kittens find forever home at wildlife conservation – ABC News

Posted on February 2, 2020 by Danzig

January 31, 2020, 6:04 PM

7 min read

A pair of endangered Florida panther kittens, whose mother was unable to care for them in the wild, have found their forever home at a wildlife conservation.

The 7-month-old brothers, named Cypress and Pepper, arrived at White Oak Conservation in Yulee, Florida, on Jan. 22, the center announced in a statement on its website this week.

"It's been great," Brandon Speeg, director of conservation at White Oak, told Jacksonville ABC affiliate WJXX. "They like to play on their rock structures, keepers are taking care of them. They've had a great first week."

A young male Florida panther, whose mother was unable to care for him in the wild due to a mysterious neurological disorder, is seen at the White Oak Conservation in Yulee, Fla.

The rare duo was rescued by the Florida Fish and Wildlife Conservation Commission last year after their mother suffered from an unknown neurological disorder that is recently affecting wild populations of panthers and bobcats. The mother was observed on trail cameras in early July 2019 struggling to walk and state wildlife officials felt her kittens, estimated to be just 2-weeks-old at the time, would not survive in the wild.

The brothers have been hand-raised in human care ever since, making them unlikely candidates to be released back into the wild. Both kittens have been tested and will continue to be monitored for the neurological disorder.

The pair was cared for and monitored at ZooTampa in Lowry Park, Florida, before being transported to White Oak Conservation last week.

A pair of young male Florida panthers named Cypress and Pepper, whose mother was unable to care for them in the wild due to a mysterious neurological disorder, are seen at the White Oak Conservation in Yulee, Fla.

Located on the banks of the St. Marys River, White Oak Conservation takes up 700 acres of the 13,000 acres of forests and wetlands on White Oak Plantation. The conservation's breeding programs have worked with the Florida Wildlife Conservation Commission as well as the U.S. Fish and Wildlife Service to bolster wild populations of Florida panthers, along with a number of other imperiled species such as rhinoceros and cheetah.

"White Oak is the only place in the world that rehabilitates injured Florida Panthers for release into the wild," Speeg told WJXX.

The Florida panther is a subspecies of the puma, also known as the mountain lion or cougar, and is the only known breeding population of puma that remains in the eastern United States, according to the U.S. Fish and Wildlife Service.

Florida panther kittens typically stay with their mother for about a year and a half before leaving to form their own territories. They live for about 12 years in the wild but are susceptible to disease, genetic disorders and getting hit by cars, according to the National Wildlife Federation.

Perceived as a threat to humans, livestock and game animals, the big cats were heavily hunted and nearly went extinct by the mid-1950s, according to the National Park Service. The Florida panther was added to the U.S. endangered species list in 1967.

The mammals are reclusive, typically living in remote, undeveloped areas of southern Florida, and thus are rarely seen by people. However, they are under threat from increasing human population and development in their habitat. Less than 130 Florida panthers are estimated to remain in the wild in a restricted range in South Florida, according to White Oak Conservation.

"They play a really important role in Florida ecology," Speeg told WJXX. "It's like playing Jenga. If you remove something, they all support each other and you aren't sure what impact that's going to have."

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CAR T Cells to Go? Outpatient Therapy Can Be Safe – Medscape

Posted on February 28, 2020 by Danzig

ORLANDO, Florida Chimeric antigen receptor (CAR) T-cell therapy can be safely delivered in the outpatient setting, which could make the life-extending treatment available to patients who don't have access to a major teaching hospital or treatment center, contend investigators who analyzed data from three clinical trials.

Looking at outcomes for patients with large B-cell lymphomas (LBCL) who were treated with the CAR T-cell construct lisocabtagene maraleucel (liso-cel) in the outpatient setting at both university-based and nonacademic medical centers in three clinical trials, Carlos Bachier, MD, from the Sarah Cannon Blood Cancer Network in Nashville, Tennessee, and colleagues found that the incidences of severe adverse events were relatively low and manageable.

"Outpatient administration of liso-cel and subsequent monitoring were successfully implemented in multiple clinical trials at both university and nonuniversity sites," he said here at the Transplantation and Cellular Therapy annual meeting.

Dr Carlos Bachier

The need to monitor and treat serious side effects from CAR T therapy, such as the cytokine release syndrome (CRS) and neurologic toxicities, has previously limited the therapy to major treatment centers with extensive resources. Yet most patients in the US with relapsed or refractory large B-cell non-Hodgkin lymphoma are treated at nonacademic centers where cancer therapies are typically delivered in outpatient infusion centers, Bachier said.

"Infusion and monitoring of patients receiving CAR T-cell therapy in the outpatient setting can lead to wider utilization and improved access," he said.

To get a better idea of the safety and efficacy of CAR T-cell therapy in the outpatient setting, Bachier and colleagues examined outcomes from the phase 1 TRANSCEND NHL 001 trial of liso-cel in one or two doses for a variety of aggressive lymphoma histologies, conducted in both university-based and nonuniversity centers; the phase 2 TRANSCEND-OUTREACH trial of outpatient liso-cel therapy after two or more prior lines of therapy against various lymphomas and lymphoproliferative disorders, conducted in nonuniversity centers; and the phase 2 TRANSCEND-PILOT-017006, testing liso-cel in patients with LBCL relapsed or refractory after a single line of immunochemotherapy who were ineligible for either high-dose chemotherapy or stem cell transplant. This trial was conducted in both university and nonuniversity settings.

In OUTREACH and PILOT, liso-cel was administered at a dose of 100 x 106 CAR-positive T cells; in TRANSCEND, it was given at doses of 50, 100, or150 x 106.

To qualify for outpatient administration and monitoring, both university centers and nonuniversity specialty oncology centers had to have at least hematopoietic stem cell therapy (HSCT) or phase 1 trial capability, an outpatient infusion center or inpatient infusion unit with same-day discharge; an affiliated aphereseis center; and a multidisciplinary medical team that can coordinate care between inpatient and outpatient settings, have standard operating procedures for outpatient monitoring and admissions when necessary, and an oncologist on call at all times.

In addition, each center had to have one designated hospital for care of CAR T-cell recipients with staff trained to manage typical CAR T-cell toxicities and a ready supply of tocilizumab (Actemra, Genentech) for treating CRS.

For their part, patients needed to have caregiver support and stay within 1 hour travel of the treatment center for the first 30 days after infusions, had to commit to returning to the site for immediate medical evaluation as necessary, and had to be educated about the early signs and symptoms of CRS and neurologic toxicities.

The analysis included data on 44 patients with a median age of 62 years (range 24 to 82), including 25 enrolled in TRANSCEND, 13 in OUTREACH, and 6 in PILOT. Eighteen patients were age 65 or older, 12 had high tumor burden, and 6 had lactate dehydrogenase (LDH) levels of 500 U/L or higher.

Treatment-related adverse events (TEAEs) occurring in at least 25% of outpatients were similar to those among all patients in TRANSCEND, with the most frequent grade 3 or 4 events being neutropenia, anemia, and thrombocytopenia. There were no treatment-related deaths among those monitored as outpatients.

CRS of any grade occurred in 12 of 25 outpatients (48%) in TRANSCEND, in 5 of 13 (38%) in OUTREACH, and in none of the 6 outpatients in PILOT. Grade 3 or 4 CRS was seen in 1 outpatient in TRANSCEND, but in none of the other patients in the other two trials.

Grade 3 or 4 neurologic events occurred in two outpatients in TRANSCEND, but were not seen in any outpatients in OUTREACH or PILOT.

Three patients in TRANSCEND and two in OUTREACH received either tocilizumab or corticosteroids for CRS, and five patients in TRANSCEND received corticosteroids for neurologic adverse events. Prolonged grade 3 or greater cytopenias were seen in three patients in TRANSCEND, five in OUTREACH, and one in PILOT.

The median onset of CRS was 5 days, and the median onset of neurologic toxicities was 8 days among all outpatients, and was similar to combined inpatient and outpatient population in TRANSCEND. The median duration of the events 6 days for CRS, 16 days for neurologic events was also similar to that seen in TRANSCEND.

Of the 44 patients from all three trials, 24 (55%) were hospitalized after liso-cel administration, for a median of 6.5 days (range 2-23). The median time to hospitalization was 5 days. One third of the hospitalizations were for either CRS or neurologic events. There were 2 cases of ICU admissions after liso-cel administration, for a median ICU stay of 4 days.

In all, 45% of outpatients did not require hospitalization, and there was no increase in ICU admissions compared with inpatients, Bachier pointed out.

The overall response rate was 80%, with a complete response rate of 55%, similar to that seen in TRANSCEND, he said.

In an interview with Medscape Medical News seeking objective commentary on the findings, Yago Nieto, MD, from the University of Texas MD Anderson Cancer Center in Houston, said that he would be comfortable with CAR T-cell therapy in the outpatient setting, provided that several key components of care are in place.

"It requires an organized effort to be able to see those patients in an outpatient clinic weekdays and weekends, having every contingency discussed beforehand, including for ICU team members to admit patients into the ICU if necessary which is unusual, particularly with liso-cel but it has to be all worked out in advance in a multidisciplinary effort," he said.

Nieto comoderated the session where the data were presented, but was not involved in the study.

Comoderator Mazyar Shadman, MD, MPH, from the Fred Hutchinson Cancer Research Center in Seattle, Washington, who was not involved in the study, told Medscape that his center treats patients with CAR T therapy in the outpatient setting.

"But it's important to know that when you talk about outpatient care, it's not your outpatient clinic where you see patients once a week," he said. "These are intensive outpatient centers. We have a team that's just outpatient, but we see these patients on a daily basis, we have dedicated nurses and practitioners, and we have labs and immunotherapy services for getting results quickly."

"I feel comfortable giving CAR T therapy to a patient in this setting," he added, "but not to a patient being treated in the middle of nowhere."

The study was funded by Juno Therapeutics, a Bristol-Myers Squibb company. Bachier disclosed advisory board activities for various companies, not including Juno or BMS. Nieto disclosed research funding and consultancy for various companies not including the sponsors of this study. Shadman disclosed research funding, honoraria, and consultancy with various companies not including Juno or BMS.

Transplantation & Cellular Therapy Meetings of ASTCT and CIBMTR 2020: Abstract29. Presented February 19, 2020.

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A 40-Year-Old Man With Dizziness, Confusion, and Neuropathy – Medscape

Posted on January 24, 2020 by Danzig

Editor's Note:The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

A 40-year-old man is referred for neurologic evaluation after presenting with peripheral neuropathy. Three years ago, he noted numbness, burning pain, and reduced temperature sensation in his feet. For the past 2 years, he has had dry eyes and dry mouth; urinary retention that requires self-catheterization; gastrointestinal symptoms, including alternating diarrhea and constipation; and nausea. His weight has decreased by 40 lb (18.1 kg) over 12 months. He has noticed decreased sweating.

For several months, he has had frequent syncopal episodes triggered by positional change. In hindsight, he reports intermittent dizziness associated with a "daydreaming" feeling that began 8 years ago; however, these spells were not associated with loss of consciousness. He was also recently diagnosed with Sjgren syndrome.

He reports no chest pain, palpitations, shortness of breath, or edema. A review of systems is otherwise unremarkable. His past medical history is notable for hypothyroidism. His family history is notable for a grandfather who had gastrointestinal problems and a sister who has palpitations. His parents are alive and have no neurologic symptoms. He takes no medications or supplements.

Medscape2020WebMD, LLC

Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Amanda Kennedy,Jeffrey Kaplan,Dianna Quan.A 40-Year-Old Man With Dizziness, Confusion, and Neuropathy-Medscape-Jan21,2020.

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Living Near Major Roadways Raises Risk of MS and Other Neurologic… – Multiple Sclerosis News Today

Posted on January 28, 2020 by Danzig

People living close to major roads or highways are at a greater risk ofmultiple sclerosis (MS),a database study of people in metropolitan Vancouver reports.

Parks and other green spaces in urban areas that might lower exposure to air pollutants did not affect a persons overall risk of developing MS, but can lessen the likelihood of other neurological diseases.

These findings were in the study Road proximity, air pollution, noise, green space and neurologic disease incidence: a population-based cohort study, published in the journal Environmental Health.

The risk of neurological conditions like MS, non-Alzheimers dementia (NAD), Parkinsons disease, and Alzheimers diseaseincreases with age, and is particularly high in people between 60 and 70 years old. As the population ages, the prevalence (proportion of people living with a disease at a given time) of these neurological ills is expected to rise.

Although certain lifestyle habits, such as smoking and physical activity, are seen to influence the risk of developing these conditions, it is not well known if other factors related to the peoples surroundings can play a role too.

A team of researchers atThe University of British Columbia (UBC), Canada,investigated a possible link between exposure to environmental factors like road proximity, air pollution, greenness and noise, and the risk of MS, NAD, Parkinsons, and Alzheimers disease.

The team analyzed data covering about678,000 people, ages45 to 84, who had been living in Metro Vancouver between January 1994 and December 1998. Researchers investigated if environmental factors over this four-year exposure periodinfluenced the development of any of these neurological conditionsin these people.

They were then followed for another four years, from January 1999 to December 2003, and reported changes in their health noted.

Over these followup years, researchers identified 13,170 cases of NAD, 4,201 cases of Parkinsons disease, 1,277 cases of Alzheimers disease, and 658 cases of MS.

Results showed that living close to a major road or highway specifically, less than 50 meters (about 54 yards) away from a major road, or less than 150 meters (about 1 mile) away from a highway was linked to a higher incidence (rate of new disease cases over a given time) of all the neurological conditions studied, including MS.

Air pollution exposure increased the risk of NAD and Parkinsons disease, the study reported. Because of the low number ofAlzheimers and MS cases in the group analyzed, researchers were unable to identify an association between these two conditions and air pollution. A larger cohort (study group) is needed to draw conclusions here, they said.

Data, however, suggested that the presence of fine particulate matter (PM2.5, produced by combustion) may contribute to the risk of MS.

Living close to green spaces within cities lowered the incidence of NAD and Parkinsons,but not of MS. Researchers speculated that this could be because of limits on data in their statistical model.

Noise from nearby major roadways also was not seen to affect the risk of developing any of the conditions studied.

For the first time, we have confirmed a link between air pollution and traffic proximity with a higher risk of dementia, Parkinsons, Alzheimers, and MS at the population level, Weiran Yuchi, the studys lead author, said in a UBC press release.

The good news is that green spaces appear to have some protective effects in reducing the risk of developing one or more of these disorders, Yuchi added. More research is needed, but our findings do suggest that urban planning efforts to increase accessibility to green spaces and to reduce motor vehicle traffic would be beneficial for neurological health.

The team believes that the findings underscore the importance of city planning, and support the incorporation of greenery and parks.

For people who are exposed to a higher level of green space, they are more likely to be physically active and may also have more social interactions.There may even be benefits from just the visual aspects of vegetation, said Michael Brauer, the studys senior author.

Given the high proportion of the population living in proximity to traffic and the growing prevalence of neurological disorders, future studies in other urban areas which address potential joint effects of multiple environmental exposures are warranted, the team concluded.

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A Neurologists Guide to Secondary Headaches and What They Mean – POPSUGAR

Posted on January 14, 2020 by Danzig

When harsh headaches strike, identifying the cause of your pain can be the least of your worries. Instead, you kick into survival mode, seeking refuge in a dark, quiet room, ice packs on deck.

But, should you be investigating your symptoms more?

If your gut is convinced something greatly differentiates this headache from those you've experienced prior, it's important to see a doctor to rule out the possibility of a secondary headache.

Unlike common migraine, tension, or cluster headaches (which fall under the primary category), secondary headaches are often telling of underlying health problems.

Before you go Google diagnosing yourself in a panic, follow up with your doctor for a proper diagnosis. For more info on the topic of mind, read through this guide to secondary headaches from Dr. Stephen A. Kulick, MD, a neurology specialist in Staten Island, ahead.

Secondary headaches are actually the symptom of another cause, like encephalitis or meningitis, for example as opposed to primary headaches, which aren't the result of another medical condition.

According to Dr. Kulick, 10 percent of all headaches are secondary, making them a lot less common than primary.

Since secondary headaches are often indicative of an undiagnosed health issue, Dr. Kulick insisted that they always warrant professional attention and a diagnosis from a neurologist.

If you're struggling to determine whether or not you have a primary or secondary headache, Dr. Kulick suggested asking yourself the following questions:

These are all reasons to see a doctor in order to rule out any serious issues and receive proper pain-relieving medication.

Remember: there is no need to stress about what your headache means until you have spoken to a doctor.

But, it's important to seek emergency care if the headache is painful or debilitating, or accompanied by confusion, fainting, or high fever, Dr. Kulick said. He also noted that secondary headaches can be attributed to imbalances in the body for example, high blood pressure, renal, thyroid, allergy, or sleep problems, and even dehydration but they could also be attributed to other dangerous conditions affecting the brain.

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Cant find your Excedrin Migraine pills at the pharmacy? Heres why – WTVR CBS 6 News

Posted on January 22, 2020 by Danzig

Pharmaceutical company GlaxoSmithKline has paused production and distribution ofsome of its Excedrin products,which many people use to treat their migraines.

A GSK spokesperson said there were inconsistencies in how we transfer and weigh ingredients for Excedrin Extra Strength Caplets and Geltabs and Excedrin Migraine Caplets and Geltabs.

But the company does not believe the products pose a safety risk to consumers.

In a statement to WKBW, a spokesperson said:

Patient safety and product quality are our utmost priorities at GSK. Based on the available data, GSK believes that the product does not pose a safety risk to consumers. However, as a precautionary measure, GSK Consumer Healthcare voluntarily implemented a temporary discontinuation of production and distribution.

This is a short term issue for which we expect production to begin again shortly. In the meantime, other Excedrin products are available along with other pain-relieving drugs, but dosages may differ. Consumers should consult their pharmacist for the most suitable alternative product.

A Tops Markets spokesperson tells WKBW that they are out of the Excedrin Migraine medicines, and are working to learn more specifics on the shortages.

A lot of people use over-the-counter medicine, like Excedrin, to treat their migraines.

Dr. Jennifer McVige, a Pediatric and Adult Neurologist at the Dent Neurology Institute, said there are migraine-specific medications that a doctor can prescribe.

Weve always hadTriptan-based medications that we could prescribe. Also, theres these new CGRP inhibitors that are coming out.

Dr. McVige warns that taking over-the-counter medication, like Excedrin, too frequently can make things worse.

Theres something called medication overuse headache that can occur if you take over the counter medications more than three days over the week, she said.

Dr. McVige said to try and avoid getting migraines, make sure to get enough sleep, drink enough water, eliminate stress and get some exercise.

This story was originally published by Ala Errebhi at WKBW.

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