Category Archives: Neurology

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.

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3-D 'Heat Map' Animation Shows How Seizures Spread in the Brains of Patients with Epilepsy - UCSF News Services

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.

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News University of California Health hospitals recognized among the best in California and the nation - University of California

Garzon, who is a Research Fellow at the Department of Neurology at the International Hospital of ... [+] Colombia in Piedecuesta, Santander, in eastern Colombia

Colombian doctor Jenny Garzon's day-to-day work involves (under the supervision of neurologists), treating patients , who have suffered from stroke, but she is also a medical researcher helping to put a number on the financial toll of strokes and not just on the patient.

Garzon, who is a research fellow at the Department of Neurology at the International Hospital of Colombia Piedecuesta, Santander in eastern Colombia, says that relatively little research has been done in Colombia into the care burdens and additional costs caused by stroke (when the blood supply to part of the brain is cut off).

"If someone has a stroke, the costs can really add up: there can be structural changes to the home, wheelchairs and more," Garzon says, adding that in Colombia, these new costs can add up to an entire monthly minimum wage or more, as neither the public health system nor private insurers usually cover the majority of these expenses in the long-term.

Garzon, who is part of a team putting together a new, as-yet-unpublished paper on the topic of the financial impacts on stroke patients and their families and care-givers, says the impact extends far beyond these medical costs.

"With these medical costs, the loss of the income of the stroke patient and usually the need for a full-time carer, you are basically looking at the loss of two to three individual wages, depending on the patient," Garzon says, "One option to fix this could be new public policies that would allow the government to cover those costs during the time the patient is in the process of rehab."

Garzon, 24, says the other solution is prevention through education and rapid response.

"Most stroke patients have much better outcomes if they can arrive at a hospital or clinic within four and a half hours," she says, adding that "telestroke" treatment, the usage of remote technology to get stroke patients treated by neurologists, doctors who have advanced training in the field, can help reduce response times even further. It is not yet available in Colombia.

Garzon says that a significant proportion of people in Colombia are not aware of how to identify the main symptoms of stroke: They can't speak well, one side of the face is numb or limbs can't move.

If people learn about stroke first signs and symptoms, then they can ask for help quickly and potentially reduce the serious health impacts after a stroke," she says.

Garzon grew up in Santander, the same department (state) where she now works.

"I've always loved everything to do with the human body," Garzon says, adding that while studying her undergraduate medical degree, she fell in love with clinical research, particularly as it pertains to brains.

"In my early path as a researcher, I've been under the mentorship of many people who have believed in me," Garzon says, adding she especially learned from neurologists Gustavo Pradilla and Federico Silva.

Garzon says the identifying and lowering costs for stroke patients is not just key in Colombia, but for patients across the entire world.

"Something that is very lovely about research is that we can do many collaborations, because not just one region has all the answers," she says, "We can do collaborations between Colombia and any other country in the world, it will make the research stronger."

Colombian neurology researcher Jenny Garzon (fifth from the left) with students and professors ... [+] during an International Brain Research Organization event in Medellin, Colombia.

A husband and wife team of Colombian scientists are also helping to improve lives through studying brain cells.

Marlene Jimenez and Carlos Velez at the University of Antioquia in Medellin, Colombia, have observed Alzheimer's precursor molecules in cells taken from newborns.

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This Colombian Researcher Helps Reveal The True Cost Of Strokes - Forbes

Most seizure medications carry a life-and-death warning: Taking this drug may increase suicide risk. Now researchers, includingMichael Sperling, MD, a professor in the department of Neurology and Director of the Clinical Neurophysiology Laboratory and the Comprehensive Epilepsy Center at Thomas Jefferson University, have discovered that the warning does not apply to many antiseizure drugs.

A new analysis, initiated by Pavel Klein, MD, a neurologist at the Mid-Atlantic Epilepsy and Sleep Center in Bethesda revealed no evidence for increased suicide risk from recently developed antiseizure medications. Despite the lack of data, all anti-seizure medications carry the warning from the U.S. Food and Drug Administration (FDA). The findings, reported today (August 2, 2021) in JAMA Neurology,call on the FDA to change its approach for applying class warnings to medication.

The approach the FDA has taken is concerning for doctors and patients alike because its not evidence based, says Dr. Sperling.

In 2008, the FDA analyzed results from nearly 200 clinical trials that assessed the efficacy of many drugs including 11 anti-seizure medications. The analysis revealed that compared with placebo, anti-seizure medications nearly doubled suicide risk among patients being treated for epilepsy, psychiatric disorders, and other diseases including chronic pain. The FDA concluded that anti-seizure medications increase suicide risk.

However, subsequent analyses did not find the same results. Yet, as a result of the FDA study, all anti-seizure medications approved since 2008 carry a warning for suicidality.

The warning affected the way new drugs are developed, which then impacted patient treatment. Trials of anti-seizure drugs since the warning came out have been careful to assess suicidality, but have also excluded people with histories of suicidal ideation. This means that trial results are difficult to extrapolate to patient treatment.

Now when a patient with epilepsy and a history of suicidal ideation comes into my office, I know nothing about whether any drug that I could prescribe is particularly risky to that individual or not, Dr. Sperling said.

Another concern is that patients may be reluctant to start or keep taking anti-seizure medications because of the warning. For patients with epilepsy, however, not taking their medications could mean more seizures, and a risk of dying from increased seizures.

Drs. Klein and Sperling wanted to find out if the warning actually applied to drugs approved since the FDAs study in 2008.

The researchers reviewed all randomized, placebo-controlled phase II and III clinical trials of the five new antiseizures medicationseslicarbazepine, perampanel, brivaracetam, cannabidiol (epidiolex) and cenobamateapproved by the FDA since 2008 that assessed suicidality. In total, they evaluated the results of 17 studies involving nearly 6000 patients.

They found no evidence for increased risk of suicidal thinking or behavior in the five drugs. Suicidal thinking or behavior occurred in 12 of the 4000 actively-treated patients in the trial (0.3%) and seven out of nearly 2000 placebo-treated patients (0.35%).

Our findings indicate the nonspecific suicide warning for all epilepsy drugs is simply not justifiable, says Dr. Sperling. The results are not surprising. Different drugs affect cells in different ways. So theres no reason to expect that every drug would increase suicide risk for every patient.

Although he acknowledges that some patients with epilepsy have pre-existing depression and perhaps are at greater risk for suicidal ideation, most do not.

Theres no reason to think that somebody with no history of depression and no risk for it would necessarily be at an increased risk for suicidality, he adds.

As some of the same brain chemistry that underlies epilepsy may be at play in depression, Dr. Sperling advises patients to pay attention to how they are feeling and to let their doctors know if they are having suicidal thoughts.

Patients and doctors must balance risks. The risk of epilepsy and seizures that are not controlled is greater than the risk of suicidality from anti-seizure medications that the FDA has highlighted, he says.

Dr. Sperling hopes that the evidence speaks for itself and that the FDA will reconsider their blanket-warnings on classes of drugs. Without the evidence to support it, the net effect of such class risk on drugs have consequences that may be worse if patients are afraid to take their medication, he says.

Reference: Suicidality risk of newer anti-seizure medications: a meta-analysis by Klein, P., Devinsky, O., French, J., Harden C., Krauss, G., McCarter, R., and Sperling. M., 2 August 2021, JAMA Neurology.DOI: 10.1001/jamaneurol.2021.2480

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Most Seizure Medications Carry a Life-and-Death Warning Heres the Problem - SciTechDaily

This article was originally published here

Neurology. 2021 Jul 29:10.1212/WNL.0000000000012578. doi: 10.1212/WNL.0000000000012578. Online ahead of print.

ABSTRACT

The COVID-19 pandemic caused by the SARS-CoV-2 virus has left many unanswered questions for patients with neurological disorders and the providers caring for them. Elderly and immunocompromised patients are at increased risk for severe symptoms due to COVID-19, and the virus may increase symptoms of underlying neurological illness, particularly for those with significant bulbar and respiratory weakness or other neurologic disability. Emerging SARS-CoV-2 vaccines offer substantial protection from symptomatic infection, but both patients and providers may have concerns regarding theoretical risks of vaccination, including vaccine safety and efficacy in the context of immunotherapy and the potential for precipitating or exacerbating neurological symptoms. In this statement on behalf of the Quality Committee of the AAN we review the current literature, focusing on COVID-19 infection in adults with neurological disease, in order to elucidate risks and benefits of vaccination in these individuals. Based on existing evidence, neurologists should recommend COVID-19 vaccination to their patients. For those patients being treated with immunotherapies, attention should be paid to timing of vaccination with respect to treatment and the potential for an attenuated immune response.

PMID:34326180 | DOI:10.1212/WNL.0000000000012578

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COVID-19 and Vaccination in the Setting of Neurologic Disease: An Emerging Issue in Neurology - DocWire News

Newswise A negative experience with food usually leaves us unable to stomach the thought of eating that particular dish again. Using sugar-loving snails as models, researchers at the University of Sussex believe these bad experiences could be causing a switch in our brains, which impacts our future eating habits.

Like many other animals, snails like sugar and usually start feeding on it as soon as it is presented to them. But through aversive training which involved tapping the snails gently on the head when sugar appeared, the snails' behaviour was altered and they refused to feed on the sugar, even when hungry.

When the team of Sussex Neuroscience researchers led by Dr Ildiko Kemenes looked a little closer, they discovered a neuronal mechanism that effectively reversed the snails' usual response to sugar after the conditioning training had taken place.

Dr Ildiko Kemenes, Reader in Neuroscience in the University of Sussex's School of Life Sciences, explained: "There's a neuron in the snail's brain which normally suppresses the feeding circuit. This is important, as the network is prone to becoming spontaneously activated, even in the absence of any food. By suppressing the feeding circuit, it ensures that the snail doesn't just eat everything and anything. But when sugar or other food stimulus is present, this neuron becomes inhibited so that feeding can commence.

"After the aversive training, we found that this neuron reverses its electrical response to sugar and becomes excited instead of inhibited by it. Effectively, a switch has been flipped in the brain which means the snail no longer eats the sugar when presented with it, because sugar now suppresses rather than activates feeding."

When researchers presented the trained snails with a piece of cucumber instead, they found that the animal was still happy to eat the healthy option - showing that the taps were associated with only the particular type of food they were trained to reject.

George Kemenes, Professor of Neuroscience at the University of Sussex and a senior member of the investigator team, added: "Snails provide us with a similar yet exceptionally basic model of how human brains work.

"The effect of the inhibitory neuron which suppresses the feeding circuit in the snail is quite similar to how, in the human brain, cortical networks are under inhibitory control to avoid 'runaway' activation which may lead to overeating resulting in obesity.

"In our research, the negative experience the snail had with the sugar could be likened to eating a bad takeaway curry which then puts us off that particular dish in future.

"We believe that in a human brain, a similar switch could be happening where particular groups of neurons reverse their activity in line with the negative association of a particular food. "

The research, funded by the Biotechnology and Biological Sciences Research Council (BBSRC) and published inCurrent Biology, also revealed that when the neuron was removed entirely from trained snails, they returned to eating sugar again.

Dr Ildiko Kemenes said: "This suggests that the neuron is necessary for the expression of the learned behaviour and for altering the response to sugar.

"However, we cannot rule out that the sugar-activated sensory pathway also undergoes some changes, so we don't make the assumption that this is all that's happening in the brain."

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Once bitten, twice shy: the neurology of why one bad curry could put us off for life - Newswise