Category Archives: Neurology

Overweight/obese levels of BMI at age 20, paired with history of infectious mononucleosis (IM) or high Epstein-Barr nuclear antigen 1 (EBNA-1) antibody levels, synergize in elevating the risk of multiple sclerosis (MS), and the effect strengthens with increasing antibody levels, according to study results published in Neurology: Neuroimmunology & Neuroinflammation. Results also indicated significant 3-way additive interactions between DRB1*15:01 allele, BMI at age 20 years, and each aspect of Epstein Barr virus (EBV) infection.

The study researchers sought to find out whether these MS risk factors had an additive interaction for the inflammatory disease, and to analyze 3-way interactions between BMI at age 20, EBV infection, and the human leukocyte antigen (HLA)-DRB1* 15:01 allele.

They used data from the Epidemiological Investigation of Multiple Sclerosis (EIMS) and Genes and Environment in Multiple Sclerosis (GEMS) studies, 2 Swedish population-based case-control studies on environmental and genetic risk factors for MS. In the former, newly diagnosed cases of MS were recruited from neurology clinics and matched with 2 randomly selected controls from the countrys national population register, frequency matched in 5-year age strata, sex, and residential area. GEMS presented prevalent cases of MS from the Swedish National MS Registry, each of whom was matched with 1 control in the same way as in EIMS.

The study researchers also included controls from the Epidemiological Investigation of Rheumatoid Arthritis, which was designed in the same manner and with a similar study population as EIMS. Participants provided blood samples for the genotyping and self-reported contraction of IM, body height, and weight.

The combination of two risk factors, overweight/obesity at age 20 years and a history of IM, synergistically increased the risk of MS 5-fold. In contrast, nonoverweight subjects with IM history had a 90% increased risk of MS and those with overweight/obesity at age 20 years (BMI I 25 kg/m2) without IM history had a 40% increased MS risk.

BMI at age 20 years and high EBNA-1 antibody levels, even without history of IM, had a similar interaction that increased with elevated EBNA-1 antibody levels.

2-way interactions were present between DRB1*15:01 and overweight/obesity at age 20 years, between DRB1*15:01 and each aspect of EBV infection, and between overweight/obesity at age 20 years and each aspect of EBV infection. DRB1*15:01, BMI at age 20 years, and each aspect of EBV infection (IM history and high EBNA-1 antibody levels, respectively) had significant 3-way interactions.

These findings held significant for both EIMS and GEMS when investigators restricted the analysis to subjects with complete data on HLA alleles and EBNA-1 antibody levels.

Limitations of the study included selection bias and recall bias in the studies and risk of misclassification when dichotomizing subjects into those with and without self-reported IM history.

The study researchers concluded, The obese state both induces a chronic immune-mediated inflammation and affects the cellular immune response to infections, which may contribute to explain our findings. They added that their data reinforce the importance of intervention efforts against childhood and adolescent obesity to reduce MS incidence.

Disclosure: Several authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors disclosures.

Reference

Hedstrm AK, Brenner N, Butt J, et al. Overweight/obesity in young adulthood interacts with aspects of EBV infection in MS etiology. Neurol Neuroimmunol Neuroinflamm. Published online December 15, 2020. doi:10.1212/NXI.0000000000000912

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Overweight/Obesity in Young Adulthood Linked to Increased Risk of MS - Neurology Advisor

1. In a largemulti-centerstudy of children with hemolytic uremic syndrome, those with any acute neurologic manifestation (ANM) had increased risk of mortality.

2. Brain infarction, brain hemorrhage, anoxic brain injury, and brain edema were independently associated with mortality.

Evidence Rating Level: 2 (Good)

Study Rundown:Hemolytic uremic syndrome (HUS) is a microangiopathic hemolytic anemia characterized by anemia, thrombocytopenia, and renal dysfunction. One of the most serious complications of HUS is neurologic injury, which can lead to devastating sequelae including death. Previously, only small studies examined acute neurologic manifestations (ANMs) of HUS, with widely varying conclusions. This study characterized ANMs and their association with in-hospital mortality in nearly 4,000 children with HUS using a database containing information from over 40 childrens hospitals in North America. Overall, ANMs occurred in 10.4% of patients. Mortality was significantly higher in patients with any ANM (13.9%) compared to those without an ANM (1.8%). Furthermore, mortality was higher in patients with 2 ANMs (17.6%) than in those with 1 ANM (11.9%). Researchers also examined risk of mortality with specific ANMs and specific combinations of ANMs. One important limitation of this study was the lack of differentiation between typical and atypical HUS, which are considered to be different disease processes. Overall, this robust analysis of data obtained from a large database provides valuable information in identifying which children with HUS are at risk for worse outcomes.

Click to read the study in Pediatrics

Relevant Reading: Neurological involvement in children with E. coli 0104:H4-induced hemolytic uremic syndrome

In-Depth [retrospective cohort]: Data was obtained from the Pediatric Health Information System database, which contains information from over 40 tertiary childrens hospitals in North America. Overall, 3915 children (52.5% female, 75.5% white, median age 3.8 years) with HUS were included in the study. The median age of patients with ANMs was 3.3 years. In addition to increased mortality in patients with ANMs, average length of stay was also longer in those with ANMs compared to those without (27.8 vs. 13.8 days, p<0.001). The three most common ANMs were encephalopathy (60% of all patients with ANMs), seizures (26.4%), and stroke (22.5%). Mortality varied between specific ANMs encephalopathy (4.3%), seizures (8.9%), meningitis (21.7%), stroke (22.2%), intracranial hemorrhage (40%), cerebral edema (25%), and anoxic brain injury (40%). Patients < 30 days old were at increased risk of mortality, as were those who required mechanical ventilation or ECMO. ANMs independently associated with mortality were brain infarction (OR 2.64, p=0.03), brain hemorrhage (OR 3.09, p=0.005), anoxic brain injury (OR 3.92, p=0.006), and brain edema (OR 4.81, p=0.002).

Image: PD

2020 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.

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Acute neurologic manifestations in children with hemolytic uremic syndrome linked to increased mortality - 2 Minute Medicine

BEER-SHEVA, Israel, Feb. 9, 2021 /PRNewswire/ -- Researchers at Ben-Gurion Universityof the Negev (BGU) have developed a new method for rapidly diagnosing brain blood vessel pathology that may lead to neurodegenerative diseases, such as Alzheimer's disease, as well as other neurological and psychiatric conditions, including epilepsy, traumatic brain injury and stroke. The novel method is based on analysis of EEG patterns using proprietary algorithms and was invented by Dr. Dan Milikovsky and Prof. Alon Friedman, MD-PhD, Departments of Physiology and Cell Biology, Cognitive and Brain Sciences, Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev.

The novel diagnostic method is based on findings from the lab of Prof. Friedman that patients with Alzheimer's disease and other brain conditions display nonconvulsive epileptic seizure-like activity that can be detected by EEG recordings. The study was published in the highly ranked Science Translational Medicine Journal [i]. This abnormal activity reflects pathological changes in dysfunction of the brain blood vessels, which contribute, according to recent studies, to the pathogenesis of various neurodegenerative and other neuro-psychiatric disorders.

"Research from our lab and others, shows that the pathological changes in the brain blood vessels, which are usually referred to as the blood-brain barrier (BBB), contribute to the formation of Alzheimer's disease and other brain disorders. Since dysfunction of the BBB is also a key component in the pathogenesis of epilepsy, we hypothesized that BBB dysfunction in Alzheimer's patients would also trigger abnormal brain activity that could be detected by EEG, an accessible and affordable tool used in the clinic, and serve as a diagnostic method for these conditions," explained Prof. Friedman. "Indeed, we find abnormal, epileptic-like EEG recordings in many patients with Alzheimer's disease as well as epilepsy, which reflect brain blood vessel pathology and can serve both for diagnosis as well as a therapeutic target."

The technology was successfully tested on animal models and dozens of patients and is now been validated on large databases of EEG records of thousands of patients.

"This new approach for diagnosing neurological conditions based on analysis of changes of blood vessels in the brain can be valuable for the early detection of Alzheimer's disease and other neurological conditions, at the stage when treatment can still slow down disease progression. The technology offers a biomarker for immediate results and allows for the continuous monitoring of the progression of the neurological condition and response to treatment," said Josh Peleg, CEO of BGN Technologies. "We are now seeking a potential industry partner for the further development of this promising method for a variety of applications, from monitoring of ICU patients, to patients after stroke and head injuries and for the diagnosis of vascular pathology in early Alzheimer's disease."

About BGN Technologies

BGN Technologiesis the technology transfer companyof Ben-Gurion University, the third largest university in Israel. BGN Technologies brings technological innovations from the lab to the market and fosters research collaborations and entrepreneurship among researchersand students. To date, BGNTechnologieshas established over 100 startup companiesin the fields of biotech, hi-tech, and cleantech, and has initiated leading technology hubs,incubators, and accelerators.Over the past decade, BGN Technologies has focused on creating long-term partnerships with multinational corporations such as Deutsche Telekom, Dell-EMC, PayPal, and Lockheed Martin, securing value and growth for Ben-Gurion University as well as the Negev region.For more information, visit the BGN Technologies website.

[i] Milikovsky1 et al. (Dec. 2019), Paroxysmal slow cortical activity in Alzheimer's disease and epilepsy is associated with blood-brain barrier dysfunction. Science Translational Medicine: Vol. 11, Issue 521, eaaw8954.

Media Contact:Tsipi HaitovskyGlobal Media LiaisonBGN TechnologiesTel: +972-52-598-9892E-mail: [emailprotected]

SOURCE BGN Technologies

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Ben-Gurion University Researchers Introduce New Method for Diagnosing Neurological and Psychiatric Conditions - PRNewswire

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Anesthesia Masks Market: Rising Prevalence of Chronic Diseases and Neurological Disorders to Drive the Market - BioSpace

By The News staff| The Hutchinson News

Hutchinson Clinic announced the addition of two doctors to its roster of physicians Drs. Rizwan Hassan and Jessica Poteet.

Dr. Hassan comes to Hutchinson from Wichita, where he has more than 40 years of experience diagnosing and treating neurological conditions ranging from epilepsy, Parkinsons, dementia, multiple sclerosis, and stroke.

Most recently, he worked with the Neurology Associates of Kansas to conduct neurological testing and procedures.

In neurology, a specialty that affects all systems of the body, Dr. Hassan approaches patient care with a long-term relationship in mind, acting with compassion and collaborating with other specialists to determine his patients best care path forward.

Dr. Poteet, a graduate of Oklahoma State University College of Osteopathic Medicine, comes to Hutchinson from Utica Park Clinic of Owasso, Oklahoma. She also served as Chief of Surgery for Bailey Medical Center and previously as Chief Resident for St. Anthony Hospital.

Dr. Poteet aims to be a health partner to the women she serves.

She takes a creative and personalized approach to care, assessing the wants and needs of her patients to find solutions that they are comfortable with and to support them during big life moments.

Hutchinson Clinic is expanding access to high-quality care in 2021 with the addition of these two new physicians to our leading clinical team, said Mike Heck, CEO of Hutchinson Clinic.

Dr. Rizwan Hassan will offer new expertise to our patients and play a vital role in building our neurology services," he said. "Our OB/GYN team continues to grow, serving mothers, women, and families in our community, with the addition of Dr. Jessica Poteet. They are both excellent providers who share in our mission and passion for serving the community.

Both are accepting new patients. Call (620) 669-2500 or visit HutchClinic.com to schedule a visit.

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Hutch Clinic welcomes new physicians in Neurology and OB/GYN - The Hutchinson News

Raquel S. Mateus, PharmD Candidate

PediatricsInvestigators highlighted 4 emergency conditions in the pediatric population: acute ischemic stroke (AIS), intracranial hemorrhage, fever and altered mental status (AMS), and seizures.1

Pediatric stroke is rare, and children younger than 5 years are the most likely to experience AIS. Children with AIS can also present with AMS, fever, or seizure. The management of pediatric stroke requires administering weight-based tPA.1

In intracranial hemorrhage, many principles of adult care are the same in pediatric patients. However, guidelines are less clear about target blood pressure in the pediatric population. In cases of cerebral edema or impending herniation, administration of either mannitol or hypertonic saline are equally acceptable.1

When a pediatric patient presents with AMS, pharmacists and other health care providers should consider acute disseminated encephalomyelitis (ADEM) and antiN-methyl-D-aspartate receptor encephalitis (NMDAR). Both ADEM and anti-NMDAR encephalitis require early initiation of steroids and empiric treatment for bacterial and viral meningitis.

In pediatric patients, seizures can take many forms, such as neonatal seizures and nonconvulsive status epilepticus. Neonatal seizures can present with mouthing (touching hands and objects to the lips or placing them in the mouth), horizontal eye deviation, blinking, or single limb extension. First-line treatment is phenobarbital 20 mg/kg.1,2

Nonconvulsive status epilepticus is associated with higher mortality, longer pediatric ICU stays, and increased long-term disability. Treatment includes a trial of a short-acting antiepileptic medications and close observation.1

ElderlyThe researchers also focused on 4 neurologic conditions in the elderly: AIS, AMS, Parkinson disease, and meningitis.1

Some atypical AIS presentations in the elderly include dizziness, falls, headache, nausea, vomiting, difficulty walking, seizure, and urinary incontinence. Advanced age alone is not a contraindication for IV tPA within 3 hours. Around 25% of older adults in the ED have some form of AMS. The Delirium Triage Screen is a valid tool to diagnose delirium, another form of cognitive impairment.1

Parkinson disease is a neurodegenerative disorder affecting 1% of the population above the age of 60 years. Acute worsening in Parkinson disease is usually due to a medication change, infection, or missed subdural hemorrhage.1

In bacterial meningitis, the elderly present with atypical symptoms and are less likely to have a fever, neck stiffness, rash, or leukocytosis. Empiric antibiotics should include vancomycin and a third-generation cephalosporin.1

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Study Examines Neurologic Emergencies at the Extremes of Age - Pharmacy Times