Category Archives: Neurology

The field of neurology education has experienced significant changes that parallels the advances in technology and a growing understanding of both, the science of learning and neurology [22]. Given that autonomic dysfunction, including AD, is associated with potentially life-threatening complications, it is important to include this topic early in medical education and equip students with the skills needed to recognize it [2,3,4]. Despite several reports describing the use of patients in undergraduate medical education, we did not find examples of sessions involving patients living with SCI. Moreover, none of the resources we find in the literature to teach about AD involve patients that have real-life experience with it [19,20,21]. We developed and implemented a MTP session in which patients living with SCI shared their experiences with second-year medical students to complement the learning occurring in the course. Our goal was to foster not only knowledge but the humanistic and emotional aspects of medicine.

The importance of neurology field exposure in medical education depends on students being able to develop the necessary patient-centered skills to communicate and form doctor-patient relationships with a wide range of patients [23]. In our MTP session, students had many opportunities to interact with the patients, which allowed them to reinforce concepts learned, including identifying the level of injury, spasticity, signs and triggers of AD, and loss of bowel and bladder control, while reminding them why what they are learning is important. Similar to experiential learning theories, the MTP session emphasizes learning through patient encounters early in the curriculum, whereby the experience broadens and deepen the concepts learned in class and the post-session quiz provided opportunities for reflection and further conceptualization [25]. Additionally, the session incorporated elements of social theories of learning, focusing on social interactions, the patients as persons, and the spinal cord injury community. Gain of knowledge was demonstrated by their performance in the post-session quiz and the final exam. Our results support prior reports of enhanced learning outcomes associated with the incorporation of patient panels [24, 26]. It is possible that by recalling patients stories, students were able to make the appropriate connections and apply their knowledge to new patient scenarios in the assessments. By correctly identifying life-threatening situations on examinations, students could later apply these same concepts to real-life patients in the hospital setting. Noteworthy, student engagement and acquisition of knowledge may have been influenced by the incorporation of a graded quiz at the end of the session [25]. Although the performance of students on the final exam in a question regarding the identification of AD was above the national average, one question is not enough to make a strong conclusion.

In agreement with prior reports, we found that interacting with patients was associated with high learners satisfaction [24]. Most students considered that the session helped them understand SCI sequelae and its impact on patients. The highest level of satisfaction was regarding how well the MTP session helped students recognize AD and its triggers. This was not surprising to us since this was the core topic of the session, with more class time dedicated to it. In contrast, although spasticity was discussed and shown in class, there might have been difficult for all students to appreciate the demonstration in the large classroom, which may explain the lower satisfaction compared to AD. It is possible that this type of demonstration may be more meaningful if done within small groups. Given that the level of student satisfaction correlated with focus of the session, the time spent on each topic and questions prepared can be adjusted based on the specific learning objectives and goals of the session.

To our surprise, the level of satisfaction with the session for the second academic year was lower than the first year of implementation, despite no changes in knowledge acquisition. The major difference between both sessions was the number of patients, time of the session and student attendance (less in all counts for the class with lower satisfaction). There are some students in the second year who did not attend the session and yet filled out the satisfaction survey. Although our study design did not account for the reasons for these differences, one possibility is that some students not attending the session felt that they needed to answer the satisfaction questions since they were at the end of the graded quiz; answering the satisfaction questions without attending the session may have altered the data. On the other hand, there might be other differences between the sessions that may have accounted for the different levels of satisfaction. For example, there were discussions that happened in the first, but not the second year, including topics related to nutrition and foods that made bowel problems worse, sex life and orgasm as a trigger for AD, and the use of endocannabinoids for pain after SCI. These discussions incited a lot of interest in students and prompted them to participate more; this may have provided a greater holistic understanding of patients living with SCI and the impact of the disability on everyday life. In addition, one of the patients in the first session is a vocal advocate for people living with SCI and had ample public speaking experience, which may have been more impactful for the students.

Establishing a partnership between patients, faculty and students is essential to enhance the learning experiences of all participants [24, 27,28,29]. For our MTP session, we made a conscious effort to assure that our patients had a meaningful and rewarding encounter with students. Like prior reports, the primary role of our patient was patient-teacher and we purposely attempted to establish a partnership with patients where they felt involved and empowered [29] During the session planning, the patients were extensively briefed on the goals and audience, and they were empowered to suggest questions and topics for discussion. During the session, most patients felt comfortable using their experiences to participate in the teaching of basic elements of their condition, for example, about neurogenic bladder, catheterization, mechanism of action of the drug, etc. Emphasis was made on the proper communication language when interacting with people with disabilities. For example, patients gave student resources and tips during the session (e.g., avoid wheelchair bound, disabled person, handicapped, etc.).

Based on our experience, we recommend that all patients should be trained before the session and have at least one rehearsal session. Although advocates with public speaking experience might be preferred in some settings, other patients can be selected as long as they are invested in the learning process. Patients should not only be comfortable with the session format and content beforehand, but they should also be empowered to suggest and make changes that they believe are important to communicate with students. Furthermore, the session should incorporate opportunities that broaden students understanding of the condition beyond the concepts learned in class, such as the impact of the condition on everyday life. We believe it is important to provide opportunities for ample interactions between students and patients that help create positive connections and increase students comfort level when talking to people with disability. These observations are in agreement with prior reports in the literature [24]. Even though our session focused primarily on AD, the same principles can be applied to other conditions/diseases.

Our results have several limitations. We evaluated only short-term knowledge acquisition, we used a small number of questions, and there was no control group to evaluate the effectiveness of the MTP compared to other learning strategies. Although comparing pedagogies was not our objective, we cannot rule out that other methods might be as effective in helping students acquire the knowledge. Nonetheless, the MTP was originally designed to complement rather than substitute and may have benefits beyond imparting knowledge. This type of patient encounter may result in enhanced long-term retention, and/or changes in behavior or practice that can be transferred to patient care. This is an important question that merits more research, involving longer time points, adequate controls, and possibly more MTP sessions.

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Meet the patient session: a strategy to teach medical students ... - BMC Medical Education

Newswise A new study involving University of Portsmouth researchers has uncovered key molecular defects underlying a rare developmental brain condition in children.

The research team, led by Dr Reza Maroofian, Dr Rauan Kaiyrzhanov and Professor Henry Houlden at University College London Queen Square Institute of Neurology, investigated the role of a specific regulatory protein in the brain known as acyl-CoA-binding domain-containing protein 6, or ACBD6. Up until now, the implication of defects in this protein have been unknown.

This study, published in the journal Brain, uncovered the role of malfunctioning ACBD6 in an ultra-rare condition in children, known as Autosomal Recessive ACBD6-related disorder. This is characterised by delays in the development of cognitive and motor skills, and is associated with dystonia and parkinsonism.

Co-lead author Dr Rauan Kaiyrzhanov said:The direct and immediate impact of this study is by introducing these genetic disorders to the medical community will help to diagnose the families affected by this condition worldwide. However, the long-term and wider effect of this study is that this ultra-rare condition can help us better understand the biology of these conditions in humans and advance our knowledge of biological mechanisms linked to much more common neurodegenerative movement disorders, like Parkinsons disease and dystonia.

This discovery was made possible through the use of advanced genomic technologies and extensive global data sharing, with 89 clinicians and scientists from 72 institutes involved worldwide.

Co-author Professor Matt Guile, Professor of Developmental Genetics at the University of Portsmouth said:We are delighted to contribute to this important piece of new research which will help improve the lives of patients and their families. This is part of our wider work to discover how Xenopus tadpoles can be used to support the diagnosis of rare genetic diseases.

The understanding of this rare disorder began with the study of a complex neurological disorder affecting three siblings from a single family, who had mutations in the ACBD6 gene. Thanks to extensive international collaboration over the following years, more affected families with similar genetic disorders were identified, and gradually a resemblance began to emerge among the distinct clinical and radiological features of those affected.

The researchers investigated 45 affected individuals from 28 unrelated families and extended their study to include animal models. This multifaceted approach uncovered evidence highlighting the essential role of ACBD6 in maintaining a healthy nervous system.

Co-lead author Dr Reza Maroofian said:This study underscores the untapped power of systematically investigating a relatively large number of well-defined individuals affected by ultra-rare disorders and highlights how much we can learn about human biology and pathology from these studies which are currently severely neglected and under-funded.

This international endeavour stands as a testament to the relentless dedication and collective expertise of the global scientific community and highlights the critical importance of not marginalising ultra-rare conditions.

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New study reveals molecular causes of rare neurological condition ... - Newswise

News from NYU Langone Health

Today Is National Clean Out Your Fridge Day FOX 5 New York November 15 -Rabia A. De Latour, MD, assistant professor, Department of Medicine, Division of Gastroenterology and Hepatology

NYU Langone Streamlines Spine Radiosurgery Treatment to One Day Beckers Hospital Review November 15 -Alec Kimmelman, MD, PhD, the Anita Steckler and Joseph Steckler Chair, and professor, Department of Radiation Oncology, Perlmutter Cancer Center -Thomas B. Daniels, MD, clinical associate professor, Department of Radiation Oncology

Brave Soap Opera Star John York, 64, Readies Himself for Long Transplant Journey to Treat Blood and Bone Marrow Cancers SurvivorNet November 14 -Jun H. Choi, MD, clinical assistant professor, Department of Medicine, Division of Hematology and Medical Oncology, Perlmutter Cancer Center

Clinical Challenges: Atopic Dermatitis in Infants (Free log-in required.) Medpage Today November 15 -Vikash S. Oza, MD, associate professor, the Ronald O. Perelman Department of Dermatology, Department of Pediatrics

Artificial Intelligence and Machine Learning Could Enhance MS Diagnosis and Management NeurologyToday November 16 -Rachel Kenney, PhD, assistant professor, Departments of Neurology, and Population Health

New Training Recommendations for the Transition from Pediatric to Adult Neurology NeurologyToday November 16 -Aaron Nelson, MD, associate professor, Department of Neurology

Scientists Identify Potential Mechanism for Sudden Unexplained Death in Epilepsy NeurologyToday November 16 -Orrin Devinsky, MD, professor, Departments of Neurology, Neurosurgery, and Psychiatry, Comprehensive Epilepsy Center

Highlights of the 2023 International Mesothelioma Symposium Asbestos November 13 -Daniel H. Sterman, MD, the Thomas and Suzanne Murphy Professor of Pulmonary and Critical Care Medicine, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, professor, Department of Cardiothoracic Surgery, Perlmutter Cancer Center

NYU Langone Health Performs Worlds First Whole-Eye & Partial-Face Transplant Eye News November 15 -Eduardo D. Rodriguez, MD, DDS, the Helen L. Kimmel Professor of Reconstructive Plastic Surgery, chair, the Hansjrg Wyss Department of Plastic Surgery -Vaidehi S. Dedania, MD, associate professor, Department of Ophthalmology -Samer Al-Homsi, MD, clinical professor, Department of Medicine, Division of Hematology and Medical Oncology, Perlmutter Cancer Center -Bruce E. Gelb, MD, associate professor, vice chair of quality, Department of Surgery, Division of Transplant Surgery

First Whole Eye Transplant Science-Based Medicine November 15 -Eduardo D. Rodriguez, MD, DDS, the Helen L. Kimmel Professor of Reconstructive Plastic Surgery, chair, the Hansjrg Wyss Department of Plastic Surgery

Cautious Hope Over Landmark Eye Transplant Optician November 16 -Eduardo D. Rodriguez, MD, DDS, the Helen L. Kimmel Professor of Reconstructive Plastic Surgery, chair, the Hansjrg Wyss Department of Plastic Surgery

Heres What a Polygenic Test Canand CantTell You About Your Health SELF November 15 -Jeffrey S. Berger, MD, associate professor, Department of Medicine, the Leon H. Charney Division of Cardiology, Center for the Prevention of Cardiovascular Disease

Is Manifesting Real? Heres the Science TheSkimm November 15 -Thea Gallagher, PsyD, clinical assistant professor, Department of Psychiatry

Spending Just ONE Night in the Emergency Room Before Being Admitted to the Hospital Can Increase Your Risk of Death, Study Suggests Daily Mail November 15 -Marc K. Siegel, MD, clinical professor, Department of Medicine, Division of General Internal Medicine

An AI Doctor in a Box Coming to a Mall Near You Forbes November 15 -Arthur L. Caplan, PhD, the Drs. William F. and Virginia Connolly Mitty Professor, Department of Population Health, Division of Medical Ethics

Whats The Worst That Could Happen? A Toothless FDA Health Affairs November 13 -Arthur L. Caplan, PhD, the Drs. William F. and Virginia Connolly Mitty Professor, Department of Population Health, Division of Medical Ethics -Lisa Kearns, senior research associate, Department of Medicine, Division of Medical Ethics

A Reduction in the Hippocampus in the Brain Linked to Cognitive Decline Risk Medical News Today November 15 -Shae Datta, MD, clinical assistant professor, Department of Neurology, NYU Langone HospitalLong Island, Concussion Center

VIDEO: Surgeon Physiologic Stress May Increase with Patient BMI During THA Healio November 15 -Joshua C. Rozell, MD, assistant professor, Department of Orthopedic Surgery, NYU Langone HospitalBrooklyn

Can You Fly While Pregnant? Health-Reporter November 15 -Meleen Chuang, MD, clinical associate professor, Department of Obstetrics and Gynecology, Family Health Centers

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NYU Langone Health in the NewsThursday, November 16, 2023 - NYU Langone Health

WATCH TIME: 5 minutes

"Our study indicates that CPAP treatment in patients with MS and sleep apnea is associated with a reduction in fatigue and an improvement in physical quality of life, offering potential benefits for long-term symptom management. Clinicians should consider exploring sleep apnea as a factor contributing to fatigue and poor sleep quality in patients with MS, as adequate treatment may lead to noticeable symptom improvement."

Fatigue, a prevalent symptom in multiple sclerosis (MS), is frequently associated with underrecognized sleep disturbances, which significantly contributes to the symptoms impact.1 In a new post-randomized controlled trial observational study, long-term continuous positive airway pressure (CPAP) use was associated with significant improvements in fatigue and physical quality of life in patients with MS and obstructive sleep apneahypopnea.2 Senior author Daria Trojan, MD, MSc, associate professor in the department of neurology and neurosurgery at McGill University, presented the findings in a scientific session at MSMilan 2023, the 9th Joint ECTRIMS-ACTRIMS meeting, held October 1113, in Milan, Italy.

In the analysis, investigators observed significant improvements in CPAP-treated patients (n = 16) compared with nonCPAP-treated patients (n = 12) for the Fatigue Severity Scale (P = .03) and MS Quality of Life-54 physical component score (P = .02). In addition, morning fatigue improved significantly (P = .048) in CPAP-treated patients compared with nonCPAP-treated patients. Also, investigators observed no significant improvements in the other outcome measures with CPAP treatment. Notably, measures of better CPAP adherence were associated with improvement on the Pittsburgh Sleep Quality Index (P = .039) and MS Quality of Life-54 physical component score (P = .049).

At the meeting, Trojan spoke an interview with NeurologyLive to discuss how CPAP treatment can impact fatigue, sleep quality, and overall well-being in patients with MS, as well as shared the key considerations for long-term adherence. She also talked about the measures that clinicians can take to address the challenges of CPAP adherence in patients with MS, and the alternative sleep apnea treatments that should be explored. In addition, Trojan spoke about the lack of data on other treatments for sleep apnea in MS, an area she suggests should be studied further in the future as well as CPAP therapy in this patient population.

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Effects of Long-term CPAP Therapy in Multiple Sclerosis: Daria ... - Neurology Live

Parkinson disease (PD), once thought of solely as a movement disorder, is now recognized as a complex heterogeneous condition with a wide range of symptoms. These symptoms encompass both motor and non-motor aspects, such as bradykinesia, sleep disturbances, and cognitive impairment. Despite being the second-most common neurodegenerative disease in the US, many patients remain undiagnosed or misdiagnosed due to the variability of the disease.

Recently, an extensive study published in npj PD showed that in 2019 only 40% of PD Medicare beneficiaries visited a neurologist in the calendar year, with only 9% of patients seeing a movement disorders specialist. The study revealed that a majority of PD patients failed to take advantage of recommended therapy services, like mental health or physical therapy, partly attributable to the lack of specialty care access and accurate diagnosis. These disheartening results highlight several glaring barriers within the PD care ecosystem.

To ensure favorable patient outcomes, the healthcare community must prioritize early and accurate diagnosis of PD and expand virtual care options. By doing so, individuals can receive timely access to the therapies they need, leading to improved quality of life and better disease management.

PD is challenging to diagnose because many initial symptoms are vague. Patients may complain about trouble sleeping during the early stages of PD, so their primary care physician (PCP) will suggest melatonin or refer them to a sleep medicine specialist. Similarly, other early symptoms such as constipation and loss of smell are often dismissed or misdiagnosed by PCPs.

Cognitive problems may also be present, but many patients will disregard them, chalking up their forgetfulness or problems thinking to old age. Patients may also experience increased mood disorders but are often referred to a psychiatrist.

If a patient shows movement symptoms, like frozen shoulder, less dexterity, or toe rigidity, they will typically get bounced to a physical therapist or orthopedic or podiatry doctor. In these cases, these specialists may misdiagnose the patient, who will eventually undergo surgery to fix their issues rather than being treated for PD. If a tremor is present, a patients family physician may diagnose them with essential tremor, a more common condition than PD.

Since PD affects many different systems in the body, PCPs often cannot diagnose PD in patients correctly. When referred to a specialist, it is rarely a neurologist or a movement disorders specialist. Ultimately, the patient continually gets bounced around the healthcare system, never being correctly diagnosed with PD or receiving the suitable therapies to alleviate their symptoms.

Patients over 60 who present with these early symptoms of PD will first typically visit their primary care facility. In many cases, their symptoms are, in fact, attributable to conditions other than PD.

However, because PD is one of the leading neurological disorders, we need to help PCPs employ a standardized protocol for the elderly population. Suppose a patient is complaining about sleep disorders, anosmia, constipation, or changes in gait (which we know are all PD-associated symptoms). In that case, PCPs should flag patients as potentially having PD and push them in the right direction for care.

Two procedures we can incorporate today into this PD standardized protocol are objective diagnostics testing and telemedicine in the field of neurology.

If patients are not able to visit a neurologist or movement disorders specialist due to demographics, then the first thing we can offer patients to improve care is an objective diagnostic test.

Surprisingly, a skin biopsy is one of the most reliable diagnostics for PD, able to detect abnormal deposits of alpha-synuclein, a hallmark of PD. Compared to dopamine transporter (DAT) scans, this method can diagnose PD ten years sooner, meaning patients can undergo the appropriate treatment strategy earlier in the disease. Fortunately, a skin biopsy is a straightforward outpatient procedure done in a medical office without the need for patients to stop other medications. If we can push this forward and accurately diagnose patients early, we can ensure patients get the care they deserve.

Next, we can offer patients telemedicine options and have trained specialists to assist in diagnosing PD. We can break down borders by offering patients access to certified neurologists through online software or mobile apps to evaluate if an individuals symptoms are attributable to PD or another condition. Rather than having to wait months for an in-office visit with a neurologist, patients can get care faster and from the comfort of their own homes. Since many health organizations already utilize telemedicine for dermatology and psychiatry, we can dramatically improve patient outcomes if we bring telemedicine to neurology and the movement disorders arena.

In the US, it has been reported that over one million individuals are living with PD. In all likelihood, this is a gross underestimate of the number of PD patients in the nation due to misdiagnosis and lack of care access. To limit the barriers to care, we need to take drastic measures in pouring resources into standardizing protocols, specifically by providing objective diagnostics and virtual care options. By doing so, we can alleviate the suffering of many patients nationwide and, at the same time, significantly reduce the socioeconomic burden on our healthcare systems.

StrivePD is a free iOS disease management application FDA-cleared on the Apple Watch that passively collects tremor and dyskinesia data via Apples Movement Disorder API. People with Parkinsons (PwPD) can download the app and explore interactive charts to track their symptoms over time and understand how medications and physical activity impact them. Users will gain insights to guide their care journey and have the ability to share their data with clinical specialists for a personalized strategy. PwPD or caregivers can download the app on theApple App Store today. For neurologists and movement disorder specialists, reach out tosupport@runelabs.ioto understand your patients disease progression and gain insights into their quality of life beyond the clinic.

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Improving Access to care in Parkinson Disease: Expanding ... - Neurology Live

THURSDAY, Nov. 16, 2023 (HealthDay News) -- Pronounced neuroaxonal damage precedes disability worsening events with or without preceding clinical relapses in people with multiple sclerosis (MS), according to a study published online Nov. 6 inJAMA Neurology.

Ahmed Abdelhak, M.D., from University of California at San Francisco, and colleagues assessed whether and when neurofilament light chain (NfL) levels are elevated in the context of confirmed disability worsening (CDW) with MS. The analysis included data from two observational cohorts seen at tertiary MS centers (609 and 1,290 participants).

The researchers found that NfL z scores were 0.71 units higher in the first cohort and 0.32 higher in the second cohort for CDW associated with clinical relapse versus stable MS. Higher NfL was detected preceding CDW independent of clinical relapse for two visits preceding the event and for the visit directly preceding the event. Findings were similar for the subset of individuals with relapsing-remitting MS.

"This cohort study documents the occurrence of NfL elevation in advance of clinical worsening and may hint to a potential window of ongoing dynamic central nervous system pathology that precedes the diagnosis of CDW," the authors write.

Several authors disclosed ties to industry.

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Neurofilament Light Chain Levels Show Precedence in Multiple ... - HealthDay