Category Archives: Neurology

The most precious resource that we have in the world is the pediatric brain, says Christopher Giza, MD, professor of pediatrics and neurosurgery and pediatric neurology division chief, UCLAs Mattel Childrens Hospital.

They represent the future of both the individuals they inhabit and the society they will influence, he fervently believes.

This is our worlds future. No matter your specialty, your goal at the end of the day is for your patient to have the healthiest, most developed brain that is possible given their circumstance.

However, brain injuries during childhood present a huge challenge. The top cause of severe traumatic brain injury (TBI) in infants is abusive head trauma (formerly called shaken baby syndrome).

Dr. Giza says he also regularly sees children injured via car/bicycle/skateboard accidents, falls, sports and recreation and other circumstances.

Children arent just little adults, says Dr. Giza. Because their brains are smaller doesnt mean their problems are smaller. Traumatic brain injury in a developing brain is the most complex injury, to the most complex organ, at the most complex time. The leading cause of acquired death and disability for people under 40 isnt cancer or hemorrhage or stroke; its TBI.

Dr. Giza has been at UCLA for 30 years. He graduated from Dartmouth College, received his medical degree from West Virginia University, interned at the University of Pennsylvania and trained in adult and pediatric neurology at UCLA.

Then he took a two-year detour: He joined the Yosemite Search and Rescue (YOSAR) team. I was mediocre among the world-class climbers in Yosemite, but I was the only physician on the team, he says.

He stayed connected to UCLA via involvement with a research project cataloging patients whod undergone pediatric epilepsy brain surgery, while also providing care to climbers whod fallen and suffered brain and spinal cord injuries.

In 1998, Dr. Giza left Yosemites ruggedness to return to UCLA. I was given the opportunity to work as a postdoctoral fellow for three years to undertake basic laboratory research in TBI, he explains.

In 2001, he joined the faculty. In 2011, he traveled to Afghanistan as a civilian advisor to the Department of Defense, and in 2012, he founded UCLA BrainSPORT, a comprehensive sports concussion/mild TBI program for safety, performance, outreach, research and treatment. In 2014, UCLA BrainSPORT was invited to President Obamas Healthy Kids and Safe Sports Concussion Summit, where President Obama announced the UCLA program.

The idea is not to make people stop playing sports but to understand risks and benefits in regard to brain development and to prevent brain injuries, says Dr. Giza.

Having served on the CDC Pediatric Mild TBI Committee, NCAA Concussion Task Force and the California Athletic Commission, he now serves on the Major League Soccer Concussion Program Committee, the National Basketball Association Concussion Committee, advises the U.S. Soccer Federation and directs the NFL Neurological Care Program at UCLA.

Once called the silent epidemic, TBI is more widely recognized today because of issues publicized by sports and the military.

Yet it is still invisible in many ways, says Dr. Giza. A cancer or stroke survivor can be an inspiring spokesperson for their condition. But for people with TBIs, its harder. Those with severe injuries may find it difficult to be spokespeople because of their injuries. And those who get better often dont want the stigma of being identified as someone with a brain injury.

Dr. Giza says he uses his vision of the supreme importance of developing brains as an anchor for education around pediatric brain injuries. His division, comprised of 14 faculty and 15 fellows, plus nurses, dietitians, occupational therapists and research assistants, offers a concussion champions TBI course, which trains 50 primary care providers in each session.

Weve never turned down an opportunity to speak about it, he says. If a small school wants us to talk to fourth graders about head injuries, well send someone. We recently did an education program for physicians, NPs and PAs in the Los Angeles Unified School District to prepare for fall sports.

Dr. Giza recently returned from the University of Tasmania in Australia, where he participated in a massive online course on head injuries. We have had tens of thousands of people viewing it, he says, noting he then went to the Queensland Childrens Hospital and provided input on new concussion guidelines for Australia and New Zealand.

Thats one way to reach a lot of people, Dr. Giza adds. But another way is right here, with daily clinics. We started with one half-day pediatric head injury clinic per week, and now we have five. Pediatric neurology clinics happen every day of the week, and cover other diagnoses like epilepsy, headaches, neurodevelopment, autism, cerebral palsy, genetics and much more.

He stresses how essential it is to teach future, as well as current, care providers about pediatric head injuries and TBI. UCLA has a pediatric neurology residency program, a pediatric epilepsy fellowship program and a sports neurology and neuropsychology fellowship program affiliated with BrainSPORT.

In addition, we train occupational therapists, general pediatricians, sports medicine doctors, etc. Then each takes what weve taught them into their own practices and spreads understanding exponentially, he says. Were aiming for all the impact we can get, because ensuring childrens brains develop to their fullest potential is the single most important thing we can do. Ive dedicated my life to it.

Biomarkers may hold key to better brain injury treatments

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Dr. Christopher Giza stresses importance of safeguarding brain ... - UCLA Health Connect

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Newswise MINNEAPOLIS People who live in neighborhoods with lower socioeconomic status are less likely to receive clot-busting medications or undergo clot-removing procedures after they have a stroke than people who live in neighborhoods with higher socioeconomic status, according to a study published in the November 1, 2023, online issue of Neurology, the medical journal of the American Academy of Neurology.

These treatments can greatly reduce death and disability from stroke, but previous studies have shown that few people actually receive the treatments, said study author Amy Ying Xin Yu, MD, of the University of Toronto in Canada. We wanted to see how socioeconomic disparities play a role, especially in an area where everyone has access to universal health care.

The study looked at all people living in Ontario, Canada, who had an ischemic stroke during a five-year period, for a total of 57,704 people. Ischemic stroke is caused by a blockage of blood flow to the brain and is the most common type of stroke.

The study looked to see how many of those people were treated with clot-busting drugs or surgery to remove blood clots.

Researchers also looked at participants neighborhoods and divided them into five groups based on their neighborhoods socioeconomic status, which was determined by factors such as the percentage of adults without a high school diploma, unemployment rate and income level.

A total of 17% of those living in the neighborhoods with the lowest socioeconomic status were treated, compared to 20% of those living in the neighborhoods with the highest socioeconomic status.

When researchers took into account other factors that could affect treatment, such as age, high blood pressure and diabetes, they found that people in the neighborhoods with the lowest socioeconomic status were 24% less likely to be treated than people in the neighborhoods with the highest socioeconomic status. There was no difference in treatment between the neighborhood with the lowest status and the middle three neighborhoods.

Our study underscores the need for tailored interventions to address socioeconomic disparities in access to acute stroke treatments, including educational and outreach programs to increase awareness about the signs and symptoms of stroke in various languages and efforts to distribute resources more equitably across neighborhoods, Yu said. Further research is needed to examine the specific causes of these disparities, so we can find ways to address the larger systemic issues that need to be improved to better serve people from under-resourced neighborhoods.

A limitation of the study was that researchers did not have information on other factors that could affect stroke treatment, such as the time symptoms started or how severe the stroke was.

The study was supported by ICES, a health research institute in Ontario; the Heart and Stroke Foundation of Canada; PSI Foundation; and Ontario Health Data Platform.

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

When posting to social media channels about this research, we encourage you to use the hashtags #Neurology and #AANscience.

The American Academy of Neurology is the worlds largest association of neurologists and neuroscience professionals, with over 40,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimers disease, stroke, migraine, multiple sclerosis, concussion, Parkinsons disease and epilepsy.

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

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Does Your Neighborhood Affect Your Care After a Stroke? - Newswise

Northwestern Medicine investigators have identified a novel therapeutic agent that is effective in treating metastatic breast cancer and brain metastases with minimal side effects, according to a recent study published in the Journal of Clinical Investigation.

The study, led by Maciej Lesniak, MD, chair and the Michael J. Marchese Professor of Neurosurgery, found that metixene, a central nervous system small-molecule inhibitor drug, induced cancer cell death in mouse models of different metastatic breast cancer subtypes and extended survival in mice with brain metastases.

The significance of this project lies in its potential to address a pressing clinical challenge: the treatment of brain metastases, particularly in the context of breast cancer. It offers hope for improving the quality of life and survival outcomes for a substantial number of patients affected by brain metastases, a common and serious complication of cancer. The identification of a novel therapeutic agent, metixene, and its mechanistic insights add a promising dimension to the field of cancer research and treatment, said Jawad Fares, MD, MSc, a neurosurgery resident at Northwestern Medicine and a postdoctoral fellow in the Lesniak laboratory who was lead author of the study.

Breast cancer is one of the major causes of brain metastases and is also the most common cause of cancer-related death in women worldwide, according to the World Health Organization. A lack of clinical trials and new therapeutic options has also slowed progress in treating patients with breast cancer brain metastases.

In the current study, the investigators screened more than 320 FDA-approved drugs known to cross the blood-brain barrier, which prevents foreign substances, including most drugs, from entering the brain. Among the drugs tested, metixene an antiparkinsonian drug was identified as a top candidate for killing cancer cells in various subtypes of metastatic breast cancer and brain metastases.

In a series of in vivo experiments, metixene not only decreased the size of breast tumors in mice, but also increased the lifespan of mice with multi-organ site metastases, intracranial solitary metastasis, and multiple brain metastases.

Subsequent functional analysis further showed that metixene induced incomplete autophagy when waste accumulates inside a cell and fails to be recycled and reused in cancer cells by activating the NDRG1 protein, which caused the cancer cells to trigger their own death.

Using CRISPR-Cas9 gene editing to knockout NDRG1 in breast cancer cell lines also led to autophagy completion and the reversal of metixene-induced apoptosis, or programmed cell death, in the cancer cells, according to the authors.

The study highlights the potential clinical significance of metixene as a promising therapeutic agent for the treatment of metastatic cancer and brain metastases. The drug was noted for having minimal reported side effects in humans, which makes it a strong candidate for consideration in clinical translation, i.e., further investigation and potential use in human clinical trials, Fares said.

Co-authors include Crismita Dmello, PhD, research assistant professor of Neurological Surgery, Peng Zhang, PhD, assistant professor of Neurological Surgery, Atique Ahmed, PhD, the Allen Buckner Kanavel Professor of Neurosurgery, Jason Miska, PhD, assistant professor of Neurological Surgery, Irina Balyasnikova, PhD, professor of Neurological Surgery, C. David James, PhD, Professor Emeritus of Neurological Surgery, Adam Sonabend, MD, associate professor of Neurological Surgery, and Amy Heimberger, MD, PhD, the Jean Malnati Miller Professor of Brain Tumor Research.

Lesniak, Dmello, Zhang, Ahmed, Miska, Balyasnikova, James, Sonabend and Heimberger are members of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

This work was supported by National Institutes of Health grants P50CA221747, R35CA197725, R01NS87990 and R01NS093903.

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Novel Therapy Extends Survival in Metastatic Cancer - News Center - Feinberg News Center

Over the last decade, research at Michigan Medicine has shown how exposure to toxins in the environment, such as pesticides and carcinogenic PCBs, affect the risk of developing and dying from amyotrophic lateral sclerosis.

Now, investigators have developed anenvironmental risk score that assesses a persons risk for developing ALS, as well as for survival after diagnosis, using a blood sample.

The results are published in theJournal of Neurology, Neurosurgery and Psychiatry.

For the first time, we have a means collecting a tube of blood and looking at a persons risk for ALS based on being exposed to scores of toxins in the environment, said first authorStephen Goutman, M.D., M.S., director of the Pranger ALS Clinic and associate director of the ALS Center of Excellence at University of Michigan.

Researchers obtained over 250 blood samples from participants in Michigan both with and without ALS. They calculated individual risk and survival models using 36 persistent organic pollutants.

Several individual pollutants were significantly associated with ALS risk. However, the risk for developing the disease was most strongly represented by a mixture of pesticides in the blood.

When considering the mixture of these pollutants, a person who was in the highest group of exposure had twice the risk of developing ALS compared to someone in the lowest group of exposure.

Our results emphasize the importance of understanding the breadth of environmental pollution and its effects on ALS and other diseases, said senior authorEva Feldman, M.D., Ph.D., James W. Albers Distinguished Professor at U-M, the Russell N. DeJong Professor of Neurology at U-M Medical School and director of the NeuroNetwork for Emerging Therapies at Michigan Medicine.

The research teams first understanding of the environments impact on ALS came in 2016 when investigators foundelevated levels of pesticides in the blood of patients with the disease.

They later uncovered thatexposure to organic pollutants advances ALS progression and contributes to worse outcomes.

When we can assess environmental pollutants using available blood samples, that moves us toward a future where we can assess disease risk and shape prevention strategies, Feldman said.

Environmental risk scores have been robustly associated with other diseases, including cancers, especially when coupled with genetic risk. This is a burgeoning application that should be further studied as we deal with the consequences of pollutants being detected throughout the globe.

Additional authors include Jonathan Boss, Dae-Gyu Jang, Ph.D., Bhramar Mukherjee, Ph.D., Rudy J. Richardson, Ph.D., and Stuart Batterman, Ph.D., all of University of Michigan.

This research was supported by the National ALS Registry/Agency for Toxic Substances and Disease Registry at the CDC (grants 1R01TS000289, CDC/ATSDR 200-2013-56856).

This research was also supported by theNational Institute of Diabetes and Digestive and Kidney Diseases, the National Institute of Environmental Health Sciences and the National Center for Advancing Translational Sciences at the National Institutes (grants K23ES027221, R01ES030049, R01NS127188, UL1TR002240). Additional support from the NeuroNetwork for Emerging Therapies, the NeuroNetwork Therapeutic Discovery Fund, the Peter R. Clark Fund for ALS Research, the Sinai Medical Staff Foundation, and Scott L. Pranger, University of Michigan.

Paper cited: Environmental risk scores of persistent organic pollutants associate with higher ALS risk and shorter survival in a new Michigan case/control cohort, Journal of Neurology, Neurosurgery and Psychiatry. DOI:10.1136/jnnp-2023-332121

Journal of Neurology Neurosurgery & Psychiatry

Data/statistical analysis

People

Environmental risk scores of persistent organic pollutants associate with higher ALS risk and shorter survival in a new Michigan case/control cohort,

27-Sep-2023

This research was supported by the National ALS Registry/Agency for Toxic Substances and Disease Registry at the CDC (grants 1R01TS000289, CDC/ATSDR 200-2013-56856). This research was also supported by the National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute of Environmental Health Sciences and the National Center for Advancing Translational Sciences at the National Institutes (grants K23ES027221, R01ES030049, R01NS127188, UL1TR002240). Additional support from the NeuroNetwork for Emerging Therapies, the NeuroNetwork Therapeutic Discovery Fund, the Peter R. Clark Fund for ALS Research, the Sinai Medical Staff Foundation, and Scott L. Pranger, University of Michigan.

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

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Drawing a tube of blood could assess ALS risk from environmental ... - EurekAlert

RWJBarnabas Health Medical Group provides comprehensive neurological care for patients with a full spectrum of conditions affecting the brain, spine or central nervous system. Our neurology team is led by a group of distinguished, board-certified physicians who treat complex conditions in both children and adults. Our goal is to improve our patients quality of life with compassionate expertise through expert medical management by utilizing the most advanced neuro diagnostic technologies available.

Some of the neurological conditions we treat include:

If youve been experiencing unexplained symptoms such as chronic headaches, memory loss, poor balance, or numbness and pain, it could indicate you have a problem related to your brain and/or nervous system. Seeing a neurologist for an exam is important if youve noticed any memory or concentration problems, muscle weakness or tremors, numbness, loss of coordination, or communication deficits.

Neurologists are physicians who specialize in treating diseases that affect the brain, spine, and nervous system, and a thorough neurological exam can help your doctor determine the cause of your symptoms.

During your neurological exam, your neurologist will conduct several evaluations. This may include cognitive testing, as well as checking your balance, sensory function, gait, language comprehension, eye control, motor strength and control, and many other skills. These detailed physical examinations are noninvasive and painless, and the exams are adapted for younger patients or other people with diminished consciousness or cognitive abilities.

Backed by a multidisciplinary team of medical experts, your neurologist can also connect you with one of our world-class neurosurgeons if surgery on your back, spine or brain becomes medically necessary.

To make an appointment with one of our RWJBarnabas Health Medical Group neurologists, please visit ourPhysician Locator to find a provider near you. You can make an appointment online, call the office or visithealthconnect.rwjbh.org/hcweb to book directly.

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New Jersey Neurology | RWJBarnabas Health Medical Group

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