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Category Archives: Neurology

Special Journal Issue on Functional Neurological Disorder Brings Attention to a Neglected Field: Investigator Q&A – Psychiatry Advisor

The latest issue of The Journal of Neuropsychiatry & Clinical Neurosciences (JNCN) focuses on Functional Neurological Disorder (FND), a neuropsychiatric condition with significant physical and mental health features. Psychiatrists commonly refer to this condition as Conversion Disorder, whereas neurologists may be more familiar with terms such as functional movement disorders and dissociative seizures, among other subtypes of FND.

Largely understudied until recently, FND presents a critical challenge to practitioners in neurology and psychiatry. Furthermore, the complex issues faced by patients require evidence-based approaches to both treatment and the medical communitys fundamental understanding of the disorder. In light of these challenges, the 5 guest co-editors of the special issue David L Perez, MD, MMSc, Selma Aybek, MD, Timothy R Nicholson, MD, PhD, Kasia Kozlowska, MBBS, PhD, W Curt LaFrance, Jr, MD, MPH put together a series of articles touching on risk factors, treatment approaches, and outcome measures, among other key topics. Psychiatry Advisor contacted Dr Perez and Dr Nicholson to discuss the special issue of JNCN and the state of the field.

Psychiatry Advisor: In your view, what is the significance of this special issue, the first published on FND in nearly 2 decades?

David Perez, MD, MMSc: This special issue on FND is a landmark event for the field. FND is among the most common conditions encountered by neurologists and neuropsychiatrists, yet because this diagnosis falls at the borderland between neurology and psychiatry, it has not had the clinical, academic, and research attention it deserves.

Over the last few decades, there have been significant breakthroughs in evidence-based diagnostic and treatment approaches, as well as the development of an improved understanding of disease mechanisms, resulting in renewed interest in FND across the clinical neurosciences. This progress is exemplified by the broad range of articles within our special issue on FND.

Psychiatry Advisor: How has our understanding of FND changed since the formative era of modern neuropsychiatry in the early 20th century?

Dr Perez: It is important to highlight that FND, previously termed hysteria and synonymous with Conversion Disorder, was of great interest to early pioneers in psychiatry and neurology, including Charcot, Freud, Janet, Babinski, and others. One of the major hopes of this special issue is that this effort will energize clinicians and researchers across the clinical neurosciences to care for and develop cutting edge research in this underserved population.

Foundational to our modern framing is the notion that FND is a neuropsychiatric disorder at the intersection of the mind and the brain. According to our perspective, this condition is brain-based and neural circuits do not artificially divide into neurological circuits and psychiatric circuits. An integrated, interdisciplinary approach that embraces neurologic, psychiatric, psychological, and rehabilitation perspectives is the present and future of FND clinical and research efforts.

Additionally, it is now recognized that there are a number of predisposing vulnerabilities or risk factors for the development of FND, and adverse life events may have etiological relevance for some but not all patients. This point is nicely exemplified by Professor Jon Stone and colleagues in their study of individuals with functional limb weakness, which notes that only about a third of patients in their sample reported childhood abuse and/or neglect.1

Psychiatry Advisor: In a recent article, an international panel of experts was organized to discuss the complexities of developing outcome measures for FND.2 Why is this an important issue in the field?

Timothy Nicholson, MD, PhD: With the long overdue growth of both clinical service provision for FND and research into its treatments comes a need to optimize outcome measurements to monitor changes in symptoms. Designing and selecting outcome measures is a complex task for any disorder, but there are particular features of FND that make this even more complex. These features, such as the wide variety of symptoms in FND and the potential for subjective rather than objective measures to be of more relevance than in other disorders, are discussed in this perspective article from a panel of 45 experts from 13 countries that aims to drive forward consensus and development of outcome measures in FND.

Psychiatry Advisor: What does FND tell us about the divide between mental and physical health?

Dr Nicholson: FND is the quintessential disorder through which to understand and conceptualize that mental and physical health are inherently intertwined, and any divide is an illusion that hinders both research and clinical care for mental health disorders, neurological disorders, and those in between. Patients with FND present with neurological symptoms that can resemble almost all other neurological disorders, but remain discernable by distinct clinical examination features (so-called positive signs).

The condition also has complex interactions with psychological processes (such as dissociation) and psychological disorders (such as PTSD and panic attacks) that have led to the traditional dominance of psychological models of the disorder. However, such models must of course be rooted in neurological (or brain-based) dysfunction, albeit at a complex multi-network level. There are exciting new theories, such as Bayesian computational models for motor and sensory dysfunction in FND that point the way forward for neuroscientific approaches. These models integrate mental and physical functions, ignoring the mirage of any false divide between them.

Psychiatry Advisor: Your editorial mentions the feasibility of implementing physical therapy for motor FND. Can you highlight other specialties outside of neurology and psychiatry that would benefit patients with FND?

Dr Perez: In addition to neurologists and psychiatrists, optimal care often involves physical therapists, occupational therapists, speech and language pathologists, psychologists, and/or social workers, among other disciplines. This interdisciplinary approach to FND is highlighted by the tree diagram that appears on the cover image for our special issue.

Psychiatry Advisor: The special issue includes an article detailing the establishment of specialized FND clinics in the United Kingdom, Switzerland and Canada. What does quality care for patients with FND currently look like?

Dr Perez: While FND care will certainly require robust engagement with general neurologists and psychiatrists, it is also encouraging that both here in the United States and internationally, such as in the United Kingdom, Switzerland, and Canada, subspecialty FND clinical programs have been developed. The article by Dr. Selma Aybek, one of the guest co-editors for this special issue, highlights the potential role of outpatient subspecialty FND clinics.3 Their roles include providing diagnostic clarification in challenging cases, as well as helping patients connect to evidence-based treatments, such as motor retraining and psychological treatments, particularly cognitive behavioral therapy.

Psychiatry Advisor: Patients with FND present with a wide variety of symptoms and comorbidities. In the context of such heterogeneity, how should clinicians approach treatment strategies?

Dr Perez: From a treatment perspective, the special issue adds to an emerging new outpatient model of care emphasizing roles for diagnostic clarification,3 treatment using cognitive behavioral therapy,4 and motor retraining as part of FND-specific physical therapy.5

Psychiatry Advisor: As you noted in your editorial, FND receives little attention, but when it does, it frequently arises as a medical mystery in stories of mass psychopathology, most recently in the case of the US embassy in Cuba. How can physicians and advocates bring attention to the far more common experiences of the patients you see on a regular basis?

Dr Perez: Indeed, FND is often hiding in plain sight, as illustrated in the article6 by Dr Popkirov and colleagues, which provides evidence that some popular news stories on medical mysteries can be reliably identified as cases of FND on the basis of positive signs of functional movement disorders or dissociative seizures. This phenomenon illustrates the critical importance of training clinicians across disciplines in the diagnosis of FND, including the delivery of the diagnosis in a way that patients can understand and accept, as well as increased awareness and understanding of the disorder among the general public. We hope that public awareness will improve and medical research funding will expand for this underserved population through academic efforts such as this special issue, educational initiatives on FND in medical school and residency training settings, and patient advocacy through organizations such as FND Hope and FND Action. The newly formed FND Society will have its inaugural conference this summer in Boston, which will include a strong training component for all relevant clinicians and scientists who want to learn more about this important, yet poorly understood, disorder.

References

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Special Journal Issue on Functional Neurological Disorder Brings Attention to a Neglected Field: Investigator Q&A - Psychiatry Advisor

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Statin Therapy and Cognitive Function in Elderly Patients – Neurology Advisor

Treatment with statins in the elderly population is not associated with accelerated memory dysfunction, greater decline in global cognitive function, or brain volume changes over 2 years, according to study results published in The Journal of the American College of Cardiology.

While many guidelines recommend statin treatment to prevent cardiovascular and cerebrovascular morbidity and mortality, there are consumer concerns regarding the possible effect of this treatment on cognitive function, because memory and/or cognitive changes are the second most common reported adverse event with statins.

The goal of the study, the Sydney Memory and Ageing Study (MAS), was to investigate the changes in memory and global cognition associated with statin therapy over 6 years and changes in brain volume over 2 years.

The MAS was a longitudinal, prospective, observational, population-derived cohort of non-demented Australians aged 70 to 90 years at baseline. Data were collected every 2 years over a 6-year period.

The study cohort included 1037 patients: 395 were statin nave and 642 had ever used statins. The mean duration of statin use at baseline was 9.1 years. At baseline, patients who had reported ever using statins were slightly younger, had higher body mass index, and had lower diastolic blood pressure than did never users. Over the observation period, 68% of patients who had used statin were continuous users.

The primary outcome measures included 2 end points: memory and global cognition, as assessed by neuropsychologic testing every 2 years. In a subgroup of 526 patients, magnetic resonance imaging was used to assess changes in total brain, hippocampal, and parahippocampal volume.

Over 6 years of observation, there was no significant difference in the rate of decline in memory and global function between patients who had ever used statins and patients who had never used statins. The trend was similar between continuous statin users and never users. Furthermore, there was no difference in rates of decline in memory and global cognition over 6 years between each statin subgroup (atorvastatin, simvastatin, and pravastatin) and the group of patients who never used statins.

Statin initiation was not associated with a change in global cognition performance or rate of decline, but was associated with an attenuation in the rate of decline of memory (P =.038).

Analyses to examine the possibility that statins may unmask memory difficulties in patients predisposed to cognitive impairment revealed no interaction between statins, risk factors for dementia, and changes over 6 years in memory and global cognition.

The researchers noted protective associations were found for some aspects of memory testing. Exploratory analyses of specific memory tests revealed a significant interaction between statin ever use and heart disease on decline in total learning. There was also evidence that supported apolipoprotein E4 carriage and slower decline in long-delayed recall in men who reported statin use compared with men who never used statins.

No difference in brain volume changes was found between statin users and never users.

The researchers acknowledged several study limitations, including its observational design, potential selection bias and survivor bias, as well as baseline differences between the groups for dementia risk factors. In addition, patients with advanced cognitive impairment were excluded from the study.

This study offers reassurance to consumers who hold concerns about harmful statin effects on memory and cognition, concluded the researchers.

Reference

Samaras K, Makkar SR, Crawford JD, et al. Effects of statins on memory, cognition, and brain volume in the elderly. J Am Coll Cardiol. 2019;74(21):2554-2568. doi:10.1016/j.jacc.2019.09.041

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Interventional Neurology Professional Inspection Report and Forecast 2020-2026 Dagoretti News – Dagoretti News

Global Interventional Neurology MarketIndustry Analysts 2020. The report has been put together using primary and secondary research methodologies, which offer an accurate and precise understanding of the Interventional Neurology market. The report offers an overview of the market, which briefly describes the market condition and the leading segments. It also mentions the top players present in the global Interventional Neurology market. The research report on the global Interventional Neurology market includes a SWOT analysis and Porters five forces analysis, which help in providing the precise trajectory of the market.

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Major Players in the Interventional Neurology Market:Medtronic, Inc. (Covidien), Penumbra, Inc., Stryker Corporation, Johnson & Johnson and Terumo Corporation

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Geographically, the Interventional Neurology market is segmented into seven regions, namely North America, Latin America, Western Europe, Eastern Europe, Asia Pacific Excluding Japan (APEJ), Japan and the Middle East and Africa (MEA). The growth of the Asia-Pacific market is supposed to be comparatively high as compared to other regions across the globe due to increasing inclination of consumers towards convenient in the regions. Interventional Neurology Market in the fast-developing nations such as China and India are estimated to witness robust revenue growth and trend to continue over the forecast period. Production of polymers such as polyethylene and polyethylene terephthalate used in manufacturing in flexible pouches is highest in North America and Europe region.

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Weekly review: The 5 ‘anxiety traps’ you fall into at workand how to escape them – The Daily Briefing

January 21, 2020

The 5 'anxiety traps' you fall into at workand how to escape them (Monday, Jan. 13)Writing for the Harvard Business Review, leadership adviser Sabina Nawaz outlines five "anxiety traps" that often occur at work and how to deal with them.

This flu season could be one of the worst in decades (Tuesday, Jan. 14)Officials are comparing this season to the 2017-2018 season, which was the deadliest in more than 40 years.

Between life and death: What a neurologist learned when his brother-in-law fell into a coma (Wednesday, Jan. 15)In neurology, there's a "middle ground" between life and death that providers and patients' family members alike struggle to navigatebut a new subspecialty could help improve communication around patients' care, Joseph Stern, a neurologist who's found himself on both the provider and family side of these difficult brain injuries, writes for the New York Times' "Well."

The happiest physiciansand the most burned-out ones in 2020, according to Medscape (Thursday, Jan. 16)More than 40% of physicians are burned out, but some specialtiesand generationsare suffering more than others, according to Medscape's 2020 National Physicians Burnout & Depression Report.

Millennials are sicker and poorer than prior generations. Here's how that's changing health care. (Friday, Jan. 17)Millennials are delaying care because of costs, have higher medical debt than previous generations, and are sicker than earlier generations were at the same agebut the generation is also poised to spur change in the U.S. health system, Daily Briefing's Ashley Fuoco Antonelli writes.

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Neurology Software Market to Witness Rapid Growth by 2025 | Brainlab, healthfusion, Athenahealth, Practice Fusion, Nextgen, Bizmatics. Dagoretti News…

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

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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