Neurosciences Commons^™

Risk Factors Associated With Moderate And Severe Traumatic Brain Injury Mortality In Admitted Older Adults: A Retrospective, Single-Center Study At A Level Ii Trauma Center., Michael Sawyers, Katherine Graham, John Elliott, Jeff Hubartt

Trauma and Acute Care Articles

Purpose: Approximately one in four adults aged ≥65 years experiences a fall each year, and over one-third of these events require medical care. Older adults are at higher risk of complications because of comorbidities. Most prior studies have focused on incidence rather than outcomes, and few have evaluated the association between age and traumatic brain injury (TBI) mortality. This study assessed risk factors and risk-adjusted mortality and morbidity among older adults with moderate or severe TBI.

Methods: We conducted a retrospective review of data from a single-center trauma registry. Inclusion criteria were age ≥65 years, admission ≥3 days (2019-2024), Abbreviated …

Amyloid-Related Imaging Abnormalities Summit Special Proceedings: Cardiovascular And Stroke Considerations For Β-Amyloid Immunotherapy In Alzheimer Disease., Steven M Greenberg, Costantino Iadecola, Sherry H-Y Chou, Petrice M Cogswell, Mitchell S V Elkind, William J Hicks, Caitlin Le, Deborah A Levine, Richard Lipton, Lauren Massimo, Stephanie M Mohl, Sudha Seshadri, Heather M Snyder, Kristine Yaffe, Kori S Zachrison, Aria Summit Working Group

Neuroscience Articles

BACKGROUND: New antiamyloid therapies (AAT) for treating patients with early Alzheimer disease (AD) have become available in the past 3 years. Although AAT can be beneficial in slowing progression of AD, they also come with potentially serious side effects, particularly for patients requiring anticoagulation or thrombolysis for cardiovascular conditions. Given that most patients with AD are older and likely to have cardiovascular risk factors, there is urgent need for additional guidance for clinicians about potential risks and benefits associated with AAT for patients with cardiovascular comorbidities, best practices for management of these patients, and special considerations with respect to emergency …

Efficacy And Safety Of A Bodyweight-Adjusted Higher Dose Of Ocrelizumab In Relapsing (Musette) And Primary Progressive (Gavotte) Multiple Sclerosis: Two Multicentre, Randomised, Double-Blind, Parallel-Group Phase 3b Trials., Stephen L Hauser, Gavin Giovannoni, Xavier Montalban, Jiwon Oh, Amit Bar-Or, Maria Pia Sormani, Martin S Weber, Sharon Stoll, Jacqueline A Nicholas, Tetyana Nehrych, Robert Bonek, Krzysztof Selmaj, Maciej Maciejowski, Dusanka Zecevic, Catarina Raposo, Rebecca Owen, Ulrike Bonati, Katrin Madjar, Eva Harfst, Qing Wang, Anastasiia Raievska, Marianna Manfrini, Hans-Martin Schneble, Ludwig Kappos, Musette And Gavotte Study Groups

Neuroscience Articles

BACKGROUND: Ocrelizumab is a humanised anti-CD20 monoclonal antibody approved for people with relapsing (RMS) or primary progressive multiple sclerosis (PPMS). In a post-hoc analysis of phase 3 trials in RMS and PPMS using a 600 mg dose, higher exposure to ocrelizumab was associated with greater B-cell depletion and lower risk of confirmed disability progression. Here, we prospectively assessed the efficacy and safety of a high dose of ocrelizumab in patients with RMS or PPMS.

METHODS: Two multicentre, double-blind, phase 3 controlled trials were conducted to compare high-dose ocrelizumab with the approved 600 mg dose of the drug in patients with …

Implementing In-House Compounding Of Nimodipine Oral Syringes For Aneurysmal Subarachnoid Hemorrhage Patients., Keaton S Smetana, Kerri J Wilcox, Aaron M Cook

Neuroscience Articles

No abstract provided.

Associations Of Snfl With Clinico-Radiological Measures In A Large Ms Population., Elias S Sotirchos, Kathryn C Fitzgerald, Carol M Singh, Matthew D Smith, Maria Reyes-Mantilla, Carrie M Hersh, Megan H Hyland, Ryan Canissario, Sarah B Simmons, Georgina Arrambide, Xavier Montalban, Manuel Comabella, Robert T Naismith, Min Qiao, Lauren B Krupp, Jacqueline A Nicholas, Katja Akgün, Tjalf Ziemssen, Richard Rudick, Elizabeth Fisher, Robert A Bermel, Ellen M Mowry, Peter A Calabresi

Neuroscience Articles

OBJECTIVE: Evaluation of serum neurofilament light chain (sNfL), measured using high-throughput assays on widely accessible platforms in large, real-world MS populations, is a critical step for sNfL to be utilized in clinical practice.

METHODS: Multiple Sclerosis Partners Advancing Technology and Health Solutions (MS PATHS) is a network of healthcare institutions in the United States and Europe collecting standardized clinical/imaging data and biospecimens during routine clinic visits. sNfL was measured in 6974 MS and 201 healthy control (HC) participants, using a high-throughput, scalable immunoassay.

RESULTS: Elevated sNfL levels for age (sNfL-E) were found in 1238 MS participants (17.8%). Factors associated with …

Benefits Of Early Treatment With Natalizumab: A Real-World Study., Daniel Ontaneda, Ellen M Mowry, Scott D Newsome, Robert T Naismith, Jacqueline Nicholas, Elizabeth Fisher, Carl De Moor, Justin Bohn, Pei-Ran Ho, Al Sandrock, Richard Rudick, James R Williams

Ambulatory and Primary Care Articles

BACKGROUND: The impact of early versus later high-efficacy disease-modifying therapy (DMT) in patients with multiple sclerosis (MS) is uncertain. This study reported the association of early versus later natalizumab treatment with real-world clinical outcomes in MS patients.

METHODS: The study included 661 participants diagnosed with MS in 1994 or later from 7 US centers participating in the MS Partners Advancing Technology for Health Solutions (MS PATHS) network. Time to natalizumab treatment between diagnosis and first infusion (TTNT) was determined from the Tysabri Outreach: Unified Commitment to Health (TOUCH) registry. Clinical outcomes were defined using neuroperformance tests included in the Multiple …

Satisfaction With Alemtuzumab In Relapsing Multiple Sclerosis Patients: Results From The Real-World Pro-Act Study., Sibyl Wray, Francois Jacques, Tamara A Miller, Jacqueline A Nicholas, Rafael Arroyo, Lori Travis, Bhupendra Khatri, Magdalena Chirieac, Roopali Gandhi, Nora Roesch, Amelie Rodrigues, Lydie Melas-Melt, Andreea M Rawlings, Samuel F Hunter

Ambulatory and Primary Care Articles

BACKGROUND: Patient-reported outcomes are increasingly used in the management of patients with multiple sclerosis to understand the patient's perspective of disease and treatment. These measures provide insights into important factors including treatment satisfaction, physical and psychological function, and quality of life.

OBJECTIVE: To present results from the real-world PRO-ACT study in patients with multiple sclerosis who switched to alemtuzumab from another disease-modifying therapy.

METHODS: This 24-month, prospective, multicenter, observational study had a primary endpoint of change in overall satisfaction, measured using the Treatment Satisfaction Questionnaire for Medication (TSQM) version 1.4. Secondary endpoints included the Multiple Sclerosis Impact Scale-29 (MSIS-29), Modified …

Sugammadex To Facilitate Neurologic Assessment In Severely Brain-Injured Patients: A Retrospective Analysis And Practical Guidance., Sara J Hyland, Punit A Pandya, Cameron J Mei, David C Yehsakul

Neuroscience Articles

Background Widely used in anesthetic management, sugammadex is increasingly employed in the reversal of neuromuscular blocking agents (NMBAs) in the emergency department and critical care arena, where little evaluative data currently exists. This study explored the utility and safety of using sugammadex to facilitate neurologic assessments in critically ill, NMBA-exposed patients. Methods We pursued a retrospective case series and single-arm cohort analysis of all brain-injured patients receiving sugammadex to facilitate neurologic evaluation during one year at a high-volume Level 1 trauma center. The primary outcome was the qualitative impact of sugammadex administration on neurosurgeon decision-making. Secondary outcomes included the change …

Tracking Health Behaviors In People With Multiple Sclerosis (Trac-Ms): Study Protocol And Description Of The Study Sample., Ruchika S Prakash, Heena R Manglani, Elizabeth J Duraney, Anita Shankar, Megan E Fisher, Alisha Janssen, Lauren Cea, Rick Petosa, Rebecca Andridge, Jacqueline Nicholas

Ambulatory and Primary Care Articles

INTRODUCTION: People with multiple sclerosis (PwMS) experience a range of physical, cognitive, and affective symptoms. Behavioral interventions targeting increased physical activity show promising support as low-cost methods to improve working memory, episodic memory, and processing speed in PwMS. In this randomized controlled trial, we will examine the efficacy of a pedometer-tracking intervention, designed to increase low-to-moderate levels of physical activity, for improving working memory in PwMS.

METHODS AND ANALYSIS: Eighty-seven PwMS, between the ages of 30-59, have been recruited for the study. Seventy-five of the eligible and interested individuals were randomized to six-month health behavior monitoring groups: a Step-track group …

Safety Experience With Continued Exposure To Ofatumumab In Patients With Relapsing Forms Of Multiple Sclerosis For Up To 3.5 Years., Stephen L Hauser, Anne H Cross, Kevin Winthrop, Heinz Wiendl, Jacqueline Nicholas, Sven G Meuth, Paul S Giacomini, Francesco Saccà, Linda Mancione, Ronald Zielman, Morten Bagger, Ayan Das Gupta, Dieter A Häring, Valentine Jehl, Bernd C Kieseier, Ratnakar Pingili, Dee Stoneman, Wendy Su, Roman Willi, Ludwig Kappos

Ambulatory and Primary Care Articles

BACKGROUND: Ofatumumab is approved for the treatment of relapsing multiple sclerosis (RMS). Ongoing safety reporting is crucial to understand its long-term benefit-risk profile.

OBJECTIVE: Report the safety and tolerability of ofatumumab in RMS after extended treatment up to 3.5 years.

METHODS: Patients completing ASCLEPIOS I/II (phase 3), APLIOS, or APOLITOS (phase 2) trials could enter ALITHIOS, a phase 3b, open-label, long-term safety study. We analyzed cumulative data of continuous ofatumumab treatment and of patients newly switched from teriflunomide.

RESULTS: The safety population had 1969 patients: 1292 continuously treated with ofatumumab (median time-at-risk 35.5 months, 3253 patient-years) and 677 newly switched …

Static And Group-Based Trajectory Analyses Of Factors Associated With Non-Adherence In Patients With Multiple Sclerosis Newly-Initiating Once- Or Twice-Daily Oral Disease-Modifying Therapy., Jacqueline A Nicholas, Natalie C Edwards, Roger A Edwards, Anna Dellarole, Luigi Manca, Danielle E Harlow, Amy L Phillips

Ambulatory and Primary Care Articles

BACKGROUND: Increased understanding of adherence may facilitate optimal targeting of interventions.

OBJECTIVE: To utilize group-based trajectory modeling (GBTM) to understand longitudinal patterns of adherence and factors associated with non-adherence in patients with multiple sclerosis (MS) newly-initiating once-/twice-daily oral disease-modifying therapy (DMT) (fingolimod, dimethyl fumarate, or teriflunomide).

METHODS: Commercial plan data were analyzed using proportion of days covered (PDC) to evaluate factors associated with non-adherence. GBTM clustered patient subgroups with similar longitudinal patterns of adherence measured by monthly PDC (≥80%) and multinomial logistic regression identified factors associated with adherence trajectory subgroups.

RESULTS: Among 7689 patients, 39.5% were non-adherent to once-/twice-daily oral …

Efficacy Of Alemtuzumab In Relapsing-Remitting Ms Patients Who Received Additional Courses After The Initial Two Courses: Pooled Analysis Of The Care-Ms, Extension, And Topaz Studies., Giancarlo Comi, Raed Alroughani, Aaron L Boster, Ann D Bass, Regina Berkovich, Óscar Fernández, Ho Jin Kim, Volker Limmroth, Jan Lycke, Richard Al Macdonell, Basil Sharrack, Barry A Singer, Patrick Vermersch, Heinz Wiendl, Tjalf Ziemssen, Alan Jacobs, Nadia Daizadeh, Claudio E Rodriguez, Anthony Traboulsee, Care-Ms I, Care-Ms Ii, Camms03409, And Topaz Investigators

Neuroscience Articles

BACKGROUND: Alemtuzumab is given as two annual courses. Patients with continued disease activity may receive as-needed additional courses.

OBJECTIVE: To evaluate efficacy and safety of additional alemtuzumab courses in the CARE-MS (Comparison of Alemtuzumab and Rebif

METHODS: Subgroups were based on the number of additional alemtuzumab courses received. Exclusion criteria: other disease-modifying therapy (DMT); < 12-month follow-up after last alemtuzumab course.

RESULTS: In the additional-courses groups, Courses 3 and 4 reduced annualized relapse rate (12 months before: 0.73 and 0.74, respectively; 12 months after: 0.07 and 0.08). For 36 months after Courses 3 and 4, 89% and 92% of patients were free of 6-month confirmed disability worsening, …

Robotic Deep Brain Stimulation (R-Dbs)-"Awake" Deep Brain Stimulation Using The Neuromate Robot And O-Arm., Girish K Hiremath

Neuroscience Articles

BACKGROUND: Deep brain stimulation (DBS) is an effective surgical technique used to ameliorate the motor symptoms associated with Parkinson's disease. One of the key elements that determine successful patient outcomes is the accurate positioning of the DBS electrode during surgery.

OBJECTIVE: To describe a robotic DBS (R-DBS) procedure using "awake" technique.

METHODS AND MATERIALS: This procedure was performed using a frame-based approach with the NeuroMate surgical robot and intraoperative image verification of DBS electrode placement using the O-arm mobile x-ray system. The procedure was performed "Awake" using microelectrode recording (MER), stimulation, and macro-electrode testing.

RESULTS: The accurate placement of DBS …

Efficacy Of Alemtuzumab Over 6 Years In Relapsing-Remitting Multiple Sclerosis Patients Who Relapsed Between Courses 1 And 2: Post Hoc Analysis Of The Care-Ms Studies., Bart Van Wijmeersch, Barry A Singer, Aaron Boster, Simon Broadley, Óscar Fernández, Mark S Freedman, Guillermo Izquierdo, Jan Lycke, Carlo Pozzilli, Basil Sharrack, Brian Steingo, Heinz Wiendl, Sibyl Wray, Tjalf Ziemssen, Luke Chung, David H Margolin, Karthinathan Thangavelu, Patrick Vermersch

Neuroscience Articles

BACKGROUND: Alemtuzumab is administered as two annual courses for relapsing-remitting multiple sclerosis (MS). Patients may relapse before completing the two-course regimen.

OBJECTIVE: The objective was to evaluate 6-year outcomes in patients who relapsed between alemtuzumab Courses 1 and 2 (early relapsers).

METHODS: Post hoc analysis of patients from the Comparison of Alemtuzumab and Rebif

RESULTS: Early relapsers (CARE-MS I: 15%; CARE-MS II: 24%) had more relapses in 1-2 years pre-alemtuzumab and higher mean baseline Expanded Disability Status Scale score than patients without relapse. Their annualized relapse rate declined from Year 1 (CARE-MS I: 1.3; CARE-MS II: 1.2) to Year 2 …

Safety Results Of Administering Ocrelizumab Per A Shorter Infusion Protocol In Patients With Primary Progressive And Relapsing Multiple Sclerosis., Timothy L Vollmer, Jeffrey A Cohen, Enrique Alvarez, Kavita V Nair, Aaron Boster, Joshua Katz, Gabriel Pardo, Jinglan Pei, Pranil Raut, Sharmin Merchant, Elizabeth Maclean, Ashish Pradhan, Brandon Moss

Neuroscience Articles

BACKGROUND: Ocrelizumab is an approved MS treatment administered as two 300-mg intravenous infusions 2 weeks apart (Dose 1), each lasting approximately 2.5 hours, followed by single 600-mg infusions every 6 months lasting approximately 3.5 hours. Our objective was to evaluate shorter-duration ocrelizumab infusions in the Phase IIIb open-label SaROD study (NCT03606460).

METHODS: Eligible patients received ocrelizumab 600-mg Dose 2 or 3 infused over approximately 2 hours (Cohort 1) or ocrelizumab 300-mg Dose 1, Infusion 2 over approximately 1.5 hours (Cohort 2). The primary endpoint was the number and proportion of patients experiencing Grade 3-4 infusion-related reactions (IRRs) in Cohort 1. …

A Noteworthy Case Report Of Neuroborreliosis In An Unvaccinated Pediatric Patient., Amber R Walker, Teresita Morales-Yurick

Neuroscience Articles

INTRODUCTION: Lyme disease typically presents with viral-like symptoms and a pathognomonic rash. With disease progression, symptoms of nervous system involvement usually include facial nerve palsy and meningitis, but other atypical neurologic manifestations have less commonly been documented.

CASE REPORT: A six-year-old male presented with prolonged fevers, rash, headache, and non-specific neurologic symptoms. The diagnosis of neuroborreliosis with meningitis and polyradiculitis was confirmed with laboratory evaluation and lumbar puncture.

CONCLUSION: Neuroborreliosis is a disseminated form of Lyme disease. While meningitis is a common sign, the presentation of polyradiculitis in children is rare and can lead to misdiagnosis and delay in treatment.

Nine-Year Prospective Efficacy And Safety Of Brain-Responsive Neurostimulation For Focal Epilepsy., Dileep R Nair, Kenneth D Laxer, Peter B Weber, Anthony M Murro, Yong D Park, Gregory L Barkley, Brien J Smith, Ryder P Gwinn, Michael J Doherty, Katherine H Noe, Richard S Zimmerman, Gregory K Bergey, William S Anderson, Christianne Heck, Charles Y Liu, Ricky W Lee, Toni Sadler, Robert B Duckrow, Lawrence J Hirsch, Robert E Wharen, William Tatum, Shraddha Srinivasan, Guy M Mckhann, Mark A Agostini, Andreas V Alexopoulos, Barbara C Jobst, David W Roberts, Vicenta Salanova, Thomas C Witt, Sydney S Cash, Andrew J Cole, Gregory A Worrell, Brian N Lundstrom, Jonathan C Edwards, Jonathan J Halford, David C Spencer, Lia Ernst, Christopher T Skidmore, Michael R Sperling, Ian Miller, Eric B Geller, Michel J Berg, A James Fessler, Paul Rutecki, Alica M Goldman, Eli M Mizrahi, Robert E Gross, Donald C Shields, Theodore H Schwartz, Douglas R Labar, Nathan B Fountain, W Jeff Elias, Piotr W Olejniczak, Nicole R Villemarette-Pittman, Stephan Eisenschenk, Steven N Roper, Jane G Boggs, Tracy A Courtney, Felice T Sun, Cairn G Seale, Kathy L Miller, Tara L Skarpaas, Martha J Morrell, Rns System Ltt Study

Neuroscience Articles

OBJECTIVE: To prospectively evaluate safety and efficacy of brain-responsive neurostimulation in adults with medically intractable focal onset seizures (FOS) over 9 years.

METHODS: Adults treated with brain-responsive neurostimulation in 2-year feasibility or randomized controlled trials were enrolled in a long-term prospective open label trial (LTT) to assess safety, efficacy, and quality of life (QOL) over an additional 7 years. Safety was assessed as adverse events (AEs), efficacy as median percent change in seizure frequency and responder rate, and QOL with the Quality of Life in Epilepsy (QOLIE-89) inventory.

RESULTS: Of 256 patients treated in the initial trials, 230 participated in …

Harnessing Real-World Data To Inform Decision-Making: Multiple Sclerosis Partners Advancing Technology And Health Solutions (Ms Paths)., Ellen M Mowry, Robert A Bermel, James R Williams, Tammie L S Benzinger, Carl De Moor, Elizabeth Fisher, Carrie M Hersh, Megan H Hyland, Izlem Izbudak, Stephen E Jones, Bernd C Kieseier, Hagen H Kitzler, Lauren Krupp, Yvonne W Lui, Xavier Montalban, Robert T Naismith, Jacqueline A Nicholas, Fabio Pellegrini, Alex Rovira, Maximilian Schulze, Björn Tackenberg, Mar Tintore, Madalina E Tivarus, Tjalf Ziemssen, Richard A Rudick

Neuroscience Articles

Background: Multiple Sclerosis Partners Advancing Technology and Health Solutions (MS PATHS) is the first example of a learning health system in multiple sclerosis (MS). This paper describes the initial implementation of MS PATHS and initial patient characteristics. Methods: MS PATHS is an ongoing initiative conducted in 10 healthcare institutions in three countries, each contributing standardized information acquired during routine care. Institutional participation required the following: active MS patient census of ≥500, at least one Siemens 3T magnetic resonance imaging scanner, and willingness to standardize patient assessments, share standardized data for research, and offer universal enrolment to capture a representative sample. …

Real-World Cost Of Treatment For Multiple Sclerosis Patients Initiating And Receiving Infused Disease-Modifying Therapies Per Recommended Label In The United States., Jacqueline Nicholas, Rachel Halpern, Marina Ziehn, Jesse Peterson-Brandt, Michael Leszko, Chinmay Deshpande

Neuroscience Articles

Aims: The study evaluated the real-world cost of treatment in multiple sclerosis (MS) patients initiating infused disease-modifying-therapies (DMT) in the United States.Materials and Methods: This retrospective cohort study using administrative claims data included adult patients with MS initiating index infusion DMT (ocrelizumab (OCR), natalizumab (NTZ) or alemtuzumab (ATZ)) from April 2017-September 2018 with 6-months pre/12-months post-index continuous enrollment. The primary cohort included patients who had prescribed annual dosing visits indicated by the approved product label (PL): 3 OCR, 5 ATZ, and 12-13 NTZ infusion visits within the first year of initiation. Annual treatment cost was the sum of all …

Burden Of Relapsing-Remitting Multiple Sclerosis On Workers In The Us: A Cross-Sectional Analysis Of Survey Data., Jacqueline A Nicholas, Batul Electricwala, Lulu K Lee, Kristen M Johnson

Neuroscience Articles

BACKGROUND: Multiple sclerosis (MS) is prevalent among working age individuals (20-60 years), leading to high burden on work productivity. Few data are available about the absenteeism and presenteeism in employed individuals with MS in comparison to non-MS personnel. This study aimed to quantify the burden of illness of employed US adults with relapsing-remitting multiple sclerosis (RRMS) and examine burden by levels of work impairment.

METHODS: A retrospective cross-sectional analysis was conducted using patient-reported responses from the US National Health and Wellness Survey (NHWS). Data from NHWS 2015-2016 were analyzed from 196 employed RRMS respondents who were matched 1:4 to employed …

Sex, Drugs, And Seizures: Subarachnoid Hemorrhage In A Young Patient., Alex Davis, Eric Cortez, Andrew Kalnow

Neuroscience Articles

A 17-year-old male patient presented to the emergency department (ED) with seizures after sexual intercourse. The patient was found to have an intracerebral hemorrhage (ICH) likely secondary to sexual intercourse and concomitant amphetamine use, an extremely rare finding in this patient population. In this case review, we will discuss the presentation, management, and disposition of subarachnoid hemorrhage (SAH), a well-known emergency diagnosis within the ED, while highlighting a case that is clearly uncommon. In addition, we discuss the etiology of ICH in the setting of intercourse and amphetamine use with the ultimate goal of understanding the interdisciplinary care of a …

Anti-N-Methyl-D-Aspartate Receptor Encephalitis., Gregory Tanquary, William Fraser, Kaitlin M Bowers

Neuroscience Articles

Anti-N-methyl-D-aspartate receptor (NMDA) encephalitis is an underrecognized encephalitis that may be mistaken for a wide variety of mental illnesses and causes of delirium. This syndrome is predominantly present in young females presenting with acute psychotic episodes, autonomic instability, and neurologic abnormalities. It is commonly associated with ovarian teratoma. Our case illustrates anti-NMDA encephalitis presenting in a young female with progressive mental status changes and neurologic abnormalities throughout her emergency department course. We review the investigative approach, diagnostic modalities, and treatment options in patient management. This case emphasizes the need for a high index of suspicion of anti-NMDA receptor encephalitis when …

The Use Of High-Dose Cervical Spinal Cord Stimulation In The Treatment Of Chronic Upper Extremity And Neck Pain., Trey A Baird, Chris S Karas

Neuroscience Articles

BACKGROUND: Dorsal column spinal cord stimulation is used for the treatment of chronic neuropathic pain of the axial spine and extremities. Recently, high-dose (HD) thoracic dorsal column stimulation for paresthesias has been successful. This study evaluates the utility of HD stimulation in the cervical spine for managing upper neck and upper extremity pain and paresthesias.

METHODS: Three patients suffering from cervical and upper extremity chronic pain were assessed. Each underwent a two-stage process that included a trial period, followed by permanent stimulator implantation. Therapy included the latest HD stimulation settings including a pulse width of 90 μs, a frequency setting …

Best Practices For Long-Term Monitoring And Follow-Up Of Alemtuzumab-Treated Ms Patients In Real-World Clinical Settings., Krista Barclay, Robert Carruthers, Anthony Traboulsee, Ann D Bass, Christopher Laganke, Antonio Bertolotto, Aaron Boster, Elisabeth G Celius, Jérôme De Seze, Dionisio Dela Cruz, Mario Habek, Jong-Mi Lee, Volker Limmroth, Sven G Meuth, Celia Oreja-Guevara, Patricia Pagnotta, Cindy Vos, Tjalf Ziemssen, Darren P Baker, Bart Van Wijmeersch

Neuroscience Articles

Multiple sclerosis (MS) is a chronic autoimmune neurological disease that typically affects young adults, causing irreversible physical disability and cognitive impairment. Alemtuzumab, administered intravenously as 2 initial courses of 12 mg/day (5 consecutive days at baseline, and 3 consecutive days 12 months later), resulted in significantly greater improvements in clinical and MRI outcomes vs. subcutaneous interferon beta-1a over 2 years in patients with active relapsing-remitting MS (RRMS) who were either treatment-naive (CARE-MS I; NCT00530348) or had an inadequate response to prior therapy (CARE-MS II; NCT00548405). Efficacy with alemtuzumab was maintained over 7 years in subsequent extension studies (NCT00930553; NCT02255656), in …

Lymphopenia And Dmts For Relapsing Forms Of Ms: Considerations For The Treating Neurologist., Edward J Fox, Guy J Buckle, Barry Singer, Vibhuti Singh, Aaron Boster

Neuroscience Articles

PURPOSE OF REVIEW: To provide neurologists with an update on the proposed mechanisms of action (MOAs) of disease-modifying therapies (DMTs) for the treatment of relapsing MS, and their effect on peripheral blood leukocytes, in order to inform treatment decisions.

RECENT FINDINGS: DMTs have vastly differing MOAs, including effects on peripheral blood leukocyte counts, particularly lymphocytes. The clinical implications of changes in lymphocyte counts need to be understood in the context of the underlying MOAs of each respective DMT, with treatment tailored to individual patient needs.

SUMMARY: DMTs can alter lymphocyte counts, subsets, activation, and distribution, and thus can influence immune …

Comparative Effectiveness Of Dimethyl Fumarate Versus Fingolimod And Teriflunomide Among Ms Patients Switching From First-Generation Platform Therapies In The Us., Daniel Ontaneda, Jacqueline Nicholas, Matthew Carraro, Jia Zhou, Qiang Hou, Jaanai Babb, Katherine Riester, Jason P Mendoza, Terrie Livingston, Mehul Jhaveri

Neuroscience Articles

BACKGROUND: Previous real-world comparative research of MS disease modifying therapies (DMTs) in the overall population has suggested dimethyl fumarate (DMF) to be comparable to fingolimod (FTY) and more efficacious than teriflunomide (TERI) in reducing relapses. However, there is limited comparative evidence in patients switching from platform DMTs in the US. The objective of the study was to compare the annualized relapse rate (ARR) and risk of relapse in MS patients who have switched from a platform therapy to DMF, FTY, or TERI.

METHODS: MS patients (18-65 years old) initiating an oral DMT from June 2013 to March 2015 were identified …

Trevo 2000: Results Of A Large Real-World Registry For Stent Retriever For Acute Ischemic Stroke., Mandy J Binning, Bruno Bartolini, Blaise Baxter, Ronald Budzik, Joey English, Rishi Gupta, Hirad Hedayat, Antonin Krajina, David Liebeskind, Raul G Nogueira, Ryan Shields, Erol Veznedaroglu

OhioHealth Research Institute Articles

Background Recent randomized controlled trials show benefit of thrombectomy for large vessel occlusion in stroke. Real-world data aid in assessing reproducibility of outcomes outside of clinical trials. The Trevo Retriever Registry is a multicenter, international, prospective study designed to assess outcomes in a large cohort of patients. Methods and Results The Trevo Registry is a prospective database of patients with large vessel occlusion treated with the Trevo device as the first device. The primary end point is revascularization based on modified Thrombolysis in Cerebral Infarction score and secondary end points include 90-day modified Rankin Scale, 90-day mortality, neurological deterioration at …

Lateral Position And Utility Of Navigation For Posterior Fixation Of Unstable Cervical Fracture With Ankylosing Spondylitis., Zubair Ahammad, Jason Milton, Kailash Narayan, Victor Awuor

Neuroscience Articles

BACKGROUND: Ankylosing spondylitis (AS) is a seronegative spondyloarthropathy within the spectrum of rheumatologic diseases. The systemic inflammation that characterizes AS leads to bone resorption and reformation. Pathologic remodeling may include kyphosis, osteoporosis, and multi-segment auto-fusion. Cervical fractures account for 53-78% of spinal trauma seen with AS. Surgical planning is often challenging owing to spinal deformity, medical comorbidities, the cervicothoracic foci of injury, and gross instability of these fracture.

CASE DESCRIPTION: A 55-year-old male with AS was presented with a three-column injury at the C6 level. The C6 vertebra was fractured, minimally displaced, and there was a focal kyphotic deformity. Attempted …

Understanding The Relationship Between The Neurologic Pupil Index And Constriction Velocity Values., Ifeoluwa Shoyombo, Venkatesh Aiyagari, Sonja E Stutzman, Folefac Atem, Michelle Hill, Stephen A Figueroa, Chad Miller, Amber Howard, Daiwai M Olson

Neuroscience Articles

The pupillary light reflex (PLR) describes the response when light hits the retina and sends a signal (cranial nerve II) to the Edinger-Westphal Nucleus which via cranial nerve III results in pupillary constriction. The Neurological Pupil indexTM (NPi) and pupil constriction velocity (CV) are two distinct variables that can be observed and measured using a pupillometer. We examine NPi and CV in 27,462 pupil readings (1,617 subjects). NPi values < 3.0 and a CV < 0.8 mm/sec were considered abnormal. Regression was used to clarify the effect of pupil size and repeated measures. An odds ratio of abnormal CV given normal NPi (and vice versa) was computed using the glimmixed (SAS) regression. Of 27,462 readings, 49.2% revealed bilaterally normal NPi wtih brisk CV, and 10.8% revealed bilaterally abnormal NPi and slow CV; 9.1% with unilaterally normal NPi and brisk CV where the opposite pupil had an abnormal NPi and slow CV. The remaining 30.9% revealed that one or both PLR had either a normal NPi with slow CV, or abnormal NPi with brisk CV. Brisk CV does not rule out an abnormal PLR; slow CV does not rule in abnormal PLR. Practitioners should consider these implications when interpreting pupillometry readings.

Treatment Of Glenohumeral Arthritis Pain Utilizing Spinal Cord Stimulation., Stephen T Susa, Chris S Karas, Nathaniel K Long

Neuroscience Articles

BACKGROUND: Dorsal column stimulation may be utilized to treat non-neuropathic pain attributed to glenohumeral arthritis.

CASE DESCRIPTION: An 84-year-old female presented with right shoulder pain for 3 years. She was diagnosed with glenohumeral arthritis and a complete loss of the joint space. She was treated with a dorsal column stimulator, requiring the electrodes to be placed from the inferior aspect of C3 to the superior aspect of T1. Six weeks postoperatively, she reported >90% coverage of her shoulder pain, demonstrated increased right arm function, and a reduction in her use of narcotics.

CONCLUSION: Dorsal column stimulation of C3-T1 proved to …