Category Archives: Neurology

Neuropsychiatric symptoms of Long COVID, including brain fog, inability to concentrate, and headache, have puzzled researchers and clinicians, who are hunting for those symptoms causes. A new study found that neuroinflammation and blood-brain-barrier dysfunction are not likely drivers of the symptoms, giving researchers more clues in their quest to uncover what actually may be the culprit.

Scientists have proposed many potential causes of the neuropsychiatric symptomsincluding damage of the blood vessels in the brain, ongoing brain inflammation, and lingering viral infection. This study is the first time researchers have tested a large cohort of people living with Long COVID for spinal fluid markers of brain inflammation and blood-brain-barrier dysfunction. The researchers published their findings in JAMA Network Open on November 10, and the outcome is significant even with the negative finding.

Our study suggests that interventions that are aimed at quieting brain inflammation likely wont help people with Long COVID, says Shelli Farhadian, MD, PhD, assistant professor of medicine (infectious diseases) at Yale School of Medicine (YSM) and first author of the study.

For many years, Farhadian and Serena Spudich, MD, Gilbert H. Glaser Professor of Neurology and senior author, have been studying neurological abnormalities caused by human immunodeficiency virus (HIV) infection. An important way to assess this is through cerebrospinal fluid (CSF), which offers a window into the brains of living people. Its the only part of the central nervous system thats easily accessible, says Farhadian. It can and has already told us a lot about the brain and people living with other infections and inflammatory diseases like multiple sclerosis, HIV, and Parkinsons disease. Researchers can look at proteins and cells in the spinal fluid to see if there is any neurological dysfunction, including abnormal immune activity or blood-brain-barrier impairment.

Beginning in late 2020, the team began enrolling participants with self-reported neurological or psychiatric Long COVID symptoms. Many of the patients were enrolled in the YSM Department of Neurologys neuroCOVID clinic. The researchers had to rely on the self-reporting of symptoms because there are no established diagnostic criteria for Long COVID.

As a control, researchers were able to use CSF and blood samples that predated COVID-19. Its increasingly difficult to find people who have never had COVID-19, says Farhadian. The CDC estimates that over 90 percent of people by this point have been infected. But fortunately, over the past decade, Farhadian and Spudich were already enrolling healthy people from the New Haven community as volunteers to donate blood samples and CSF as research volunteers. Their team was able to use these samples collected before the pandemic as a control.

Our study suggests that interventions that are aimed at quieting brain inflammation likely wont help people with Long COVID.

All participants in the experimental cohort consented to give blood samples and underwent a lumbar puncture to collect CSF. Using these samples, researchers measured levels of inflammatory proteins called cytokines, immune cells, and neopterin, another marker of inflammation. They also evaluated the CSF-to-blood albumin ratio, which indicates blood-brain-barrier integrity. We chose these markers because theyve previously been found to be elevated in other neuroinflammatory conditions, says Farhadian.

The researchers did not find any significant differences between the experimental and control groups, suggesting that neuroinflammation and blood-brain-barrier dysfunction are unlikely to be the causes of neuropsychiatric symptoms associated with Long COVID. Now, the team can turn its attention to other potential causes of Long COVID and eventually home in on those that are supported by scientific evidence. Its been two years since the pandemic, and its time to reassess what we know and dont know about Long COVID so that we can focus our efforts on finding a solution, says Farhadian. We were really lucky that our participants were generous in agreeing to enroll in our study.

Farhadian and Spudich now plan to focus on other hypotheses that may reveal the biological underpinnings of neuropsychiatric symptoms of Long COVID. They will do this by leading translational research conducted through the COVID Mind Study at Yale, Specifically, the team will study whether lingering viral infection of the central nervous system plays a role in symptoms.

Other research led by Lindsay McAlpine, MD, instructor in the division of neurological infections and global neurology and co-author of the neuroinflammation and blood-brain-barrier study, is assessing structural and vascular brain abnormalities. We still dont understand whats causing neurological Long COVID, says Farhadian. But our hope is that with more studies, we can start to eliminate some of the possibilities and zero in on some of the others.

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Brain Fog: New Study Examines Causes of This Long COVID ... - Yale School of Medicine

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"You see a lot of lectures in terms of clinical experience, real-world evidence, but also highlighting a lot of the new data on many of the novel treatments that have emerged in the past few years."

Migraine headache has long been recognized as one of the most burdensome and prevalent diseases worldwide. There are several types of migraine, including abdominal migraine, basilar-type migraine, hemiplegic migraine, menstrual-related migraine, retinal migraine, and migraine without headache. In recent years, there have been significance advances in the treatment of these disorders, including the introduction of calcitonin gene-related peptide (CGRP)-targeting agents, which have proven to be effective and safe options.

In addition to its traditional meeting, the American Headache Society (AHS) is hosting its annual Headache Symposium, taking place November 15-19th in Scottsdale, Arizona. The 4-day event is designed for not just neurologists and headache specialists, but for a wide range of medical professionals including general practitioners, psychiatrists, physician assistants, nurses, dentists, and much more. Throughout the meeting, attending clinicians can learn more about the advances in headache migraine disorders, including ways to enhance patients experience, complementary medicine, and headache in children, among other topics.

Prior to the meeting, NeurologyLive sat down with Emad Estemalik, MD, director of the headache section at Cleveland Clinics Neurological Institute, to discuss the excitement around the event fueled by some of the recent advances in the field. Estemalik, who serves as an assistant professor of neurology at the Lerner School of Medicine, also provided context on some of the current unmet needs in the field, such as why certain patients and genders experience a worse condition. While he recognizes the significant strides made, Estemalik believes there is room for continued growth.

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Excitement Behind the 2023 American Headache Society ... - Neurology Live

November 15, (THEWILL) The lead consultant of Neurology at the University Of Calabar Teaching Hospital, Professor Ekanem Ephraim, has so far spent about 116 days in kidnappers den in Cross River State.

Professor Ephraim was kidnapped about four months ago on July 13, 2023, around the Atimbo Axis of Calabar Municipality, by unknown gunmen and taken into captivity.

Her abduction reportedly took place at her residence in Calabar by kidnappers, who posed as relations to a patient in dire need of medical attention.

The incident shook the medical community in the state and the state branch of the Nigeria Medical Association embarked in an industrial action to protest against the rising spate of doctor targeted kidnappings in the state.

The industrial action lasted for about forty days and occasioned a major and unquantified crisis in the states healthcare sector.

The strike action was later called off by the State NMA in the wake of the deteriorating health sector in the state and the need to give government a chance to arrest the situation.

In suspending the industrial action, the state Chairman of the Nigeria Medical Association disclosed that Following a letter of appeal from Gov. Otu, advice of the national president of the association and for the sake of many of the citizens who are suffering, we have suspended the strike to give government time to rescue our member.

This action has been carried out despite the fact that our member has not been released; however, if any of our member is kidnapped again, we will go back to strike.

We are appealing to security agents to step up and maintain the momentum that has been established in the last few weeks, which has reduced cases of kidnapping in the state, Archibong had stated then.

However, following her prolonged stay in captivity, Dr Felix Archibong has bemoaned her colleagues prolonged captivity.

Dr Archibong said that it was regrettable that security agencies and the state government have not been able secure her release after several promises made to that effect.

While noting that the state have become inhabitable due to the activities of kidnappers, said several others, including medical personnel, have suffered same fate as Prof. Ephraim.

This is the situation in the state and it is regrettable that our colleague is still in captivity after 115 days.

We are trying so hard not to make industrial action another alternative to getting the government and security agencies to keep to their promises, he stated.

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Insecurity: UCTH's Neurology Professor Remains In Kidnappers ... - thewill news media

Hackensack Meridians Neuroscience Institute is proud to announce the recertification of its Center for Multiple Sclerosis and Related disease at Hackensack University Medical Center as aCenter for Comprehensive Multiple Sclerosis Care through the National Multiple Sclerosis Societys Partners in MS Care program. The renewal of the national certification also recognizes HUMC neurologists also practice out of JFK University Medical Center, making similar services available in Edison.

The Hackensack Meridian Neuroscience Institute at Jersey Shore University Medical Centers Center for Multiple Sclerosis is also nationally recognized by the National MS Society as a Comprehensive MS Center, renewing its certification earlier this year.

While the search for a cure formultiple sclerosis (MS) continues, effective strategies can help modify or slow the diseases progression, treat relapses (also called attacks or exacerbations), improve symptoms and function, and address emotional health.

As a Comprehensive MS Center, the Hackensack Meridian Neuroscience Institute, isnt just treating one aspect of a persons MS diagnosis, but working collaboratively across disciplines to treat the whole patient, saidFlorian Thomas, M.D., Ph.D.,Chair of Neuroscience Institute & Department of Neurology atHackensack University Medical Center and Founding Chair and Professor of Neurology and Associate Dean for Faculty Advancement at Hackensack Meridian School of Medicine.MS impacts many aspects of a patients life. By working with colleagues across our network, our MS Centers offer convenient and complete care for all aspects of our patients MS diagnosis.

An accurate diagnosis of MS is the first step and clinicians at Centers across our network are skilled in ruling out conditions that mimic MS and confirming the disease. Once a diagnosis is confirmed, symptom management is important. By offering care for symptoms such as bladder, bowel and sexual dysfunction, botox injections and intrathecal baclofen therapy pump for spasticity, rehabilitative assessments and care for physical or cognitive impairment, headache management, infusion therapy, pain management, specialty sleep services, speech therapy, swallow therapy and vision services.

TheCenter for Multiple Sclerosis and Related Diseases at Hackensack University Medical Center has been treating patients with this collaborative model for seven years. This recertification further recognizes the success of this model saidKrupa Pandey, M.D., Associate Professor of Neurology at Hackensack Meridian School of Medicine, and Director of the MS Center at Hackensack University Medical Center and Clinical Research for Neurosciences at Hackensack University Medical Center. MS is a complex disease, and symptoms are not the same patient to patient. Since the inception of the Center, we have continued to expand the research division and addition of clinicians such as psychologists trained in adjustment to the diagnosis, neuro-ophthalmologists to recognize the impact of MS on the eyes and neuro-rehabilitative care to improve or maintain day to day functioning.

In January, the MS Center at Jersey Shore University Medical Center was certified as a Center for Comprehensive MS Care through the National Multiple Sclerosis Societys Partners in MS Care program.

Im so incredibly proud of our centers team and the care we provide our patients, saidDavid Duncan, M.D. FAAN MSCS, Program Director of the MS Center at Jersey Shore University Medical Center.In three short years we have expanded into a dynamic comprehensive Multiple Sclerosis Program which focuses on all the aspects of treating and managing multiple sclerosis. Patients are extremely impressed with our centers all under one roof design which allows us to evaluate and treat patients in one location thanks to our on site exam and procedure rooms, infusion center, gait lab and adjacent state of the art 3T MRI. We are also in the final stages of plans of adding Neuro-urology for quick assessment of any MS related bladder complaints as well as cognitive testing all within the center. We work to make the whole process easy for patients by providing assistance with appointments and scheduling to help patients accomplish multiple consultations in one visit.

Both centers provide patients access to the latest in emerging therapies available through our numerous clinical trials and research.

The MS Society saysthe model ofcomprehensive MS carebest treats the patient as whole. It involves the expertise of many different healthcare professionals each contributing in a unique way to the management of the disease and the symptoms it can cause.Coordinating the efforts of health professionals trained to treat MS from various disciplines provides patients with neurological and nursing care, individual and family counseling and education, physical, occupational, and speech therapies, and social services. An interdisciplinary approach to MS care facilitates coordination of services and continuity of care, while avoiding duplication and fragmentation for the patient and family. Comprehensive care embraces a philosophy of empowerment the person with MS is an active participant in planning and implementing healthcare and self-care activities. He or she is a consultant to the team, which is important because MS, like all chronic illnesses, will last a lifetime.

This formal recognition honors the Centers ongoing commitment to high-quality MS care. The Comprehensive MS Care Center distinction is appointed by a national committee, and the organization must demonstrate coordinated, multi-disciplinary care for MS. To receive this recognition, Hackensack Meridian Neuroscience Institute specialists have continually demonstrated a wealth of knowledge, experience, and the important attention to detail necessary in treating people living with MS.

I am proud that the MS Society recognized the significant benefit our Neuroscience Institutes comprehensive strategy has for patients,said Maria Coello, vice president of Care Transformation Services including Neurosciences, Hackensack MeridianHealth. It is further recognition of our doctors, team members and staffs commitment to allowing MS patients to live full and complete lives, by caring for the whole person, not just the neurological symptoms of the disease.

For more information, visit Hackensack Meridian Neuroscience Institutehere. To learn more about MS and the National MS Society, visitwww.nationalMSsociety.org.

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Hackensack Meridian Neuroscience Institute Recognized Nationally ... - Hackensack Meridian Health

WEDNESDAY, Nov. 15, 2023 (HealthDay News) -- Black women reporting having experienced interpersonal racism may have higher risk for having a stroke, according to a study published online Nov. 10 inJAMA Network Open.

Shanshan Sheehy, Sc.D., from the Slone Epidemiology Center at Boston University, and colleagues examined the association of perceived interpersonal racism with incident stroke among U.S. Black women. The analysis included 48,375 participants in the Black Women's Health Study with follow-up from 1997 through 2019.

The researchers identified 1,664 incident stroke cases, of which 550 were definite cases confirmed by neurologist review and/or National Death Index linkage. For those reporting experiences of racism in all three domains of employment, housing, and interactions with police, there was a 38 percent increase in incident stroke (95 percent confidence interval [CI], 1.14 to 1.67) and a 37 percent increase in definite cases (95 percent CI, 1.00 to 1.88) compared with that seen in women with no such racism experiences. A similar trend was seen for comparisons of women in the highest quartile of the everyday interpersonal racism score versus those in the lowest quartile (hazard ratio, 1.14 [95 percent CI, 0.97 to 1.35] for all incident stroke; hazard ratio, 1.09 [95 percent CI, 0.83 to 1.45] for definite cases).

"It is possible that the high burden of racism experienced by Black U.S. individuals may contribute to racial disparities in stroke incidence," the authors write.

One author disclosed financial ties to Qmetis.

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Experiencing Racism Increases Stroke Risk in Black Women, Study ... - HealthDay

A new Northwestern Medicine study has uncovered previously unidentified intracellular mechanisms in the peripheral nervous system that cause CharcotMarieTooth Type 2B disease, a rare congenital disorder that causes sensory deficits and muscle atrophy and weakness.

The findings improve the understanding of the origins of the disease and may also inform the development of new targeted therapies, according to the study published in the Proceedings of the National Academy of Sciences.

These findings are important as they highlight an essential role for properly regulated mitochondria-lysosome contact site dynamics and function in the axons of sensory peripheral neurons, and demonstrate that this may be an important pathway in the pathogenesis of Charcot-Marie-Tooth Type 2B disease, said Yvette Wong, PhD, assistant professor of in the Department of Neurologys Division of Movement Disorders and co-lead author of the study.

Charcot-Marie-Tooth Type 2 diseases are a group of hereditary neuropathic disorders characterized by the degeneration of axons in peripheral nerves.

CharcotMarieTooth Type 2B disease is specifically caused by mutations in a GTPase protein called Rab7, which leads to the degeneration of axons of peripheral sensory neurons. Wong and other Northwestern Medicine investigators previously found that mitochondria-lysosome contact sites can form to support essential crosstalk between mitochondria and lysosomes, and that the untethering of these contact sites is driven by Rab7s GTPase activity. In the context of CharcotMarieTooth Type 2B disease, Wong and colleagues also previously discovered that disease mutant Rab7 prevents the untethering of these contact sites, resulting in downstream defects in mitochondrial dynamics.

In the current study, Wong and colleagues aimed to determine in peripheral sensory neurons whether mitochondria-lysosome contact sites disrupted by mutant Rab7 lead to mitochondrial defects and whether those defects preferentially occur in axons in peripheral neurons, as observed in patients with the disease, or in the neuronal cell body.

The investigators created a new mouse model of Charcot-Marie-Tooth Type 2B disease mutant Rab7; the mice displayed sensory behavior defects and neuropathy but had normal motor behavior. Using super-resolution and live microscopy to study the peripheral sensory neurons from these mice, the investigators identified mitochondria-lysosome contact sites that could not efficiently untether in axons. Importantly, promoting the untethering of mitochondria-lysosome contact sites was sufficient to improve mitochondrial dynamics in the axons.

The findings suggest that targeted therapies which help improve mitochondria-lysosome contact site tethering dynamics and function may improve mitochondrial health in these axons, according to the authors.

These findings also suggest that mitochondria-lysosome contact sites may play an important role in other genetic forms of Charcot-Marie-Tooth Type 2 disease, which also exhibit axonal degeneration, as well as in other neurological disorders that have mitochondrial dysfunction or axonal degeneration, according to Daniela Maria Menichella, MD, PhD, 08, 11 GME, associate professor of Neurology in the Division of Neuromuscular Disease and senior author of the study.

Our study demonstrates a critical role for mitochondria-lysosome contact sites to maintain the health of peripheral nerves. Moreover, defects in this important pathway have been recently linked to the pathogenesis of multiple neurodegenerative diseases, including Parkinsons disease and lysosomal storage disorders, said Menichella, who is also an associate professor of Pharmacology.

According to the authors, next steps include understanding how defects in mitochondria-lysosome contact site dynamics and function contribute to the degeneration of peripheral neurons, uncovering new roles for mitochondria-lysosome contact sites, and identifying new pathways for how mitochondria and lysosomes interact with other organelles to maintain neuronal health and contribute to additional neurological disorders.

Together, this work provides important insights into mitochondria-lysosome contact site regulation in peripheral neuropathy and has important consequences for advancing the fields of organelle contact site biology and neurodegeneration, Menichella said.

NirupaDoris Jayaraj, senior research associate in the Meninchella laboratory, was co-lead author of the study. Co-authors include Dongjun Ren, a postdoctoral fellow in the Department of Pharmacology; Tayler Belton, a research technologist in the Wong laboratory; George Shum, a research technologist in the Wong lab; Hannah Ball, a student in the Driskill Graduate Program in Life Sciences (DGP) program and a member of the Wong lab; and Dimitri Krainc, MD, chair and the Aaron Montgomery Ward Professor of Neurology and director of the Simpson Querrey Center for Neurogenetics.

This work was supported by National Institutes of Health grants NINDS R00 NS109252, NINDS Diversity Research Supplement 3R00NS109252-04S2, NINDS R24 NS098523 and R37 NS054154, R01 NS104295-0, and NIH HEAL initiative supplement R01 NS104295-01 and R01 AR077691-01.

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Investigating the Pathogenesis of Rare Congenital Nerve Disorder ... - Feinberg News Center