Category Archives: Neurology

Article In Brief

Women neurologists have become more prominent in leadership at the AAN by serving on committeesfrom 14 percent in 1997 to 36 percent in 2017. And significantly, their academic achievement improved when first and last authorship in Neurology were analyzed.

The last two decades have ushered in a growing number of women in neurology. Still, representation in positions of leadership, publication, and award appointments has often been far from equitable. A Neurology study published online ahead of print on September 15 found some encouraging trends in the recognition of women from recent years (between 2007 and 2017), based on data from US-based AAN members.

However, there is a lot more work to be done.

Given the large inequity prior to 2007, it will likely take until 2047 for women to reach 50 percent of US neurologist members, study author Janis Miyasaki, MD, MEd, FRCPC, FAAN, director of the Parkinson and Movement Disorders Program at the University of Alberta in Edmonton, Canada, told Neurology Today.

Despite this, we found that women have become more prominent in leadership at the AAN by serving on committeesfrom 14 percent in 1997 to 36 percent in 2017. And significantly, their academic achievement improved when first and last authorship in Neurology were analyzed.

The analysis showed that, while in 1997 and 2007 US female AAN members were equally as likely as male members to be first author on papers in Neurology, by 2017, women were more likely to have first authorship than men (p <0.001). Further, the rate ratio of a woman being a last author in a Neurology publication was 0.38 in 1997, but by 2017, it had grown to 1.06.

At the medical student level, as each year achieves a greater proportion of women in neurology, women medical students can see themselves as belonging to neurology. Each intervention [to improve representation] has an effect on other measures that we looked at in an almost endless cycle, Dr. Miyasaki said.

When you read articles written by women, you imagine that you could be an investigator or scientist. When you see women at the podium, you believe you could be there some day. My personal experience with the AAN has been that it was progressive when other organizations or institutions were not.

For a long time, the argument has been that the pipeline will solve all problems of women's participation, Dr. Miyasaki continued. But if we wait passively for the pipeline to fix everything, women will not progress.

Recognizing this, she said, the AAN has made a concerted effort to champion women in neurology, and the analysis shows these labors are beginning to pay off.

When I first started as a volunteer with the AAN in 1999, I was often the only woman on a committee or work group. And I was often the only person who was not White. When I look around the room now, I see many more individuals from varied backgrounds. This can only help make our organization stronger because we better represent the demographic in medicine and, hopefully, we will come to represent the demographic in society as a whole, Dr. Miyasaki said.

Using membership data from the AAN, Dr. Miyasaki and colleagues reported that in 1997, US male AAN members outnumbered US women 4:1; in 2007 and 2017, the ratio of US women to men increased to 1:2.3 and 1:1.5, respectively. Additionally, American Medical Association and the Accreditation Council for Graduate Medical Education data showed that while female medical students were less likely than male medical students to enter neurology residency programs in 1997, in 2007 and 2017, there was no significant difference between these groups.

And although there were fewer women receiving AAN awards in absolute terms, when analyzed proportionately, women were more likely to receive recognition awards in all years studied (1997, p=0.008; 2007, p<0.001; 2017, p<0.001), according to the analysis.

Dr. Miyasaki suggested that some of these improvements may stem from the growing trend of equity, diversity, and inclusion officers in departments of neurology across the country, as well as the AAN's leadership programs for women and those underrepresented in medicine (UIM).

In the leadership cohorts, there is a concerted effort to ensure that each class is representative of our membership in sex (women and men) and UIM, and thus ensure that women are better represented, she added.

Still, it is important to remember that the AAN is just one influencer in neurology and neuroscience, Dr. Miyasaki said. Universities, research institutes, granting agencies, and editorial boards have significant influence on attracting women into neurology and also supporting their careers. Until we see women in the highest positions in significant numbers as chairs of neurology departments, ordare we dreamdeans of medical faculties or presidents of universities, women will still have challenges in achieving equity and inclusion in their local institutions, she said.

Dr. Miyasaki noted that many AAN members are in community practices and should be asking the same questions of their own organizations and leadership.

The Neurology paper had some notable limitations, including its inability to examine ethnicity, gender identity, geographic location, or other factors that may result in marginalization of neurologists; its use of a single journal (Neurology) for authorship data; and its inclusion of US-only AAN members.

In the future, we should also examine the intersectionality of gender, gender minorities and ethnicity for these same metrics. Research shows that participating in education on this topic is not enough, she added; we need to examine what steps can change behaviorfor example, hiring more diverse faculty, choosing more diverse trainees, collaborating with those outside your usual research group.

Responding to the findings, neurology leadersall of whom were involved in the AAN's Gender Disparity Task Force Reportsaid the results were encouraging and further evidence of the importance of continuing to fight for representation of women, as well as other minority groups.

The most important takeaway from this article is that an inclusive and proactive approach to recognizing and identifying talent among women can lead to real change within an organization, whether it is a professional society like the AAN or a university, medical school, or neurology practice, said Nassim Zecavati, MD, MPH, FAAN, associate professor of neurology at Virginia Commonwealth University and director of epilepsy at the Children's Hospital of Richmond.

There has undoubtedly been a concerted effort by the AAN to ensure the Academy's leaders and publications reflect the diversity of its members. The breadth and growth of the AAN's leadership programs reflect this. However, there is much work left to be done as women make up a dismal 13 percent of health care CEOs in the United States (according to the Oliver Wyman Report), Dr. Zecavati emphasized.

In senior positions in academia and large health systems, she added, we continue to see the underrepresentation of women. It is incumbent upon organizations to scrutinize their leaders and ask, do these leaders reflect the diversity of our organization, both in terms of gender and ethnicity? If the answer is no, then concrete steps need to be taken to promote gender equity and parity in the organization.

Lynne P. Taylor, MD, FAAN, Alexander M. Spence Endowed Chair in Neuro-Oncology and clinical professor of neurology and neurologic surgery and medicine at UW Medicine, remembers in 1992, after Patty Murray was elected as the first female Senator from Washington State. It made an impression on her then and inspired her determination to become involved in the AAN, but, she said, couldn't see her way into what appeared to be an old man's society.

Dr. Taylor wrote a letter addressed to the Academy declaring, This is the year of the woman in politics and I think you need more female representation in the AAN. Without any connections to the organization, she never expected to hear back, but less than a week later she received a phone call from Robert C. Griggs, MD, FAAN, who was then the chair of the AAN's Education Committee.

I couldn't believe he was calling me. He said, how would you like to be involved? With that phone call, he put me on a committee, and I have been very involved in the AAN ever since.

The lesson, perhaps, is that you can't be who you can't see. She continued: When academies and organizations put their annual meeting together or decide who will give their annual lecture, they should always ask the question, Is it equitable?

Since the publication of a number of articles showing disparities in pay based on gender within medicine, there has been concern with the equity of professional achievement for women in medicine, Elaine C. Jones, MD, FAAN, a member of the AAN's Board of Directors, said.

With neurology showing some of the largest disparities in pay based on gender and subsequent research suggesting lower rates for awards to female neurologists compared to males, AAN leadership focused on this area. One important point that came up was that transparency was vital to understanding the issues and dealing with any discrepancies.

Dr. Jones said she was pleased to see the investigation by Dr. Miyasaki and colleagues, as well as the results. While there are some limitations to the conclusions, as pointed out in the article, the overall findings suggest that as of 2017 and within the AAN's scope of leadership roles, awards and publications, women are equal or even slightly ahead of men in these areas.

She added that these findings, though encouraging, will need to be monitored over time to ensure continuity. I would like to see similar investigations of other underrepresented groups, including by race, geographic location, and age, although these are harder factors to determine with this type of data analysis.

In the future, it will also be important to look at how gender roles in society factor into women's professional achievement, she said. It is well documented that women tend to be the caregivers for the family and so some women may be unable to pursue professional advancement due to these other demands on their time. Is there a selection bias for the type of women that are able to achieve these goals?

Due to loss of school and extracurricular participation, the current pandemic has created a need for one parent to be home more than in the past, Dr. Jones said. Women have borne the brunt of some of this and may have had to forego work opportunities that could lead to future professional advancement. It is important to continue to monitor these areas for impact in the future.

There is also the possibility telecommunication will encourage and allow more women and underrepresented groups to become involved, Dr. Taylor said.

It will likely take years to fully understand the effects of the pandemic on the workforce Dr. Zecavati agreed, but it is a very concerning possibility that women and minorities will be disproportionately affected.

Link:
Study Finds Women Increasingly Represented in AAN... : Neurology Today - LWW Journals

In patients hospitalized with coronavirus disease 2019 (COVID-19), stroke was associated with those who were older and presented with stroke risk factors. They were found to have a slightly higher frequency of stroke compared with the estimation for the general population, according to study results published in the Journal of Stroke and Cerebrovascular Diseases.

Study researchers sought to investigate the frequency and clinical characteristics of patients with both COVID-19 and stroke. This analysis was a systematic review of observational studies, case series, and case reports that disclosed the incidence of ischemic or hemorrhagic stroke in patients with COVID-19. In total, 10 retrospective cohort studies, 10 case reports, and 6 case series were included in the final meta-analysis. A pooled cohort of 183 patients with both COVID-19 and stroke were assessed.

Among the 6368 hospitalized patients with COVID-19, the reported frequency of stroke was 1.1% (95% CI, 95% CI, 0.6-1.6; I2=62.9%). The mean age of the study cohort was 66.6 years (95% CI, 58.4-74.9; I2=95.2%), and over half of the patients were men (65.6%). Comorbidities included hypertension (69.4%), dyslipidemia (44.4%), diabetes (43.5%), acute coronary syndrome/coronary artery disease (26.9%), atrial fibrillation (23.1%), prior stroke/transient ischemic attack (10.4%), and malignancy (14.8%).

In patients who had data describing their stroke type, approximately 96.6% had ischemic stroke. The mean number of days from the onset of COVID-19 symptoms to stroke was 8 days (95% CI, 4.1-11.9; I2=93.1%; I2=93.1%; P <.001). The mean D-dimer was 3.3 g/mL (95%CI, 1.7-4.9; I2=86.3%), and the mean C-reactive protein level was 127.8 mg/L (95% CI, 100.9-154.6; I2=0%).

In 50.7% of patients, the etiology of stroke was cryptogenic (95% CI, 31.0-70.4; I2=64.1%). Among 100 patients, the case fatality rate was 44.2% (95% CI, 27.9-60.5; I2=66.7%).

Limitations of this study included the small sample size, potential publication bias in the included case reports and series, and the presence of considerable heterogeneity in the pooled patient population.

The study researchers concluded that additional studies could be helpful to decipher the pathophysiology and prognosis of stroke in COVID-19 to achieve the most effective care for this population to decrease mortality.

Reference

Yamakawa M, Kuno T, Mikami T, Takagi H, Gronseth G. Clinical characteristics of stroke with COVID-19: A systematic review and meta-analysis. J Stroke Cerebrovasc Dis. 2020;29(12):105288. doi:10.1016/j.jstrokecerebrovasdis.2020.105288

Originally posted here:
Stroke Incidence Slightly Higher in Hospitalized Patients With COVID-19 - Neurology Advisor

Executive summary

The World Health Organization (WHO) has identified mental health as an integral component of the COVID-19 response. Its rapid assessment of service delivery for mental, neurological and substance use (MNS) disorders during the COVID-19 pandemic, on which this report is based, is the first attempt to measure the impact of the pandemic on such services at a global level. The data were collected through a web-based survey completed by mental health focal points at ministries of health between June and August 2020. The questionnaire covered the existence and funding of mental health and psychosocial support (MHPSS) plans, the presence and composition of MHPSS coordination platforms, the degree of continuation and causes of disruption of different MNS services, the approaches used to overcome these disruptions, and surveillance mechanisms and research on MNS data.

In total, 130 (67%) WHO Member States, across all WHO regions, submitted answers to the survey. Data were disaggregated by region, income group and stage of transmission of COVID-19.

The vast majority, 116 or 89% of responding countries, reported that MHPSS response is part of their national COVID-19 response plans. However, only 17% of these countries have ensured full additional funding for MHPSS covering all activities.

Two-thirds (65%) of responding countries have a multisectoral MHPSS coordination platform for COVID-19 response, and more than 65% of these countries include the ministries of health, social/family affairs and education and also nongovernmental organizations as part of these platforms.

Almost half (51%) of responding countries reported that ensuring the continuity of all MNS services was included in the list of essential health services in their national COVID-19 response plan, while 40% of countries reported the inclusion of some MNS services in the list of essential health services in their national response plan.

To understand government policies on access to a range of MNS services, the status of closure of existing services was checked across different categories and settings. A total of 10 types of services for MNS disorders were included, such as inpatient and outpatient services at mental hospitals; outpatient services, inpatient psychiatric and neurological units as well as treatment of substance use disorders at general hospitals; and services for MNS disorders at primary health care, residential, home and day care services at community level. No country reported a full closure of all services; but in only 7% of responding countries were all services fully open, with 93% of countries reported disruptions in one or more of their services for MNS disorders.

There were differences in the types of service affected by closure, with outpatient services in mental and general hospitals as well as community-based services predominantly more affected. For example, community-based services were more impacted compared with inpatient facilities, with full or partial closure in more than 40% of countries and home care and day care services reaching levels of full or partial closure in 6070% of countries.

Countries were also asked to report on disruption (complete or partial) of delivery of specific MNS interventions. For the purpose of the survey, complete disruption was defined as more than 50% of users not served as usual, and partial disruption as between 5% and 50% of users not served as usual.One-third (33%) of responding countries reported complete or partial disruption across at least 75% of specific MNS-related interventions/services. This level of disruption was the highest within countries in the community transmission stage of COVID-19 (44%).

An important finding is that some life-saving emergency and essential MNS services were reported as being disrupted; 35% of countries reported some disruption of management of emergency MNS manifestations (including status epilepticus, delirium and severe substance withdrawal syndromes) and 30% reported disruption in supply of medications for people with MNS disorders.

Prevention and promotion mental health services and programmes were most severely affected. Around three-quarters of school mental health or workplace mental health services were wholly or partially disrupted. Approximately only 30% of mental health services for children and adolescents or for older adults were available with no disruption, and fewer than 40% of antenatal or postnatal mental health services were not disrupted. Almost 60% of all psychotherapy and counselling services were reported as partially disrupted. Overdose prevention and management programmes and critical harm reduction services were disrupted in more than 50% of countries.

The main causes of disruption were identified as a decrease in outpatient volume due to patients not presenting, travel restrictions hindering access to health facilities for patients and a decrease in inpatient volume due to cancellation of elective care.

Community-based services and mental health prevention and promotion programmes, already limited in availability, are reported to be disrupted at a time when society needs them the most due to the adverse mental health impacts COVID-19.

Countries have responded to the disruption of MNS services in multiple ways. Some 70% of countries have responded by using telemedicine/teletherapy to replace in-person consultations (this included use of any remote contact, such as telephone or video conferencing). Other measures that were reported include helplines for MHPSS (68%) and specific measures for infection prevention and control in mental health services (65%). Training in basic psychosocial skills for health care providers working in COVID-19 treatment centres was the most common approach in low-income countries (60%). Generally speaking, however, interventions such as task sharing through building the capacity of general health workers seem to be underutilized in many countries (38%).

Slightly more than half of responding countries (53%) were reported to be collecting data on MNS disorders or manifestations in people with COVID-19, and two-thirds (66%) of countries reported ongoing or planned studies related to the impact of COVID-19 on mental health. A gap was identified in the areas of substance use and neurology research related to the pandemic.

This report provides key insights into the extent of disruption of MNS services and measures being adopted in response. Certain limitations should be kept in mind when examining the results of this rapid assessment; these include the limitations associated with self-reported data, particularly concerning judgements often being made by a single focal point.

The survey highlights the need to strengthen the monitoring of changes in service availability, delivery and utilization at country level, and to establish informed decision making on required adaptations and strategies for MNS services during the pandemic. WHO has published Maintaining essential health services: operational guidance for the COVID-19 context (1) which should be considered when making specific adaptations and considerations for safe delivery and restoration of MNS services, including emergency acute care and outpatient care guidance.

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The impact of COVID-19 on mental, neurological and substance use services: results of a rapid assessment - World - ReliefWeb

The ability to create and respond to music is said to be one of the key evolutionary developments made by humankind. Humans found meaning in music long before finding meaning in words. This is the reason why understanding the human brains connection with music has been an area of interest for scientists for centuries now. Many studies have shown that getting musical training can hone many cognitive skills and functions.

A study published in 2009 in the Journal of Neuroscience indicated that just 15 months of musical training in early childhood can improve musically relevant motor and auditory skills thanks to training-induced structural changes in the brain. Another study in BJPsych International in 2017 shows that the way music stimulates the brain can be used as a non-invasive psychotherapeutic method to treat neurological disorders like autism spectrum disorder, Alzheimers disease and Parkinsons disease. This study also suggests that music therapy can aid children with epilepsy.

Music for attention and memory

A new study published in Frontiers in Neuroscience has found new evidence to support this beneficial link between music and the human brain. The Chile-based researchers behind this study have discovered that children who are trained in music, especially those who learn to play an instrument, not only have better memory and concentration levels but also the parts of their brain related to attention, focus control and auditory encoding are more activated. This brain activation enables them to be better readers, have higher resilience towards adversity, greater creativity and therefore have a better quality of life.

The study included 40 healthy, right-handed, Spanish-speaking children aged 10-13 years, all of whom had normal hearing and normal or correct-to-normal (meaning they wear glasses or contact lenses) vision. Twenty of these children were musically trained members of youth orchestras in Santiago, Chile, with at least two years of instrumental training. These participants practiced their instruments (ranging from flutes and clarinets to violins and cellos) at least two hours per week, had orchestra rehearsals at least once a week and had started their musical training around the age of nine years.

The other 20 participants of the study were recruited from Santiagos public schools and had no musical training beyond what was given in their school. Unlike the musically-trained group, these children were unable to read or write musical scores. The attention and working memory of all participants was tested by the researchers using something called a bimodal (auditory/visual) attention and working memory (WM) task. During these tasks, the participants were exposed to visual and auditory stimuli and their brain activity was measured using functional magnetic resonance imaging (fMRI).

The study found that there were two mechanisms that contributed to the marked improvements in attention and memory of the musically trained participants. First, these children had a higher activation level of the fronto-parietal control network of the brain which is linked to attention, focus and concentration mechanisms. Second, these kids also had higher activation of two other parts of the brain - left inferior frontal gyrus (IFG) and left supramarginal gyrus (SMG) - which are linked with the phonological loop. The phonological loop is the component of working memory that keeps auditory information active in the consciousness, thereby helping memory recall and problem-solving abilities.

The study found that while these parts of the brain were highly activated among musically-trained participants, the same did not occur with the other children. The researchers, therefore, recommend musical training for all children to improve cognitive abilities like attention and memory. Moreover, the researchers insist that such training would not only help children develop their minds better but also bring them joy by being able to learn the universal language of music.

For more information, read our article on Tips to improve brain power.

Health articles in Firstpost are written by myUpchar.com, Indias first and biggest resource for verified medical information. At myUpchar, researchers and journalists work with doctors to bring you information on all things health.

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Musical training in childhood likely to improve memo.. aid treatment of neurological disorders, find studies - Firstpost

Article In Brief

A brain-computer interface (BCI), developed by a company tied with Elon Musk, offers an innovative new technology to move the field forward. But independent experts said some of the claims about what that technology can potentially do are somewhat hyperbolic at this stage. Other efforts around BCI are also featured.

It's going to blow your mind, said Elon Musk, the billionaire founder and CEO of Tesla, SpaceX and Neuralink. Speaking via a webcast on August 28, Musk introduced the latest developments, or at least made the latest claims, regarding Neuralink's brain-computer interface (BCI), a computer-based system that measures and analyzes brain activity and then converts signals into commands that are relayed to output devices that carry out the desired action.

The US Food and Drug Administration (FDA), he announced, had given the company a Breakthrough Devices Designation, and good progress, he said, was being made toward clinical trials.

As evidence of that progress, Musk presented what he called the Little Pigs demo. Three pigs in the webcast looked equally healthy, but one of them had been implanted with a device that was wirelessly transmitting neural spikes from the snout area of its brain as it rooted around in a pen.

There's a lot of function that this device could do related to monitoring your health and warning you about a possible heart attack or stroke, and convenience features like playing music, Musk said. It's sort of like if your phone went in your brain.

He predicted that, one day, you will be able to save and replay memories...Over time we could actually give someone super vision. You could have ultraviolet or infrared, or seeing radar, and actually have superhuman vision.

Alas, none of those capabilities has ever been demonstrated by Musk's company or, for that matter, by any scientist or company. Neurologists and neuroscientists who have been laboring in the field for over a decade seek not to endow healthy humans with superpowers, but to help people with neurodegenerative diseases, strokes or traumatic injuries to regain speech and motor functions. Despite that disconnect, however, leaders in the field told Neurology Today that they are impressed by the legitimate progress Neuralink appears to have made.

The company's implantable device, they say, is doing things that none of their own devices have yet achieved: It communicates to a nearby computer wirelessly, rather than through wires; its low-powered battery, also recharges wirelessly, lasts up to a day; it bristles with over a thousand electrodes, compared to a few hundred in traditional arrays; and rather than attaching those electrodes to inflexible shanks, the Neuralink device uses flexible threads so delicate they are implanted by a robotic sewing machine.

If indeed they have made a device that can detect a thousand channels with good fidelity, and it can scan through this wireless technology, that is an important development, said Karunesh Ganguly, MD, PhD, associate professor of neurology at the University of California, San Francisco. At some point, you want to see it peer reviewed to know that what they're identifying as a neuron is actually a neuron. But they do seem to be pushing the technology ahead.

More evidence of progress in the BCI field came with a September 7 report by Dr. Ganguly's group in Nature Biotechnology. Unlike other approaches for invasive BCIs, his plug and play system based on electrocorticography (ECoG) has permitted an individual with tetraplegia to maintain control of a computer cursor without daily recalibration and retraining.

While he and other scientists in the BCI field expressed some skepticism about some of the claims made by Neurolink and Musk, they told Neurology Today they appreciate the interest that Neuralink is bringing to the field.

It will be really important, as these technologies become available, hopefully over the next few years, for neurologists to become familiar with how BCI can help the patients they see in their daily practice, said Leigh Hochberg, MD, PhD, FAAN, professor of engineering at Brown University, senior lecturer in neurology at Harvard Medical School, and director of the Center for Neurotechnology and Neurorecovery at Massachusetts General Hospital.

As a neurologist, I am completely focused on developing and testing technology that will help patients I see who have paralyzing disorders to maintain or regain their ability to move and speak.

Companies like Neuralink, he said, are essential to achieving that goal.

At the end of the day, neither universities nor academic medical centers make the final marketed and supported medical devices that become available to patients outside of clinical trials, Dr. Hochberg said. That is always done by a company. The engagement of companies in this field will ultimately benefit our patients.

Although Neuralink has not published a description of its technology in peer-reviewed scientific literature, and neither Musk nor any of the scientists working for him responded to requests for interviews, some detailed descriptions have appeared on the preprint server bioRxiv.

In March of 2019, Philip Sabes, PhD, of the University of California, San Francisco (and a founding team leader at Neuralink) was the lead author of a paper describing the sewing machine his group had developed with funding by the Defense Advanced Research Projects Agency (DARPA).

The fixed, rigid metal arrays used since the 1950s to penetrate the brain, the paper noted, disturbs the vasculature and attracts immune cells. Thinner, more flexible probes, however, would not be stiff enough to insert into the brain directly. Dr. Sabes' solution was to design a system that works like a sewing machine, with stiff needle-like injectors that implant polymer probes with the aid of a neurosurgical robot.

Each of the system's 96 polymer threads, the paper stated, holds 32 electrodes, for a total of 3,072 electrodes. We developed miniaturized custom electronics that allow us to stream full broadband electrophysiology data simultaneously from all these electrodes. We packaged this system for long-term implantation and developed custom online spike detection software that can detect action potentials with low latency.

Five months later, in August of 2019, Musk was listed as the first author of another preprint on bioRxiv that described Sabes' sewing machine as part of Neuralink's BCI platform. We have built arrays of small and flexible electrode threads, Musk's paper stated, with as many as 3,072 electrodes per array distributed across 96 threads.

As described by Musk in his webcast in August, implantation of the company's device will require removal of what he called a coin-sized piece of skull by its robot. Then the device replaces the portion of skull that we removed.

Technological advances already made and anticipated from the Neuralink effort are remarkable and will serve the neuroengineering community well, Lee E. Miller, PhD, Distinguished Professor of Neuroscience at the Feinberg School of Medicine of Northwestern University, said. This scale of private investment of financial and intellectual effort is unprecedented in our field. He added, however, that the company needs to demonstrate that its device is doing what it claims to be doing.

They showed these rasters of brain activity on the webcast, with cool bloopy sounds, he said. For peer review, I would insist on seeing the actual signals they recorded. Although there is no reason to believe it to be the case, they could be recording movement artifacts.

My hunch is that it will not be as expensive as deep brain stimulation for Parkinson's disease, which costs tens of thousands of dollars. But it's going to be more expensive than, say, LASEK surgery.

DR. LEE MILLER

When I was first approached about working on brain-machine interfaces, I thought, This is crazy. But we went farther than we could have reasonably hoped to do. That's why I'm not completely closed to the wildest claims Musk makes. It's not insane that maybe one day we can replay memories.

DR. SLIMAN BENSMAIA

Dr. Miller also took issue with Musk's prediction that a BCI device could eventually cost as little as a few thousand dollars. That's not going to happen any time soon, Dr. Miller said. My hunch is that it will not be as expensive as deep brain stimulation for Parkinson's disease, which costs tens of thousands of dollars. But it's going to be more expensive than, say, LASEK surgery.

He also disagreed with Musk's over-the-top claims about recording and replaying memories.

There's a lot of science in the realm of memory, he said, including Wilder Penfield's decades-old work that appeared to show existing memories being triggered by electrical stimulation of the brain's temporal lobes during neurosurgery.

That's a far cry, however, from suggesting it would ever be possible to record from a particular memory and play it back, Dr. Miller continued. While short-term, working memory very likely is based on reverberating neural activity and amenable to the intriguing hippocampus memory prosthesis that Ted Berger has been working on, long-term memories almost certainly require protein synthesis and structural changes to neurons that couldn't even be recorded, let alone played back. That's pure science fiction, and to suggest otherwise sets up all sorts of false expectations.

Sliman Bensmaia, PhD, the James and Karen Frank Family Professor of Organismal Biology and Anatomy at the University of Chicago, runs a laboratory there devoted to research in somatosensory neuroscience and prosthetics. Earlier this year, before COVID-19 restrictions began, he visited the Neuralink offices and gave a talk.

There's a team of really great people working there, and the device they have come up with is really remarkable, Dr. Bensmaia said. The device that I work with, that almost everyone works with, the only device that has been used in humans so far, is the Utah array, made of metal microelectrodes. It's like a mini bed of nails that you press into the brain. Of course the brain doesn't like that, and the electrodes don't last. So the fact that Neuralink has these thin, flexible fibers should cause much less damage. And they have a lot more electrical contacts. The question is how robust and stable it will be. Will it last for decades? But it's pretty cool. It's way further along now than it was just six months ago when I visited them.

Despite all that, Dr. Bensmaia added, Then there is Musk and the way he talks about it. Some of the stuff he says is outrageous. It might be possible to achieve some of the things he's talking about one day, but it won't happen for a very long time.

Even so, he said, the progress made in the field in recent years is already beyond anything he thought possible in such a short time.

I participated in DARPA's Revolutionizing Prosthetics program, he said. When I was first approached about working on brain-machine interfaces, I thought, This is crazy. But we went farther than we could have reasonably hoped to do. That's why I'm not completely closed to the wildest claims Musk makes. It's not insane that maybe one day we can replay memories.

In fact, a 2018 paper published in the Journal of Neural Engineering described a study involving epilepsy patients with surgically implanted electrodes near the hippocampus whose electrical spikes were recorded and analyzed while they performed a memorization task. When scientists stimulated the CA1 region by playing back the sequence of neural firing made when the subjects correctly remembered a preliminary set of memorizing tasks, their performance on subsequent memorization tasks improved by 35 percent.)

Dr. Hochberg leads the BrainGate consortium, which includes researchers from Massachusetts General Hospital, Brown University, the Providence VA Medical Center, Stanford University and Case Western Reserve.

Over the past few years, in our published research, the participants in our trial who had very little or no movement of their arm or hand have been able to control an unmodified tablet computer for email, for texting, for controlling their music players, Dr. Hochberg said.

I used to say it would take decades before a BCI is available to people outside of research trials that could offer a true clinical benefit. I now think we are just a few years away. Right now these systems often require the oversight or engagement of a trained technician to start the system and calibrate it at the beginning of each day. We need it to work 24 hours a day, seven days a week, in the absence of any technical oversight. On all those merits, we are on track to achieve that goal with a flexible, powerful and reliable system.

Because Mass General has a clinical research support agreement with Neuralink, Dr. Hochberg said he should not speak specifically about the company. But, he said, I'm excited by the entrants of multiple companies to the BCI field. The engagement of companies will ultimately benefit our patients who have neurological disease or injury.

As for those neurologists who remain leery of a field in which companies like Neuralink are publishing accounts of apparent gains in preprints posted without peer review, a University of Toronto fellow said, essentially, this is a sign of things to come in this burgeoning world of technology.

What we are seeing is a shift to Silicon Valley-style neurotechnology companies that attract venture capital and a lot of talent quickly, said Graeme Moffat, PhD, a former managing editor of Frontiers in Neuroscience who now also runs a company developing non-invasive brain imaging devices.

The pace of iteration in fields that adopt this approachseveral new electronics designs every year and regular software updatesis too fast for journal review cycles. We'll see papers on the long term effects of new BCIs on the brain, but the peer-reviewed scholarly literature is just unsuited to reflecting the rapid innovation in devices like those that Neuralink is building.

Dr. Ganguly has received a one-time consulting fee from Lightside Medical, a medical incubator company. Dr. Stavisky is a scientific advisor to Vorso Corporation and Broad Mind Inc. and has equity in both companies. Dr. Angle owns stock and is employed by Paradromics. Drs. Miller, Bensmaia, and Moffat had no disclosures.

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Brain-Computer Interfaces Move Forward at the Speed of Musk : Neurology Today - LWW Journals

By Stephanie Cajigal October 8, 2020

Two neurologists contennd that stroke disparities are only partially explained by differences in the prevalence of traditional stroke risk factors between Black and White patients. They discuss the framework for understanding the effects of racism on stroke risk and where the field needs to go from here.

Black Americans are twice as likely to have a stroke and 40 percent more likely to die from one as compared with White Americans, according to the Centers for Disease Control and Prevention. Although decades of research have highlighted racial stroke disparities, there is a dearth of evidence on why they exist.

Now two prominent stroke neurologists are calling on the field to investigate how racism may impact vascular health. In an opinion article published online on August 21st in JAMA Neurology, Bruce Ovbiagele, MD, FAAN, and Olajide A. Williams, MD, note that stroke disparities are only partially explained by differences in the prevalence of traditional stroke risk factors between Black and White patients.

Dr. Ovbiagele, professor of neurology at the University of California San Francisco Weill Institute for Neurosciences, and Dr. Williams, professor and chief of staff of the department of neurology at the Columbia University Vagelos College of Physicians and Surgeons, recently spoke with Neurology Today about a framework for understanding the effects of racism on stroke risk and where the field needs to go from here.

Dr. Ovbiagele: While stroke disparities have been well documented, we haven't fully resolved what all the explanations or solutions are. This is an issue that has been pervasive for five decades. As you saw from the article, we can only explain about half of what seems to be contributing to Black-White disparity in terms of stroke outcomes.

Dr. Williams: I think the nation is sensitized, the world is sensitized, given the events of George Floyd in addition to the devastating disparities that were illuminated by COVID-19. Bruce and I have been working within the world of health disparities for decades, but it's amazing just how few Americans understand the severity of these disparities and how they impact all of us. I think COVID really showed the interconnectedness of all of us in society, whether you are the cleaning person going into a patient's room, or whether you are the physician walking into it, or a nurse, or a nursing aide. If one of those people in that chain has COVID, everyone is at risk. It shows we have to take care of the least among us. We thought we should take advantage of this moment by expanding the knowledge of the academic community on this topic.

Dr. Williams: Institutionalized racism is the codification of discrimination and bias into the structures of societies. These structural biases are driven by individual-level biases. For example, if I put a group of biased individuals on the governance committee of a particular organization, those individuals will translate their bias into policies and procedures. And then there is internalized racism, which is the effect of chronic racism on an individual. Chronic discrimination, chronic dehumanization, chronic marginalization causes the individual on the receiving end to ask, what is my worth? Before you know it, that individual will start internalizing the worth that society has placed on him. Once you internalize racism, it can be self-destructive.

What happens across these different levels is the systematic denial of opportunities such as access to health care. There is also the denial of diversity within health care by discriminating against people of color seeking admission into the medical field. This was highlighted by the Flexner Report [on medical education in the United States and Canada, originally published in 2010].

So structurally, you're being denied access, denied opportunities, and denied the ability to improve diversity within medicine. Personally, you're experiencing daily discrimination. Bruce and I included the Everyday Discrimination Scale in our paper to highlight the daily injustices experienced by people of color as a result of personally mediated racism. That in itself can be quite traumatic; it can generate anxiety, it can generate chronic stress responses, which in turn can lead to higher levels of inflammation, hypertension, etc. Couple that with decreased access to get these things fixed; couple that with decreased motivation to get these things addressed because you don't value yourself. Now you're dealing with a perfect storm that may lead to strokes and earlier mortality among people of color.

Dr. Ovbiagele: What we do know is that on the surface, at least, there are clearly differences in the timeliness and appropriateness of care that is delivered to Black people either at risk for stroke or who have experienced stroke. Can you categorically say that is due to racism? It is very hard to say. But that is what we are trying to call people to look into. If we don't have clear evidence pointing in one direction, it would be hard to design interventions or solutions to address it.

Dr. Williams: The 2013 Institute of Medicine report, Unequal Treatment, reviewed examples of implicit biases in medicine and showed quite tangibly that due to implicit bias, Black individuals may not receive the same level of pain treatment as White individuals. They showed that Black individuals may not get appropriate referrals for cardiac catherization compared to White individuals. We need much more rigorous research into this area in order to best determine where our resources should be focused.

Dr. Ovbiagele: Specifically, for stroke, as noted in the American Stroke Association Racial-Ethnic Disparities in Stroke Care statement in 2011. Black individuals have longer waiting times in the emergency department and are less likely to receive tPA or carotid revascularization procedures than White individuals.

Dr. Williams: I think the vascular effects of racism need to be better studied. For example, we now know the effects of rumination on blood pressure. We know that among people who are exposed to a racist eventsuch as when police pull someone over, grab him/her out of their car, and handcuff that person because he/she is Blackblood pressure surges due to the acute stress response at that moment. But these events are not isolated experiences, and so the cycle repeats itself. Moreover, the events are also replayed in your mind in the form of recurrent nightmares, the post-traumatic stress disorder of that experience. So not only is the experience continuing to happen in the real world, you're also being assaulted by the memory of the experience over and over again. All this causes vascular effects and inflammatory responses.

Dr. Ovbiagele: We need more representation of people of color but especially African-Americans in trials... I think we need to incorporate measures of discrimination and racism into trials as well. I would like to see those as endpoints in trials. I think those are the things that could be done almost immediately, and it would be wonderful to get the NIH to encourage that. I think grooming more researchers of all stripes; it doesn't have to be just people of color, who are interested in health inequities, to consider studying the issue of racism, would also be very important. We need more training programs to help people develop their careers in stroke disparities research. We need all hands-on deck if we are actually going to successfully tackle this issue.

Dr. Williams: There aren't enough Black neurologists, certainly not enough Black stroke neurologists to do the volume of work required. Because this is a societal problem, it's critically important for us to mobilize not just people of color, but allies who feel passionate about this injustice to join hands and help with the research and solutions.

Dr. Ovbiagele: Advocacy with nongovernmental organizations, professional organizations like the American Academy of Neurology, the American Neurological Association, the American Stroke Association, as well as major funders like the NIH. And, also not to just make this an American issue...this is a call to motivate a global cohort of people to address potentially racism-contributing stroke disparities in their countries.

Dr. Williams: There have been many acts of racism in medicine against the Black community, such as [the Tuskegee Study of Untreated Syphilis in the Negro Male] that have really drowned the confidence that people of color have with the health care system. They need truth and reconciliation. They need to be told that it's not in their minds; it's not in their heads. This is real, and it happened, and it is still happening. There needs to be acknowledgment before there is that recovery.

Dr. Williams: It all begins with the individual. I would say, listen, learn, and become an ally.

Dr. Ovbiagele: Undergo implicit bias and cultural sensitivity awareness training. Look at your own practice and routinely examine whether there are racial differences in care and outcomes among the stroke patients you see and address them. Lend your voice to support studies and programs aiming to eliminate this prominent and long-standing health disparity in our country. In Forecasting the Future of Stroke in the United States (Stroke. 2013;44:2361-2375), it's been projected that racial/ethnic disparities in stroke will likely worsen with time, without new concerted efforts, so there is no time like the present to strongly address this issue.

Drs. Williams and Ovbiagele reported no relevant disclosures.

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More Research Is Needed to Understand How Racism... : Neurology Today - LWW Journals