Nervous System Diseases Commons^™

When Biomarkers Disagree: Diagnostic Challenges In Alzheimer’S Disease, Hayya Ali, Omar C. Chishti

Rowan-Virtua Research Day

Alzheimer’s disease (AD) is commonly diagnosed using a combination of clinical evaluation and biomarkers, including amyloid positron emission tomography (PET) imaging and tau protein levels. However, discordant biomarker findings can complicate diagnosis and clinical decision-making. We present a case study of a patient with progressive cognitive decline who demonstrated positive amyloid PET imaging but negative tau biomarkers. The objective of this case report is to demonstrate key diagnostic challenges in Alzheimer’s disease and highlight the need for a comprehensive, multimodal diagnostic approach. This case underscores the limitations of relying on a single biomarker modality and highlights the potential for overlap …

Sleep Architecture And Delirium In Patients With Intracerebral Hemorrhage: A Preliminary Observational Study, Lily Roessler, Kevin Eaise, Jamie Feinour Msn, Crnp, Jennifer Jond Ms, Pa-C, Vanessa Salasky Md, Mikel Shea Ehntholt Md, Bethany C. Young

Rowan-Virtua Research Day

Background: Delirium is common among ICU stroke patients and could possibly be associated with disrupted sleep. However, the relationship between specific sleep characteristics and delirium remains unclear.

Objective: To evaluate the association between sleep architecture and delirium in intracerebral hemorrhage (ICH) patients in the ICU.

Methods: We performed a primary analysis of 14 ICU ICH patients who underwent polysomnography. Sleep variables included total sleep time, sleep efficiency, sleep stages (N1, N2, N3, REM), arousal index, and sleep latency. Delirium was assessed using the Confusion Assessment Method for the ICU (CAM-ICU). Patients were categorized by presence or absence of delirium. Continuous …

Prevalence And Clinical Correlates Of Restless Legs Syndrome In Neuromyelitis Optica Spectrum Disorder: A Systematic Review And Meta‑Analysis, Jamir Pitton Rissardo Md, Daarsh Goradia, Jarvish Shah, Nishant Patel, Pranaya Gade, Ana Leticia Fornari Caprara Md

Rowan-Virtua Research Day

Background: Restless legs syndrome (RLS) is increasingly recognized in neuromyelitis optica spectrum disorder (NMOSD), yet published prevalence estimates remain highly variable, largely because of small sample sizes and methodological heterogeneity. We sought to estimate the pooled prevalence of RLS in NMOSD using published observational studies. Methods: A systematic literature search of PubMed was performed using the terms “restless legs syndrome” AND “neuromyelitis optica spectrum disorder”, identifying all original studies reporting RLS prevalence in NMOSD. Seven studies (2016–2026) met inclusion criteria. Study‑level data on RLS events and NMOSD sample size were extracted. A proportion‑weighted fixed‑effect meta‑analysis was performed. Pooled prevalence estimates …

Wearable And Technology‑Assisted Gait And Balance Interventions In Parkinson’S Disease: A Systematic Review And Meta‑Analysis, Jamir Pitton Rissardo Md, Nishant Patel, Jarvish Shah, Daarsh Goradia, Pranaya Gade, Ana Leticia Fornari Caprara Md

Rowan-Virtua Research Day

Background: Wearable sensors and cue‑based technologies are increasingly used to augment rehabilitation in Parkinson’s disease (PD). However, the magnitude of benefit across clinical domains remains uncertain. Objective: This meta‑analysis aimed to quantify the effects of technology‑assisted interventions in PD. Methods: Randomized controlled trials evaluating wearable‑assisted interventions were systematically identified from PubMed. Outcomes included motor severity (Movement Disorders Society Unified Parkinson Disease Rating Scale Part III), balance (Berg Balance Scale, Mini‑BESTest, POMA balance), gait speed, walking endurance, freezing of gait (FOG‑Q/NFOG‑Q), fear of falling, and quality-of-life (PDQ‑39/PDQ‑8). Meta‑analyses were performed using random‑effects models to account for between‑study heterogeneity. Statistical heterogeneity was …

Trends And Disparities In Mortality Involving Epilepsy And Aspiration Pneumonia Among Older Adults In The United States, 1999–2020, Pranaya Gade, Jarvish Shah, Daarsh Goradia, Nishant Patel, Jamir Pitton Rissardo Md, Ana Leticia Fornari Caprara Md

Rowan-Virtua Research Day

Introduction: Epilepsy in older adults is frequently complicated by swallowing dysfunction, increasing the risk of aspiration pneumonia. Despite its clinical relevance, national trends and demographic disparities in deaths involving these conditions remain poorly characterized. Methods: We analyzed death certificate data from the CDC WONDER Multiple Cause of Death database (1999–2020) for individuals aged ≥65 years with epilepsy (ICD-10 G40, G41) and aspiration pneumonia (J69) listed as causes. Age-adjusted mortality rates (AAMRs) per 100,000 and annual percentage changes (APCs) with 95% confidence intervals were calculated using Joinpoint Regression. Analyses were stratified by sex, race/ethnicity, census region, and state. Results: From 1999 …

Cerebrospinal Fluid And Serum Manganese Levels In Parkinson’S Disease: A Method‑Stratified Meta‑Analysis, Jamir Pitton Rissardo Md, Daarsh Goradia, Jarvish Shah, Nishant Patel, Pranaya Gade, Ana Leticia Fornari Caprara Md

Rowan-Virtua Research Day

Background: Manganese (Mn) exposure can cause parkinsonism, but circulating and cerebrospinal fluid (CSF) Mn levels in idiopathic Parkinson’s disease (PD) have been reported inconsistently. This study aims to determine whether Mn concentrations differ between patients with PD. Methods: A systematic review of PubMed/Medline studies reporting CSF/serum Mn concentrations in PD was done. Random‑effects models with inverse‑variance weighting were used to pool mean differences (MDs). Studies were stratified a priori by analytical method. Results: For CSF Mn, the overall pooled effect showed no significant difference between PD and controls (MD 0.08 μg/L, 95% CI −0.31 to 0.47; I2=85.7%). Subgroup analysis revealed …

Efficacy And Safety Of Levetiracetam For Essential Tremor: A Systematic Review And Meta‑Analysis, Jamir Pitton Rissardo, Daarsh Goradia, Nishant Patel, Jarvish Shah, Pranaya Gade, Ana Leticia Fornari Caprara Md

Rowan-Virtua Research Day

Background: Essential tremor (ET) is a common movement disorder with limited therapeutic options. Levetiracetam has been proposed as a potential treatment, but published studies report inconsistent efficacy and safety findings. We performed a meta‑analysis to quantify the efficacy and safety of levetiracetam in patients with essential tremor using pooled effect estimates. Methods: A systematic review of PubMed was performed to identify clinical studies evaluating levetiracetam for ET. Continuous efficacy outcomes were pooled using standardized mean differences (SMD) with inverse‑variance random‑effects models. Binary adverse events were pooled using risk ratios (RR) with Mantel–Haenszel random‑effects models. Heterogeneity was assessed using I2 statistics. …

Effects Of Subthalamic Nucleus Deep Brain Stimulation On Depressive Symptoms In Patients With Parkinson’S Disease: A Meta‑Analysis, Jamir Pitton Rissardo Md, Jarvish Shah, Nishant Patel, Daarsh Goradia, Pranaya Gade, Ana Leticia Fornari Caprara Md

Rowan-Virtua Research Day

Background: Depression is a prevalent non‑motor symptom of Parkinson’s disease (PD) and may adversely affect quality-of-life and overall treatment outcomes. Subthalamic nucleus deep brain stimulation (STN‑DBS) is an established therapy for motor symptoms, yet its impact on depressive symptoms remains controversial. This meta‑analysis aimed to evaluate the effect of STN‑DBS on depressive symptoms in PD. Methods: PubMed‑indexed studies meeting predefined eligibility criteria were identified and included. Random‑effects meta‑analyses were performed using REML. Mean differences (MDs) between STN‑DBS and control conditions were pooled separately for Beck Depression Inventory (BDI) and its revision (BDI-II), and the Hamilton Depression Rating Scale (HAMD). Heterogeneity …

Collet–Sicard Syndrome Secondary To Internal Carotid Artery Dissection Following Cervical Self-Manipulation, Ryan K. Alali, James Espinosa Md, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 40-year-old male presenting with progressive dysphagia who was ultimately diagnosed with Collet–Sicard syndrome secondary to internal carotid artery (ICA) dissection. While most reported cases are associated with trauma, this case highlights an atypical etiology following cervical self-manipulation. The patient presented with dysphagia to solids, liquids, and saliva, along with several days of ipsilateral headache and neck pain. Neurologic examination revealed tongue deviation, prompting advanced imaging. CTA demonstrated left ICA dissection, which was further characterized on MRI. The patient was managed with dual antiplatelet therapy and multidisciplinary care, including neurology, neurosurgery, and speech-language pathology, and …

High-Intensity Interval Training And Circulating Brain-Derived Neurotrophic Factor In Healthy Young Adults: A Scoping Review, Rikuto Abe, Safe Elhakeem, Mohamed Elhakeem

Rowan-Virtua Research Day

Abstract

Background: Brain-derived neurotrophic factor (BDNF) plays an important role in synaptic plasticity, neuronal survival, and cognitive function (1,2,3). High-intensity interval training (HIIT) has emerged as a time-efficient exercise modality capable of inducing neurotrophic adaptations (4,5). However, the magnitude and consistency of its effects on circulating BDNF remain unclear.

Objective: This scoping review evaluated the current evidence examining the effects of HIIT on circulating BDNF levels measured via enzyme-linked immunosorbent assay (ELISA) in healthy young adults.

Methods: A systematic search of PubMed, Embase, and Scopus was conducted for randomized and controlled clinical trials published between 2020 and 2025. Studies were …

Gut Microbiota Dysbiosis In Down Syndrome: Implications For Gastrointestinal And Neurological Health, Ashlyn Mcclelland, Jennifer Lecomte, Wendy Aita, Andrea Iannuzzelli

Rowan-Virtua Research Day

Down syndrome (DS) is the most common autosomal aneuploidy and has strong associations with increased gastrointestinal, neurological, and immune disorders. Emerging evidence suggests that gut microbiota dysbiosis may play a prominent role in disorders of gut-brain interaction, including constipation and irritable bowel syndrome affecting over half of individuals with DS. This review examines how gut microbiota alterations can contribute to chronic systemic inflammation and neurological manifestations in DS. Included articles were published between 2014 and 2025 and evaluated microbiota composition, inflammatory markers, and gastrointestinal or neurological outcomes in human or animal models of DS.

Across seven studies, characteristic microbiome shifts …

Holmes Tremor In A Patient With Multiple Sclerosis: A Case Report, Delaney Rowe

Rowan-Virtua Research Day

Multiple Sclerosis (MS) is a neurologic condition characterized by demyelination of motor neuron axons. About a third of MS patients experience tremor, typically postural or intention type. This case study details a patient with a history of Multiple Sclerosis-associated therapy-resistant severe rubral tremor. Reviewed literature demonstrates an increased need for diagnostic tools specific to MS patients with Holmes tremors, as well as further investigation of dopamine-based pharmacologic therapy for such patients.

Feasibility Of 90-Day Follow Up For Patients With Intracerebral Hemorrhage: Early Data From A Neuro Icu Sleep Quality And Delirium Study, Sierra Triolo, Bethany C. Young, Mikel Shea Ehntholt, Anuoluwapo Fadare, Jamie R. Feinour, Jennifer A. Jond, Jonathan Perumpail, Kevin Eaise, Lily Roessler, Shay Lynn Greco, Vanessa Salasky

Rowan-Virtua Research Day

Background. Neuro intensive care unit (ICU) patients often experience sleep deprivation due to serial neurologic assessments, among other factors. Subjective sleep disturbance has been associated with increased delirium risk in patients with intracerebral hemorrhage (ICH).¹ However, relationships between specific sleep features, delirium and subsequent outcomes in neurocritically ill patients have not been studied.¹ Additionally, ICH-related clinical research has not historically been conducted at Virtua Our Lady of Lourdes (VOLOL) Hospital. This study aimed to assess feasibility of obtaining quantitative sleep data, delirium assessments, and 90-day functional outcomes in neurocritical care patients with ICH.

Hypothesis. We hypothesized that 90-day …

Targeting The Dorsolateral Prefrontal Cortex With Transcranial Direct Current Stimulation To Improve Depression And Anxiety In Parkinson's Disease, Brock Renicks

Honors Theses

The aim of this study is to observe the outcomes of transcranial direct current stimulation (tDCS) as a treatment for Parkinson’s Disease (PD). This study will primarily look at changes in depression and anxiety, as these symptoms are often comorbid with Parkinson’s Disease. Transcranial direct current stimulation is a non-invasive, very low-intensity form of electrical stimulation of the brain. It is being increasingly used as a form of treatment for Parkinson’s Disease and depression and anxiety, however the literature is ambiguous, showing mixed results throughout various studies, with no standardization of tDCS administration. To determine the effect of tDCS on …

Targeting The Dorsolateral Prefrontal Cortex With Transcranial Direct Current Stimulation To Improve Depression And Anxiety In Parkinson’S Disease, Brock Renicks

Poster Presentations

Around 40% of people with Parkinson’s Disease experience depression and anxiety (Zhao et al, 2025). Depression and Anxiety have been said to be localized to the dorsolateral prefrontal cortex (Brunoni et al, 2016). Transcranial Direct current stimulation (tDCS) has been shown to modulate depression and anxiety by targeting the dorsolateral prefrontal cortex (Sreeraj et al, 2023). It is beneficial due to its cost, portability, and simplicity of use. Thus we will be assessing the efficacy of tDCS in reducing depression and anxiety in individuals with Parkinson’s Disease.

Novel Biomarker Discovery In Multiple Sclerosis, Manisha Gangasani

Honors Theses

Multiple Sclerosis (MS) is a chronic neuroinflammatory disorder affecting the brain, spinal cord, and optic nerve. Patients experience cognitive, motor, autonomic, and emotional symptoms that often overlap with other neurological conditions, making early diagnosis challenging. Current diagnostic criteria require evidence of lesions with dissemination in time and space. Racial disparities in MS outcomes are well documented, with Black individuals often exhibiting greater disease severity, higher relapse rates, and increased disability compared to White individuals. These differences likely reflect a combination of genetic, biological, environmental, and healthcare access factors, underscoring the need to improve early diagnosis and reduce inequities in care. …

Play To Win: A Randomized Controlled Trial To Assess The Effects Of Play-Based Training On Upper Extremity Function In Children With Hemiplegia, Vivian London

Honors Scholar Theses

Hemiplegia, or paralysis of one side of the body, is the primary symptom of unilateral cerebral palsy, a subtype of cerebral palsy, the most common movement disorder in children. Standard of care is regular physical and occupational therapy to improve performance in bimanual activities, but conventional therapy can be expensive and draining for caregivers and children, so a need exists for a novel intervention that can take place at home and that is economical for families while being engaging for children. This thesis reports data from a subset of ten children seen as part of a randomized controlled clinical trial …

Safety And Efficacy Of Individualised Exercise And Nad+ Precursor Supplementation In Patients With Friedreich’S Ataxia In The Usa: A Single-Centre, 2 × 2 Factorial, Randomised Controlled Trial, Kimberly Lin, Anna Bucha, Kara Mcsweeney, Kristin Wade, Antoneta Karaj, Jaclyn Tamaroff, Shannon O'Malley, Nicole Chung, Nicolette Cilenti, Julianne Wanner, Gabriel Adzika, Clementina Mesaros, Ian Blair, Teerapat Rojsajjakul, Suraj Serai, Jennifer Farmer, Kyle Bryant, Yingying Lu, Michael Harhay, David Weber, Stephen Paridon, Erin Seifert, Mary Putt, Payman Zamani, Joseph Baur, David Lynch, Shana Mccormack

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

BACKGROUND:Friedreich's ataxia is a rare, chronic, progressive, neurodegenerative condition affecting multiple organ systems, including neurological, musculoskeletal, cardiac, and endocrine systems, and is marked by low cardiopulmonary fitness. We tested the effect of exercise and NAD⁺ precursor supplementation with nicotinamide riboside, which have each shown benefits in animal and early clinical studies, on cardiopulmonary fitness in individuals with Friedreich's ataxia.

METHODS: This 12-week, outpatient, phase 2, single-site (Children's Hospital of Philadelphia, Philadelphia, PA, USA), randomised, 2 × 2 factorial clinical trial recruited individuals aged 10–40 years with an ejection fraction of 45% or greater who were able to exercise. A …

Pattern Dynamics And Stochasticity Of Brain Rhythms And Spike Trains In A Tauopathy Mouse Model Of Alzheimer’S Disease, Clarissa M. Hoffman

Dissertations and Theses (Open Access)

Systems neuroscience posits that every aspect of perceived physical reality, every aspect of animal and human behavior, and every cognitive phenomenon emerges from patterns of neuronal activity. While most researchers embrace this idea, there are major difficulties in describing and analyzing these complex neuronal dynamics—spike flows produced by cells ensembles, synchronized extracellular field oscillations, and other patterns—which limits our understanding of how the activity of individual neurons and the whole-animal cognition and behavior might be connected. In particular, we lack the approaches and even the semantics for connecting the individual cell outputs and the integrated results of their activity. Current …

Assessment Of Clinical And Neuroimaging Efficacy Of Treatment Targeting Tau Pathology In Mild Cognitive Impairment And Mild To Moderate Alzheimer’S Disease With Hydromethylthionine Mesylate Using External Control Data, Bjoern O. Schelter, Helen Shiells, Serena Lo, Nafeesa Nazlee, Emily Evans, Peter Bentham, Serge Gauthier, Henrik Zetterberg, Gordon K. Wilcock, Lutz Froelich, Alistair Burns, Emer Macsweeney, Clive Ballard, Jin-Tai Yu, Tay Siew Choon, Vahe Asvatourian, Natalia Muehlemann, Jan Priel, Karin Kook, Tenecia Sullivan, Diane Downie, Sonya Miller, Carol Pringle, John M. D. Storey, Tom Baddeley, Charles R. Harrington, Roger Staff, Anca-Larisa Sandu, Claire Hull, Richard G. Stefanacci, Claude M. Wischik

College of Population Health Faculty Papers

BACKGROUND: Hydromethylthionine mesylate (HMTM) targets tau pathology and also has tau-independent symptomatic activity. A traditional randomised placebo-controlled trial (RCT) was precluded by loss of blinding due to urinary colouration and therapeutic activity at the minimum dose required to maintain blinding.

OBJECTIVE: To evaluate the efficacy of HMTM in participants with mild cognitive impairment (MCI) and mild to moderate dementia due to Alzheimer's disease (AD).

METHODS: Because a traditional RCT was not feasible without loss of blinding, we compared HMTM 16 mg/day in TRx-237-039 with propensity score matched true placebo controls from the FDA-sponsored Critical Path for AD (CPAD) database with …

Brain Delivery Of Antibody-Derived Biologicals For Alzheimer’S Disease: An Updated Narrative Review, Rachita K. Sumbria, Ruben J. Boado

Pharmacy Faculty Articles and Research

Antibodies directed against β-amyloid (Aβ) have been developed for the treatment of Alzheimer’s disease (AD). However, the in vivo central efficacy is reduced by the poor penetration of antibodies across the blood–brain barrier (BBB). In addition, these antibodies have been associated with adverse effects like amyloid-related imaging abnormalities. Thus, the development of new antibody-based therapies for AD with improved transport across the BBB may improve efficacy and reduce adverse effects. Antibodies targeting the BBB transferrin receptor (TfR) are able to cross the BBB through receptor-mediated transcytosis, producing a global distribution throughout the brain. Along the same line, bispecific antibodies directed …

Sedentary Behavior Modifies The Effect Of Balance Rehabilitation On Balance Discordance In Parkinson’S Disease, Franziska Albrecht, Sarah J. Conklin, Andrew Hooyman, Daniel S. Peterson, Jason K. Longhurst, Erika Franzén

Physical Therapy Faculty Articles and Research

Individuals with Parkinson’s disease (PD) often experience a misalignment between their perceived and actual balance ability, known as balance discordance, which has been associated with falls. We examined whether high-intensity balance and gait training (HiBalance) alters balance discordance in individuals with PD, and whether baseline sedentary behavior influences these changes. A secondary analysis examining pre- to post-intervention discordance changes of two HiBalance clinical trials (N = 97) using linear regression with interactions between sedentary behavior and pre-intervention discordance. The sample included two cohorts: one clinical and one research based. The model including sedentary behavior and its interaction with pre-intervention …

Bilateral Intracranial Subdural Hematoma Following Epidural Anesthesia, Eric B. Cox, Adaeza Onuoha

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

Structural Degeneration Of The Neoaortic Valve Leading To Pseudoaneurysm And Neurologic Complications Post-Ross Procedure, Cassandra Millan, Sarita Thanedar, Chandra Kunavarapu

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

Dual Antiplatelet Therapy And Bleeding Risk In Carotid Endarterectomy, Sara Khan, Sydney Parker, Ryan Turley

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

The Unusual Suspects: A Rare Presentation Of Waterhouse-Friderichsen Syndrome, Nafis Deen, Nawsin Baset, Bravein Amalakuhan

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

An Unusual Brain Invader: A Case Of Adult Viral Meningitis, Gregory Williams, Jonathan Barnett

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

Progressive Neuropathy With Normal Vitamin B12 Levels And Demyelinating Findings, Michael Rollins, Juan Rodriguez, Laura Preece

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

Symptomatic Chiari 1 Malformation In A 35-Year-Old Female, Ignatius Mmodebelu, Jaime Natividad, Jonathan Carpenter, Juan Rodriguez

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

Improving Anesthesia Provider Confidence In The Identification, Management, And Treatment Of Postoperative Delirium, Brittany M. Whistle, Charles Dustin Phelps

Scholars Week

Purpose: Postoperative Delirium (POD) is a potentially devastating complication of anesthesia that is poorly understood by clinical staff leading to poor outcomes for surgical patients. This study is meant to determine if a focused knowledge presentation accompanied by visual aids could increase anesthesia providers confidence in identifying, diagnosing, and treating Postoperative Delirium.

Methodology: Utilizing a statistical model to analyze respondents results on a standardized test administered before and after an informational presentation with visual aids on the topic of Postoperative Delirium.

Results: Results indicated a statistically significant difference between pretest and posttest scores, with a p-value of .002, t(11) = …