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Category Archives: Neurology
Daniel Gibbs had received only four monthly doses of Biogens experimental Alzheimers drug in a clinical trial in 2017 when he ended up in an intensive care unit.He had an excruciating headache, and his blood pressure was so high that doctors thought he might be having a stroke.
It turned out that the retired Portland, Ore., neurologist who had treated Alzheimers patients before he was diagnosed with the disease himself in 2015 was experiencing some of the worst reported side effects of the drug. Doctors prescribed medicines to lower his blood pressure, which reached 206/116, and later to reduce brain swelling. But for weeks afterward, he struggled to read, follow conversations, and do simple math. He recovered but never again took the Alzheimers drug.
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A lawsuit filed against the Florida Neurological Center, LLC and its owner, Dr. Lance Kim of Ocala, in which the defendants were accused of several fraudulent practices under the False Claims Act, has been partially settled.
Kim and the Florida Neurological Center (FNC), located at 2237 SW 19th Ave. Road, Suite 101, have agreed to pay $800,000 to resolve allegations that Kim prescribed medically unnecessary and unreasonable prescription drugs, according to a press release from the U.S. Attorneys Office for the Middle District of Florida.
The release specifically noted Acthar Gel, a prescription drug that cost the Medicare program around $35,000 for every five-day supply Kim prescribed.
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The agreement partially resolves the allegations brought against Kim and the center, andthere has been no determination of liability.
The lawsuit was filed in Orlando by Michael Singbush, Andrea Herrera and Harvey Kessler MeyerIV, all former employees of the Florida Neurological Center between 2014 and 2017. Under the False Claims Act, private individuals, or relators, can sue, on behalf of the government, companies and individuals that they believe to be defrauding government programs.
Also under the act, the relators are permitted to receive a share of the recovery, totaling $144,000 in this case.
Florida Attorney General Ashley Moodys office issued a press release on the settlement Tuesday, stating that she is working with federal partners to recover thousands of dollars for Floridas Medicaid program related to the settlement.
The program will receive over $113,000 in restitution from the agreement.
Defrauding Floridas Medicaid program is not a victimless crime, Moody said in the release. It harms the taxpayers of our great state. My Medicaid Fraud Control Unit investigators work hard to protect taxpayers by identifying, investigating and stopping fraud exploiting this taxpayer-funded health care program and recovering lost funds whenever possible.
FNC has served Marion County since 1998, according to its website. It specializes in evaluating and treating neurological disorders such as Alzheimers disease, neuropathy, muscle disorders and sleep disorders.
Kim received his undergraduate degree in biochemistry from Boston University and medical degree from Nova Southeastern University in Fort Lauderdale.
He has worked as a research fellow at the Harvard Medical School/Massachusetts General Hospital, interned in internal medicine at Northwestern University Medical Center and received a residency and fellowship in neurology from the University of Chicago.
Kim is the owner and sole practicing physician of FNC.
In a pretrial statement from May, the plaintiffs had maintained that Kim and FNC violated the False Claims Act (FCA) and that each plaintiff faced retaliation after complaining of the illegal actions.
The relators explained that the basic requirement for reimbursement from Medicare, Medicaid and other government healthcare programs is that services are reasonable and medically necessary. They described various ways in which they believed FNC submitted false claims.
The defendants denied any wrongdoing under the FCA, and the parties agreed to a voluntary dismissal of most of the counts on Tuesday.
The claimsthat each relator faced retaliation for questioning the practices and was either forced to resign or fired are still pending.
FNC and Kim deny any retaliation or that the relators engaged in protected activity, which prevents whistleblowers from retaliation.
FNC also soughtdamagein a counterclaim against Singbush, Herrera and Meyer, alleging unlawful use and disclosure of confidential information about patients, as well as breach of employment agreements. Those claims were dismissed in June.
The U.S. Attorneys Office for the Middle District of Florida reminds that tips about potential fraud, waste, abuse and mismanagement can be reported to the Department of Health and Human Services at 800-HHS-TIPS (800-447-8477).
Contact reporter Danielle Johnson at firstname.lastname@example.org.
Oyesiku to Receive Distinguished Service Award from Society of University Neurosurgeons | Newsroom – UNC Health and UNC School of Medicine
The award will presented to Dr. Oyesiku at the Societys 2021 Annual Meeting August 8-11.
Nelson M. Oyesiku, MD, PhD, FACS, Chair Chair of the UNC School of Medicine Department of Neurosurgery, will receive the Distinguished Service Award given by the Society of University Neurosurgeons at their 2021 Annual Meeting in Whitefish, Montana, August 8-11.
Prior to joining the UNC faculty on April 1, 2021, Dr. Oyesiku was Professor of Neurological Surgery and Medicine (Endocrinology) at Emory University, Atlanta, Georgia and the Inaugural Daniel Louis Barrow Chair in Neurosurgery, Vice-Chairman of the Department of Neurological Surgery and Director of the Neurosurgical Residency Program. Dr. Oyesikus clinical expertise is pituitary medicine and surgery. Dr. Oyesiku was co-director of the Emory Pituitary Center and has developed one of the largest practices entirely devoted to the care of patients with pituitary tumors in the country and has performed over 3,700 pituitary tumor operations. Dr. Oyesiku obtained his MD from the University of Ibadan, Nigeria. He obtained an MSc in Occupational Medicine from the University of London, UK and completed a PhD in Neuroscience at Emory University. He completed his Surgery Internship at the University of Connecticut-Hartford Hospital and obtained his neurosurgical training at Emory University, Atlanta. He is board-certified by the American Board of Neurological Surgery. He received an NIH K08 Award and Faculty Development Award from the Robert Wood Johnson Foundation was a recipient of an NIH R01 award and PI of the NIH/NINDS R25 Research Education Program for Residents and Fellows in Neurosurgery. Dr. Oyesiku has served on several NIH Study Sections. Dr. Oyesikus research is focused on the molecular pathogenesis of pituitary adenomas, and tumor receptor imaging and targeting for therapy.
Dr. Oyesiku has served on various state, regional, national and international committees for all the major neurosurgical organizations. He has served on the Board of Directors and as Chairman of the American Board of Neurological Surgery. He was on the ACGME-Residency Review Committee of Neurosurgery. He is a Fellow of the American College of Surgeons and has served on its Board of Governors. Dr. Oyesiku has been President of the Congress of Neurological Surgeons. He has served as Secretary/Treasurer and President of the Georgia Neurosurgical Society, President of the Society of University Neurosurgeons, and Vice-President of the American Academy of Neurological Surgeons. He is President of the International Society of Pituitary Surgeons. He is President-Elect of the World Federation of Neurological Surgeons.
Dr. Oyesiku is Editor-in-Chief of NEUROSURGERY, OPERATIVE NEUROSURGERY and NEUROSURGERY OPEN leading journals in neurosurgery. He is author of over 180 scientific articles and book chapters.
He has been selected by his peers as one of The Best Doctors in America and was selected by the Consumer Research Council of America as one of Americas Top Surgeons. He is named in Marquis Whos Who in America. He is a member of the Honor Medical Society Alpha Omega Alpha. He was awarded the Gentle Giant Award by the Pituitary Network Association for his services to Pituitary Surgery and Medicine. He is on the Medical Advisory Board of the Cushings Support and Research Foundation. He has been visiting professor and invited faculty at several departments of neurosurgery in the United States and abroad.
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Oyesiku to Receive Distinguished Service Award from Society of University Neurosurgeons | Newsroom - UNC Health and UNC School of Medicine
Delays in thrombolysis during COVID-19 are associated with worse neurological outcomes: the Society of Vascular and Interventional Neurology…
This article was originally published here
J Neurol. 2021 Jul 31. doi: 10.1007/s00415-021-10734-z. Online ahead of print.
INTRODUCTION: We have demonstrated in a multicenter cohort that the COVID-19 pandemic has led to a delay in intravenous thrombolysis (IVT) among stroke patients. Whether this delay contributes to meaningful short-term outcome differences in these patients warranted further exploration.
METHODS: We conducted a nested observational cohort study of adult acute ischemic stroke patients receiving IVT from 9 comprehensive stroke centers across 7 U.S states. Patients admitted prior to the COVID-19 pandemic (1/1/2019-02/29/2020) were compared to patients admitted during the early pandemic (3/1/2020-7/31/2020). Multivariable logistic regression was used to estimate the effect of IVT delay on discharge to hospice or death, with treatment delay on admission during COVID-19 included as an interaction term.
RESULTS: Of the 676 thrombolysed patients, the median age was 70 (IQR 58-81) years, 313 were female (46.3%), and the median NIHSS was 8 (IQR 4-16). Longer treatment delays were observed during COVID-19 (median 46 vs 38 min, p = 0.01) and were associated with higher in-hospital death/hospice discharge irrespective of admission period (OR per hour 1.08, 95% CI 1.01-1.17, p = 0.03). This effect was strengthened after multivariable adjustment (aOR 1.15, 95% CI 1.07-1.24, p < 0.001). There was no interaction of treatment delay on admission during COVID-19 (pinteraction = 0.65). Every one-hour delay in IVT was also associated with 7% lower odds of being discharged to home or acute inpatient rehabilitation facility (aOR 0.93, 95% CI 0.89-0.97, p < 0.001).
CONCLUSION: Treatment delays observed during the COVID-19 pandemic led to greater early mortality and hospice care, with a lower probability of discharge to home/rehabilitation facility. There was no effect modification of treatment delay on admission during the pandemic, indicating that treatment delay at any time contributes similarly to these short-term outcomes.
PMID:34333701 | DOI:10.1007/s00415-021-10734-z
3-D ‘Heat Map’ Animation Shows How Seizures Spread in the Brains of Patients with Epilepsy – UCSF News Services
For 29 years, from the time she was 12, Rashetta Higgins had been wracked by epileptic seizures as many as 10 a week in her sleep, at school and at work. She lost four jobs over 10 years. One seizure brought her down as she was climbing concrete stairs, leaving a bloody scene and a bad gash near her eye.
A seizure struck in 2005 while she was waiting at the curb for a bus. I fell down right when the bus was pulling up, she says. My friend grabbed me just in time. I fell a lot. Ive had concussions. Ive gone unconscious. It has put a lot of wear and tear on my body.
Rashetta Higgins at the UCSF Helen Diller Medical Center at Parnassus Heights after surgery to implant more than 150 electrodes to monitor her seizures. Photo courtesy ofRashetta Higgins
Then, in 2016, Higgins primary-care doctor, Mary Clark, at La Clinica North Vallejo, referred her to UC San Franciscos Department of Neurology, marking the beginning of her journey back to health and her contribution to new technology that will make it easier to locate seizure activity in the brain. Medication couldnt slow her seizures or diminish their severity, so the UCSF Epilepsy Center team recommended surgery to first record and pinpoint the location of the bad activity and then remove the brain tissue that was triggering the seizures.
In April, 2019, Higgins was admitted to UCSFs 10-bed Epilepsy Monitoring Unit at UCSF Helen Diller Medical Center at Parnassus Heights, where surgeons implanted more than 150 electrodes. EEGs tracked her brain wave activity around the clock to pinpoint the region of tissue that had triggered her brainstorms for 29 years.
In just one week, Higgins had 10 seizures, and each time, the gently undulating EEG tracings recording normal brain activity jerked suddenly into the tell-tale jagged peaks and valleys indicating a seizure.
To find the site of a seizure in a patients brain, experts currently look at brain waves by reviewing hundreds of squiggly lines on a screen, watching how high and low the peaks and valleys go (the amplitude) and how fast these patterns repeat or oscillate (the frequency). But during a seizure, electrical activity in the brain spikes so fast that the many EEG traces can be tough to read.
We look for the electrodes with the largest change, says Robert Knowlton, MD, professor of Neurology, the medical director of the UCSF Seizure Disorders Surgery Program and a member of the UCSF Weill Institute of Neurosciences. Higher frequencies are weighted more. They usually have the lowest amplitude, so we look on the EEG for a combination of the two extremes. Its visual not completely quantitative. Its complicated to put together.
Enter Jonathan Kleen, MD, PhD, assistant professor of Neurology and a member of the UCSF Weill Institute of Neurosciences. Trained as both a neuroscientist and a computer scientist, he quickly saw the potential of a software strategy to clear up the picture literally.
The field of information visualization has really matured in the last 20 years, Kleen said. Its a process of taking huge volumes of data with many details space, time, frequency, intensity and other things and distilling them into a single intuitive visualization like a colorful picture or video.
Kleen developed a program that translates the hundreds of EEG traces into a 3-D movie showing activity in all recorded locations in the brain. The result is a multicolored 3-D heat map that looks very much like a meteorologists hurricane weather map.
This video shows the OPSCEA (or "Ictal Cinema") technology developed at the UCSF Epilepsy Center. It converts the usual complex "traced-based" recordings of brain waves that doctors see (on the right) into an intuitive heat map projected on the patient's own 3D reconstructed brain (right hemisphere of brain show in main view). Each trace (line) on the right is from a single intracranial electrode (black dots in the brain view). The seizure intensity is calculated automatically from the traces (specifically from the location of the arrow) and converted into color intensity (using a "line length" algorithm), revealing how activity in a given seizure moves in space and time. The technology also applies "slice views" (example shown halfway through the video) so that activity from electrodes deep in the brain can be seen in addition to the brain surface.
The heat maps cinematic representation of seizures, projected onto a 3-D reconstruction of the patient's own brain, helps one plainly see where a seizure starts and track where, and how fast, it spreads through the brain.
The heat map closely aligns with the traditional visual analysis, but its simpler to understand and is personalized to the patients own brain.
To see it on the heat map makes it much easier to define where the seizure starts, and whether theres more than one trigger site, Knowlton said. And it is much better at seeing how the seizure spreads. With conventional methods, we have no idea where its spreading.
Researchers are using the new technology at UCSF to gauge how well it pinpoints the brains seizure trigger compared with the standard visual approach. So far, the heat maps have been used to help identify the initial seizure site and the spread of a seizure through the brain in more than 115 patients.
Kleens strategy is disarmingly simple. To distinguish seizures from normal brain activity, he added up the lengths of the lines on an EEG. Seizures show up as high peaks and low valleys that make their cumulative length quite long, while gently undulating brain waves make much shorter lines. Kleens software translated these lengths into different colors, and the visualization was born.
The technology proved pivotal in Higgins treatment.
Before her recordings, we had feared that Rashetta had multiple seizure-generating areas, Kleen said. But her video made it plainly obvious that there was a single problem area, and the bad activity was rapidly spreading from that primary hot spot.
The journal Epilepsia put Kleens and Knowltons 3-D heat map technology on the cover, and the researchers made their software open-source, so others can improve upon it.
Its been a labor of love to get this technology to come to fruition Kleen said. I feel very strongly that to make progress in the field we need to share technologies, especially things that will help patients.
Higgins has been captivated by the 3-D heat maps of her brain.
It was amazing, she said. It was like, Thats my brain. Im watching my brain function.
And the surgery has been a life-changing success. Higgins hasnt had a seizure in more than two years, feels mentally sharp, and is looking for a job.
When I wake up, Im right on it every morning, she said. I waited for this day for a long, long time.
News University of California Health hospitals recognized among the best in California and the nation – University of California
University of California HealthThursday, July 29, 2021
The hospitals of University of California Health (UCH) once again have been rated among the best in the state and the nation, according toU.S. News & World Reports 2021-2022 Best Hospitals rankings.
UCLA Health is recognized on the Best Hospitals Honor Roll as the third best in the nation and first in California. UCSF Health is ninth nationally and first in Northern California. All five UC academic health centers that own or operate hospitals were among the best in the state out of 416 California hospitals evaluated.
UCH hospitals further distinguished themselves by being nationally ranked in two or more specialties. Only 140 of the more than 1,800 hospitals eligible for the analysis were ranked in the top 50 in one or more specialty. The neurology and neurosurgery program at UCSF Health is ranked first in the nation.
"We have a high concentration of physician and researcher expertise within University of California Health (UCH), and they share that knowledge across the system. That spirit of collaboration keeps us at the forefront of academic medicine and improves our patients quality of care. Dr. Carrie L. Byington, executive vice president of UCH and an infectious disease expert
The rankings for each of the medical centers are:
U.S. News & World Report has been publishing its Best Hospitals report for three decades to help make hospital quality more transparent. The Honor Roll recognizes the top 20 hospitals across the nation that deliver exceptional treatment across multiple areas of care.
The rankings are based on measures such as risk-adjusted survival and discharge-to-home rates, volume and staffing of nursing, among other care-related indicators. Additionally, the report considers input from physicians across the nation who vote for the best hospitals in their specialty.
University of California Health (UCH) comprises six academic health centers, 20 health professional schools, a Global Health Institute and systemwide services that improve the health of patients and the Universitys students, faculty and employees. All of UCs hospitals are ranked among the best in California and its medical schools and health professional schools are nationally ranked in their respective areas.