Neurosciences Commons^™

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 …

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 …

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 …

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 …

Comparison Of Disease-Modifying Therapies For The Management Of Multiple Sclerosis: Analysis Of Healthcare Resource Utilization And Relapse Rates From Us Insurance Claims Data., Jacqueline Nicholas, Aaron Boster, Ning Wu, Wei-Shi Yeh, Monica Fay, Jon Kendter, Ming-Yi Huang, Andrew Lee

Neuroscience Articles

BACKGROUND: Data on comparative healthcare resource utilization and costs associated with the newer oral disease-modifying therapies (DMTs) for managing relapsing-remitting multiple sclerosis (MS) in routine clinical practice are limited. The purpose of this study was to estimate healthcare resource utilization, costs, and relapse rates in the year after initiating treatment with dimethyl fumarate (DMF), interferon (IFN)-β, glatiramer acetate (GA), teriflunomide, or fingolimod in routine clinical practice for patients with MS who did not receive a DMT in the previous year.

METHODS: Patients initiating DMF, IFNβ, GA, teriflunomide, or fingolimod were identified based on claims data from 2012 to 2015 in …

Interhospital Transfer Before Thrombectomy Is Associated With Delayed Treatment And Worse Outcome In The Stratis Registry (Systematic Evaluation Of Patients Treated With Neurothrombectomy Devices For Acute Ischemic Stroke)., Michael T Froehler, Jeffrey L Saver, Osama O Zaidat, Reza Jahan, Mohammad Ali Aziz-Sultan, Richard P Klucznik, Diogo C Haussen, Frank R Hellinger, Dileep R Yavagal, Tom L Yao, David S Liebeskind, Ashutosh P Jadhav, Rishi Gupta, Ameer E Hassan, Coleman O Martin, Hormozd Bozorgchami, Ritesh Kaushal, Raul G Nogueira, Ravi H Gandhi, Eric C Peterson, Shervin R Dashti, Curtis A Given, Brijesh P Mehta, Vivek Deshmukh, Sidney Starkman, Italo Linfante, Scott H Mcpherson, Peter Kvamme, Thomas J Grobelny, Muhammad S Hussain, Ike Thacker, Nirav Vora, Peng Roc Chen, Stephen J Monteith, Robert D Ecker, Clemens M Schirmer, Eric Sauvageau, Alex Abou-Chebl, Colin P Derdeyn, Lucian Maidan, Aamir Badruddin, Adnan H Siddiqui, Travis M Dumont, Abdulnasser Alhajeri, M Asif Taqi, Khaled Asi, Jeffrey Carpenter, Alan Boulos, Gaurav Jindal, Ajit S Puri, Rohan Chitale, Eric M Deshaies, David H Robinson, David F Kallmes, Blaise W Baxter, Mouhammad A Jumaa, Peter Sunenshine, Aniel Majjhoo, Joey D English, Shuichi Suzuki, Richard D Fessler, Josser E Delgado Almandoz, Jerry C Martin, Nils H Mueller-Kronast, Stratis Investigators

Neuroscience Articles

BACKGROUND: Endovascular treatment with mechanical thrombectomy (MT) is beneficial for patients with acute stroke suffering a large-vessel occlusion, although treatment efficacy is highly time-dependent. We hypothesized that interhospital transfer to endovascular-capable centers would result in treatment delays and worse clinical outcomes compared with direct presentation.

METHODS: STRATIS (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) was a prospective, multicenter, observational, single-arm study of real-world MT for acute stroke because of anterior-circulation large-vessel occlusion performed at 55 sites over 2 years, including 1000 patients with severe stroke and treated within 8 hours. Patients underwent MT with or …

Comparative Effectiveness Research Of Disease-Modifying Therapies For The Management Of Multiple Sclerosis: Analysis Of A Large Health Insurance Claims Database., Aaron Boster, Jacqueline Nicholas, Ning Wu, Wei-Shi Yeh, Monica Fay, Michael Edwards, Ming-Yi Huang, Andrew Lee

Neuroscience Articles

INTRODUCTION: Limited data are available on the real-world effectiveness of newer oral disease-modifying therapies (DMTs) in multiple sclerosis. The purpose of this study was to retrospectively compare the real-world effectiveness of dimethyl fumarate (DMF), fingolimod, teriflunomide, and injectable DMTs in routine clinical practice based on US claims data.

METHODS: Patients newly-initiating DMF, interferon beta (IFNβ), glatiramer acetate (GA), teriflunomide, or fingolimod in 2013 were identified in the Truven MarketScan Commercial Claims Databases (N = 6372). Relapse episodes were identified based on a published claim-based algorithm and used to determine the annualized relapse rate (ARR) for the year before and after …

Biomarkers Of Acute Stroke Etiology (Base) Study Methodology., Edward C Jauch, Andrew D Barreto, Joseph P Broderick, Doug M Char, Brett L Cucchiara, Thomas G Devlin, Alison J Haddock, William J Hicks, Brian C Hiestand, Glen C Jickling, Jeff June, David S Liebeskind, Ted J Lowenkopf, Joseph B Miller, John O'Neill, Tim L Schoonover, Frank R Sharp, W Frank Peacock

Neuroscience Articles

Acute ischemic stroke affects over 800,000 US adults annually, with hundreds of thousands more experiencing a transient ischemic attack. Emergent evaluation, prompt acute treatment, and identification of stroke or TIA (transient ischemic attack) etiology for specific secondary prevention are critical for decreasing further morbidity and mortality of cerebrovascular disease. The Biomarkers of Acute Stroke Etiology (BASE) study is a multicenter observational study to identify serum markers defining the etiology of acute ischemic stroke. Observational trial of patients presenting to the hospital within 24 h of stroke onset. Blood samples are collected at arrival, 24, and 48 h later, and RNA …

The Severity Of Intracranial Hemorrhages Measured By Free Hemoglobin In The Brain Depends On The Anticoagulant Class: Experimental Data., Kyle M Ware, Douglas L Feinstein, Israel Rubinstein, Prudhvi Battula, Jose Otero, Lee Hebert, Tzu-Fei Wang, Alexandra Ivanova, Shweta Chaudhary, Jessica Hemminger, Sergey V Brodsky

Neuroscience Articles

Background and Purpose. Anticoagulant therapy is broadly used to prevent thromboembolic events. Intracranial hemorrhages are serious complications of anticoagulation, especially with warfarin. Direct oral anticoagulants reduce but do not eliminate the risk of intracranial hemorrhages. The aim of this study is to determine the degree of intracranial hemorrhage after application of anticoagulants without additional triggers. Methods. Rats were treated with different anticoagulant classes (vitamin K antagonists, heparin, direct thrombin inhibitor, and factor Xa inhibitor). Brain hemorrhages were assessed by the free hemoglobin concentration in the brain parenchyma. Results. Vitamin K antagonists (warfarin and brodifacoum) significantly increased free hemoglobin in the …

Assessment Of Treatment Patterns Associated With Injectable Disease-Modifying Therapy Among Relapsing-Remitting Multiple Sclerosis Patients., J Nicholas, J J Ko, Y Park, P Navaratnam, H S Friedman, F R Ernst, V Herrera

Neuroscience Articles

BACKGROUND: Availability of oral disease-modifying therapy (DMT) for relapsing-remitting multiple sclerosis (RRMS) may affect injectable DMT (iDMT) treatment patterns.

OBJECTIVE: The objective of this paper is to evaluate iDMT persistency, reasons for persistency lapses, and outcomes among newly diagnosed RRMS patients.

METHODS: Medical records of 300 RRMS patients initiated on iDMT between 2008 and 2013 were abstracted from 18 US-based neurology clinics. Eligible patients had ≥3 visits: pre-iDMT initiation, iDMT initiation (index), and ≥1 visit within 24 months post-index. MS-related symptoms, relapses, iDMT treatment patterns (i.e. persistency, discontinuation, switching, and restart), and reasons for non-persistency were tracked for 24 months. …