Category Archives: Neurology

A neurologist said theres another long-lasting symptom of COVID-19: severe headaches.

Dr. Jaclyn Duvall said post-viral headaches are nothing new, but whats different about COVID is how long the headaches last and how intense they can be. Dr. Duvall said without treatment, these headaches can be crippling.

"This can be completely life-changing," Duvall said.

Amber Ostasik is one of Dr. Duvall's patients at Hillcrest's Utica Park Clinic. She suffered severe headaches for months after her COVID-19 diagnosis.

"It was very debilitating," Ostasik said. "I was in and out of urgent care because the pain would get so bad that I didn't know what to do."

Ostasik said she was diagnosed with COVID-19 last June and after a few weeks of recovery thought she was in the clear, but the headaches came back.

"When they came back, they came back with a vengeance. Headaches, that doesnt sum up what I was having. I was having head pain. I mean I couldnt see straight the pain was so bad.By the time I saw Dr. Duvall I was in a desperate place," Ostasik said.

Dr. Duvall said the majority of people with the coronavirus won't experience such serious symptoms, but a growing number of people aren't so fortunate.

"I'd say a vast majority of individuals are actually improving within the first few weeks after recovery, but we are seeing a number of patients that are having these lingering effects, even in Amber's case up to 100 days after experiencing COVID," Dr. Duvall said.

Ostasik recovered after specialized treatment but said when she was first diagnosed with COVID-19, she never expected such severe symptoms to last so long.

"I'm in my mid-thirties, I run marathons, I'll be fine. If I get it, I'll get over it within two weeks," Ostasik thought. "I think it was really eye-opening not just for me, but for everyone around me. This could be potentially life-changing."

Dr. Duvall said if your symptoms also linger well after a COVID diagnosis, you should consider going to a specialist for treatment.

Excerpt from:
Neurologist Says Severe Headaches Can Be Long-Lasting COVID-19 Symptom - News On 6

When a patient complains of forgetfulness, a neurologist might not know immediately whether it results from normal aging, reduced blood flow to the brainor, more ominously, Alzheimers disease. For much of the past century, a definitive Alzheimers diagnosis could only be made during an autopsy. Brain imaging and spinal fluid tests now make it possible to spot the disease in patients even before the initial symptoms appear. But these invasive tests are expensive and generally limited to research settings that are not part of routine care for the millions of people suffering from the most common neurodegenerative disorder.

An era in which an Alzheimers diagnosis can begin in a doctors office is now arriving. Advances in technologies to detect early signs of disease from a blood sample are helping doctors to identify the memory-robbing disorder more accurately and to screen participants more quickly for trials of potential treatments for the more than five million people in the U.S. afflicted with Alzheimers. (Estimates predict that, by 2030, there will be 76 million people worldwide who will receive a diagnosis of Alzheimers or other dementias.)

Last fall, a blood test developed by C2N Diagnostics in St. Louis, Mo., became available to most of the U.S. as a routine lab testregulated under the CMS Clinical Laboratory Improvement Amendments (CLIA) program. It has also received a CE mark as a diagnostic medical device in the European Unionindicating it has met safety, health and environmental protection standards for the region.

The development of a blood-based test for Alzheimers disease is just phenomenal, says Michelle Mielke, a neuroscientist and epidemiologist at the Mayo Clinic. The field has been thinking about this for a very long time. Its really been in the last couple of years that the possibility has come to fruition.

The C2N test, called PrecivityAD, uses an analytic technique known as mass spectrometry to detect specific types of beta-amyloid, a protein fragment that is a pathological hallmark of disease. Beta-amyloid proteins accumulate and form plaques visible on brain scans two decades before a patient notices memory problems. As plaques build up in the brain, levels of beta-amyloid decline in the surrounding fluid. Such changes can be measured in spinal fluid samplesand now in blood, where beta-amyloid concentrations are significantly lower. PrecivityAD is the first blood test for Alzheimers to be cleared for widespread use and one of a new generation of such assays that could enable early detection of the leading neurodegenerative diseaseperhaps decades before the onset of the first symptoms.

PrecivityAD is meant for 60- to 91-year-olds with early signs of cognitive impairment. The prescribing physician ships patient blood samples for analysis at C2Ns lab and receives results within 10 business days. The resultsa probability score that reflects the likelihood of an amyloid-positive brain scanare calculated using a proprietary algorithm that incorporates the persons age with measurements of beta-amyloid and a protein called apolipoprotein E that is known to influence Alzheimers disease risk.

Rather than serving as a stand-alone tool, the results are meant to enhance the accuracy of a clinical diagnosis by distinguishing Alzheimers dementia from memory loss caused by other conditions. The test costs $1,250 and is not currently covered by insurance, though a financial assistance program can bring out-of-pocket costs down to between $25 and $400 for eligible patients, says C2Ns chief executive Joel Braunstein.

By comparison, beta-amyloid tests using positron-emission tomography (PET) brain imaging typically cost around $5,000 and are typically not covered by insurance, and those that sample cerebrospinal fluid (CSF) usually cost from $800 to $1,000. Compared with these more invasive and burdensome procedures, the ease and lower cost of blood tests open up many exciting possibilities for clinical use and therapeutic development, says Adam Boxer, a neurologist at the University of California, San Francisco. Blood tests can be collected from people repeatedly in remote locations or in their homes. No drugs have yet been approved that change the course of Alzheimers. But readily available early tests could improve treatment by letting patients take measures to stay healthy, affording them an opportunity to plan for an uncertain future and participate in clinical trials.

From a preventive standpoint, blood tests could help identify whos at risk, Mielke says. Testing could also be used to screen potential participants for experimental drugs. In some past trials of beta-amyloid-reducing treatments, 15 to 30 percent of patients who met clinical criteria for Alzheimers turned out not to have brain amyloid. Nowadays trials often require participants to show evidence of disease pathology through PET scans or CSF measures. Prescreening with a cheap blood test could halve the number of PET scans needed to enroll volunteers, according to a new study published on January 22 in the journal Brain.

This would lower the cost of trials, which means more potential treatments can be tested, and that increases the chances of finding a cure, says Elisabeth Thijssen, a researcher studying blood biomarkers for Alzheimers at Amsterdam University Medical Centers in the Netherlands. Blood tests would be particularly helpful in identifying patients for trials of potential drugs that could be most effective long before the first symptom of cognitive decline.

Looking for beta-amyloid is not the only option. Some researchers believe other disease markersfor example, certain forms of the protein taucould prove more promising when incorporated in blood tests for Alzheimers. Beta-amyloid levels start to drop very early in the disease process and then reach a plateau, whereas tau markers go up later and continue to rise. That observation suggests amyloid tests could work better for early detection while tau levels are more meaningful at later stages of the disease, when someone is on the verge of decline or already symptomatic, says Oskar Hansson, a neurologist at Lund University in Sweden. Last year Thijssen and Hansson published separate studies showing that tau blood tests could distinguish Alzheimers from other neurodegenerative diseases nearly as well as CSF measurements and PET scans. Quanterix, a company in Billerica, Mass., has developed an immunoassay that detects amyloid and tau in conjunction with other neurological markers and inflammatory proteins. So far these tests are not available outside of research settings.

We researchers are super enthusiastic about these tests, Thijssen says. Most studies have been conducted in extensively studied groups of patients in neurology clinics, however. Now we have to make the step into the real world, she says. When a new patient comes in with memory complaints, is a blood test going to help physicians make a proper diagnosis?

Patients in other settings may have other ailments that could affect the accuracy of assays. Some medical conditions can influence the levels of blood proteins, possibly skewing test results. If somebody has chronic kidney disease, that can affect the clearance of proteins, Mielke says. Individuals with a high body mass index tend to have higher blood volume, so that could reduce protein levels.

UCSF neurologist Gil Rabinovici agrees that all these markers need to be validated in more diverse and generalizable cohorts. He is helping to lead a new study that will test blood assays against amyloid PET scans in 5,000 patients recruited at 350 clinical siteswith an emphasis on patients from Black and Latinx populations, which are historically underrepresented in dementia research.

See more here:
Detecting Alzheimer's Gets Easier with a Simple Blood Test - Scientific American

An in-home telemedicine model implemented at the Comprehensive Epilepsy Center of Childrens Mercy Kansas City showed high rates of satisfaction among advanced practice registered nurses (APRNs) and other clinicians, according to preliminary data presented by Erin Fecske, DNP, APRN, CNRN, CPNP-PC, FAES, at AES2020.1

The telehealth model was initiated in March 2020 in response to the coronavirus 19 disease (COVID-19) pandemic. At 3 months after implementation of the intervention, Dr Fecske and colleagues sent surveys to 36 clinicians at the epilepsy center to assess satisfaction with the model. A total of 24 providers responded, including 12 attending physicians, 11 advanced practice registered nurses (APRNs), and 1 resident physician.

Nearly all respondents (96%) said that in-home telehealth provided them with an adequate evaluation of patients with epilepsy. Of the 2901 patients with epilepsy seen via in-home telehealth visits within the 3-month period, 66 patients (2%) required an in-person visit within 2 weeks of the virtual visit.

Clinicians at the Comprehensive Epilepsy Center are using telehealth in various ways and settings for epilepsy visits. The first modality is in-home telehealth for new or follow-up visits, Dr Fecske said in an interview. These visits are unfacilitated, meaning that a clinician is not at the patient location to assist with the visit. Although in-home follow-up visits typically do not involve use of ancillary devices (eg, stethoscope, handheld camera), new patient visits conducted in-home are somewhat limited as they require camera use by families to allow for a visual examination.

The second modality is facilitated telehealth at an offsite location with telehealth-trained registered nurses and ancillary equipment assisting the patient, said Dr Fecske. These visits are utilized by new and follow-up patients as we would utilize a traditional clinic visit since the examination is not limited, she noted.

Alternatively, facilitated visits may occur at one of our regional primary care partners offices, Dr Fecske explained. The telemedicine visit [using Microsoft Teams] occurs in the patients primary care office. This facilitated visit includes a staff member from the primary care office, which we hope will improve engagement of the primary care provider in the care of patients with epilepsy.

In all of these modalities, we can engage with our consult services such as dietitians and social workers to provide the same support we would provide for a traditional in-person visit, Dr Fecske said. In situations where I would have a joint visit with an epileptologist [such as presurgical planning], the epileptologist can attend the telehealth appointment with the epilepsy APRN.

We have an APRN run a multidisciplinary ketogenic diet screening clinic that preCOVID required a 2+ hour in-person clinic visit from families, Dr Fecske said. With the use of telemedicine, we created videos for families to watch ahead of time and the actual time in clinic is reduced to about an hour during an in-home telemedicine visit. During that time we are able to have an occupational therapist, dietitian, social worker, chef educator, pharmacist, and epilepsy APRN meet with the family and complete appropriate assessments for ketogenic diet readiness.

Other members of the care team also can be added at the request of the patient, Dr Fecske said. Ive had children in group home settings, and we are able to include care team members as identified by the family, which has been very beneficial.

The decision to use telehealth over an in-person visit is at the discretion of the provider, who selects the modality when placing an order for follow-up. In-person visits may be preferred for infants or patients with epileptic spasms, Dr Fecske explained. Additionally, most new patients seen via in-home telehealth for their first visit will be seen in-person for their next visit to allow for a complete neurologic examination to be conducted, she said.

Before the COVID-19 pandemic, telehealth at the epilepsy center was limited to facilitated visits where patients presented to off-site locations and ancillary devices were required. At that time, only a small number of providers were credentialed for telemedicine, according to Dr Fecske.

With the original stay-at-home orders for our states we had to pivot to a more inclusive telemedicine model quickly, Dr Fecske explained. Now all of our neurology providers are credentialed to provide telemedicine. As we work to provide more in-person visits, we also are monitoring spacing in the clinic to ensure that we can follow Centers for Disease Control and Prevention recommendations. Therefore, weve continued to utilize our telemedicine offerings to ensure that patients continue to be seen regularly and monitored appropriately.

Technology limitations were one of the most commonly cited issues by the survey respondents. Families may not have a camera with a high enough resolution, may have poor internet connectivity or no internet access, or may have difficulties using video applications, Dr. Fecske noted. Additionally, while some caregivers may be able to assist in obtaining portions of the examination, other components such as reflexes are difficult to obtain.

Thus, although we may consider telemedicine a great way to improve access, we also need to consider how it can be another barrier to access for our patients and families, Dr Fecske said.

One of the biggest benefits of shifting to this telemedicine model is that it allowed us to continue to provide care to patients in a safe manner during an unusual situation, Dr Fecske said. I have patients that continue to request in-home visits as they feel that is the safest option for them at this time. In addition, epilepsy involves so much history taking that much of our visits are spent talking to families and patients and getting accurate descriptions, all of which we can accomplish during an in-home telemedicine model.

Additionally, telehealth for epilepsy may reduce the number of missed work hours for adult patients and parents as well as missed school time for children with epilepsy, Dr Feckse noted. She advised clinicians who practice telehealth for epilepsy visits to recognize what aspects of care they are and are not comfortable using the technology for.

If you need an in-person visit to get a better assessment, advocate for what you feel is going to be safest for your patient, Dr Feckse said.

1. Fecske E, Le Pichon JB, Wellman C, Waller M, Abdelmoity A. Transition to telemedicine: being nimble during COVID-19. Poster presented at: AES2020; December 4-8, 2020.

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In-Home Telehealth Model for Epilepsy Is Highly Rated by NPs and MDs - Clinical Advisor

One of Arizonas premier brain injury doctors will travel to Tampa Bay to bring his expertise to the sports worlds biggest stage.

TAMPA, Fla. Dr. Javier Cardenas has worked on the sidelines for three Super Bowls. Hes the director of Concussion and Brain Injury at the Barrow Neurological Institute.

During Sundays game between the Tampa Bay Buccaneers and the Kansas City Chiefs in Florida, Cardenas will serve as a backup concussion doctor.

Cardenas said players are generally cooperative when undergoing concussion protocols, even if it means being pulled from the game.

There is almost never push and pull, Cardenas said. Of course, they want to play, but this process is a collaboration between the NFL and players association.

Concussion protocols were established during negotiations between the players union and the NFL. Over the years, Cardenas says the culture has changed and players understand the dangers of concussions.

When Kansas City Chiefs star quarterback Patrick Mahomes showed signs of concussion in a playoff game three weeks ago, he dutifully exited the field. Cardenas says thats a sign of where the NFL is at today.

Cardenas reminds young athletes that players have even been pulled from the Super Bowl if they show signs of brain injury.

Whether they (high school athletes) say we have a big rivalry game coming up or the state championships, what I remind them is that even in the biggest game of the world, we are removing athletes from play, Cardenas said.

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Valley neurologist will work at Super Bowl for the third time - 12news.com KPNX

Although many people get coronavirus and may not even know it, others can experience mild symptomsand then get worse. Potentially for life. They are called Long Haulers and they have Long COVID. "Three quarters of patients hospitalized with COVID-19 had at least one ongoing symptom 6 months after their acute illness," say the authors of a new presentation on the CDC website, written by clinicians on the front lines. And furthermore, many who weren't hospitalized can remain ill too. Keep reading to discover the most common symptoms of what's being called Long COVIDand to ensure your health and the health of others, don't miss these Sure Signs You've Already Had Coronavirus.

"Persons with long COVID often present reporting persistent severe fatigue," says Alfonso C Hernandez-Romieu, MD, MPH, LCDR, U.S. Public Health Service, Late Sequelae Unit, Clinical Team, COVID-19 Response, Centers for Disease Control and Prevention, in the presentation. "The most comprehensive longitudinal data is from a recently published Chinese cohort. Among 1,733 patients, 3/4 of patients hospitalized with COVID-19 have at least one ongoing symptom six months after their acute illness, with 63% endorsing fatigue and muscle weakness."

Brain fog is "defined as mild subjective cognitive impairment," says Dr. Hernandez-Romieu. Dr. Anthony Fauci, the chief medical advisor to the President and the director of the National Institute of Allergy and Infectious Diseases, has called this an "inability to concentrate." You might also feel memory loss, confusion and a "foggy" feeling.

These can feel like a jackhammer and not stop. And unfortunately: "There aren't any specific treatments we have for post-COVID neurologic symptoms," Dr. Felicia Chow, MD, associate professor of neurology and medicine at the University of California, San Francisco, tells Neurology Today. "It's symptomatic management of the issues they're having, whether that's headache or dizziness or cognitive complaints."

26% of those in the study had difficulty sleeping. Insomnia, vivid dreams (or nightmares) and nighttime hallucinations have all been reported by long haulers. "The virus is capable of altering the delicate processes within our nervous system, in many cases in unpredictable ways, sometimes creating long-term symptoms," says the Atlantic. "Better appreciating the ties between immunity and the nervous system could be central to understanding COVID-19and to preventing it."

26% of those in the study had dyspnea. "Few sensations are as frightening as not being able to get enough air," reports the Mayo Clinic. "Shortness of breath known medically as dyspnea is often described as an intense tightening in the chest, air hunger, difficulty breathing, breathlessness or a feeling of suffocation."

23% in the study suffered anxiety or depression. "A lot of these patients have depression, anxiety or PTSD from their experience with COVID," said Dr. Allison P. Navis, MD, assistant professor in the division of neuro-infectious diseases at the Icahn School of Medicine at Mount Sinai in Neurology Today. "I try to address the mental health aspects, to let patients know it's okay if they're dealing with that." Dr. Ross Zafonte, DO, chair of the Harvard Medical School department of physical medicine and rehabilitation at Spaulding, told the journal: "Some of these patients can have an affective issue that could be making things worse. Depression or PTSD can have a real impact on their other symptoms. What I've noticed is that these post-COVID symptoms are really, really multi-factorial."

Actress Alyssa Milano is perhaps the most notable long hauler who lost her hair after contracting COVID. "Thought I'd show you what #Covid19 does to your hair," Milano captioned a video, of her hair loss. "Please take this seriously. #WearADamnMask #LongHauler."

As you likely know, COVID can cause one to lose their sense of taste or smell. For some patients, these senses never come back. According to Advisory Board: "Narly 25% of Covid-19 patients who reported losing their sense of smell said they did not regain their olfactory function even 60 days after they noticed it was gone, according to a large prospective study in the Journal of Internal Medicinea potentially pervasive loss that providers believe could affect patients' nutrition and mental health."

"As Chimre Smith clicked on the link to join the COVID-19 Slack support group, she could feel her body shaking. Not because of an internal buzzing sensation reported by some people struggling with the illness though she is certainly familiar with that," reported the Washington Post. "Smith, a 38-year-old Baltimore middle school teacher, fell ill in March with symptoms progressing rapidly from a sore throat to crushing fatigue to heart palpitations. Still dealing with symptoms several weeks in, she was confused and afraid but alive though that, it seemed, could change at any moment."

RELATED: Simple Ways to Avoid a Heart Attack, According to Doctors

"Many of the symptoms of the coronavirus mimic the typical symptoms of a viral infection or flu syndrome," says Dr. Stuart J. Fischer in OrthoInfo. "One of these symptoms may be muscle aches or myalgias. You may get pain in your arms, legs, or back that develops spontaneously with no injury. Typically, in a coronavirus infection, the pain is in muscles rather than in joints. But if you have an arthritic joint in your arm or leg, the virus may exaggerate the symptoms. The pain may be severe and limiting."

"Another important finding among patients attending the post-acute COVID clinic in France was that more than 1/4 developed new neurological signs and symptoms after their acute COVID-19 illness," says Dr. Hernandez-Romieu. "These included but were not limited to cognitive dysfunction, balanced disorders, paresthesia, and swallowing and speech disorders."

"SARS-CoV-2 infection can also lead to specific complications like stroke, Guillain-Barre Syndrome, and multisystem Inflammatory disorder which can cause prolonged symptoms and disability," says Dr. Hernandez-Romieu.

RELATED: 7 Tips You Must Follow to Avoid COVID, Say Doctors

"Prolonged symptoms are common in patients with mild COVID-19 disease not requiring hospitalization," says Dr. Hernandez-Romieu. "In three studies that focused on people who were not hospitalized for COVID-19 in a post-acute COVID clinic in France, and telephone surveys of patients in the Faroe Islands in Switzerland, anywhere from 35% to 54% of patients had persistent symptoms after two to four months. Half to 3/4 of patients attending the post-acute COVID clinic in France endorsed new symptoms not initially present or symptoms that reappeared after initial resolution."

If you experience these symptoms, contact a medical professional immediately. There is no cure for Long COVID but specialists can potentially alleviate your symptoms with existing medications until there is one. Long COVID support groups like Body Politic can also be extremely useful. And to protect your life and the lives of others, don't visit any of these 35 Places You're Most Likely to Catch COVID.

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Sure Signs You've Already Had COVID, Say COVID Experts - Eat This, Not That

Long-term disease modifying therapies for patients with multiple sclerosis (MS) were effective at reducing relapse and disability accumulation, according to study results published in Neurology.

The predominant goal of MS treatments is the prevention of long-term disability accrual. Study researchers sought to determine whether immunotherapy could prevent long-term disability in patients with relapsing-remitting MS.

In this observational cohort study, researchers assessed patients (N=14,717) with MS who were eligible for class IV immunotherapy. They collected patient data from the MSBase registry.

71% of patients were women (mean age, 36 years; mean age at disease onset, 309 years) and had a median of 6 (interquartile range [IQR], 3.1-10) years of prospective follow-up data. Patients had a median of 4 (IQR, 2-6) relapses, and 69% were exposed to immunotherapies. A total of 1085 patients had at least 15 years of follow-up data (median years of prospective follow-up, 17 years; 95% CI, 15.6-18.8).

Patients who received continuous treatment were less likely to have a relapse event compared with those who were not continuously treated (annual relapse rate, 0.32 vs 0.46, respectively; hazard ratio [HR], 0.60; 95% CI, 0.43-0.82; P =.0016) and less likely to have a 12-month confirmed disability accumulation event (disability accumulation, 0.9 vs 1.5 events, respectively, at 15 years; HR, 0.56; 95% CI, 0.38-0.82; P =.0026).

Compared to untreated patients, fewer patients with continuous treatment reached an Expanded Disability Status Scale (EDSS) step 6 at 15 years (41% vs 13%, respectively; HR, 0.33; 95% CI, 0.19-0.59; P =.00019).

Study researchers did not observe significant difference in disability improvement between the treated and untreated patients (HR, 1.20; 95% CI, 0.96-1.50; P =.1). They also observed similar patterns, stratified by disease duration and age, between these two cohorts.

Limitations of this study include its observational design, the inability to assess delayed treatment effects, and the inability to generalize findings beyond patients with MS followed in academic centers.

These data indicated patients receiving long-term immunotherapy were at decreased risk for disease relapse and neurologic disability escalation. The study authors concluded that sustained, long-term immunotherapy from early stages of MS is advisable as a strategy to preserve patients neurological capacity over the long-term.

Disclosure: Multiple authors declared affiliations with the pharmaceutical industry. Please refer to the original article for a full list of disclosures.

Reference

Kalincik T, Diouf I, Sharmin S, et al. Effect of Disease Modifying Therapy on Disability in Relapsing-Remitting Multiple Sclerosis Over 15 Years. Neurology. Published online December 28, 2020. doi:10.1212/WNL.0000000000011242

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Long-Term Immunotherapy Linked to Reduced Relapse in Relapsing-Remitting MS - Neurology Advisor