Neurology Commons^™

Aggressive Herpes Zoster In Young Patients With Multiple Sclerosis Under Dimethyl Fumarate: Significance Of Cd8, Maria Anagnostouli, Georgios Velonakis, Marinos Dalakas

Department of Neurology Faculty Papers

Dimethyl fumarate (DMF), approved for relapsing-remitting multiple sclerosis (RRMS), exerts immune-mediated mechanisms crucial for T-cell survival and migration, preferentially reducing CD8+ T cells.1 Although baseline absolute lymphocyte count (ALC) is considered the most critical predictor of developing lymphopenia,2 it was recently concluded that lymphocyte subset monitoring is not required for safety vigilance because T-cell subset reduction does not increase risks for serious infections.3 We present 2 young patients with RRMS, under DMF treatment, negative for HIV and SARSCoV-2 (by RT-PCR in nasal swab) and with normal follow-up white blood cell (WBC)/ALC counts, who developed severe herpes zoster (HZ) infection with …

Tolerability Of Switching Cholinesterase Inhibitors To Memantine Monotherapy Versus Adding Memantine As Combination Therapy For All-Cause Neurodegenerative Disorders, Estevana Isaac, Md, Mijail Serruya, Md, Phd, Keith Scott, Phd, Michael R. Sperling, Md, Carol Lippa, Md

Health Equity and Quality Improvement (HEQI) Summit

Background: Prior studies have focused on the clinical efficacy of combination therapy, Donepezil and Memantine, for patient’s diagnosed with Alzheimer’s disease. However, the potential adverse drug reactions while described as mild can have serious sequelae in older adults who are already managing the side effects of polypharmacy.

Objective: This study looks to explore the tolerability of switching cholinesterase inhibitors to memantine monotherapy versus adding memantine as combination therapy for all-cause neurodegenerative disorders.

Methods: The study is a retrospective chart review that includes 175 patients aged 50 and older diagnosed with neurocognitive disorders (ICD 10 F00-F03.91 and ICD10 G30-G31.84) managed on …

Addressing Health Disparities And Access In The Department Of Neurology Outpatient Setting In The Era Of The Covid-19 Pandemic: A Quality Improvement Initiative, V. Wang, M. Rehman, K. Burda, L. Liao, M. Braslavsky, T. Chuang, J. Diep, Md, E. Isaac, E. Wong

Health Equity and Quality Improvement (HEQI) Summit

Neurology, a largely outpatient specialty, has joined many other fields in the endeavor of incorporating telemedicine.^4,6,7 We present the results of analysis of the Epic Electronic Medical Record (EMR) of all outpatient visits from the Thomas Jefferson University Hospital Department of Neurology from 2019 to 2020 in order to identify areas of ethnic minority and geographic disparities with regards to usage of telemedicine. For our analyses, we have included Neurology patients across the General Neurology (JUP Neurology 909 Walnut NEU), Headache Center (HA), and Multiple Sclerosis Center (MS). Additionally, based on patient surveys from a subset of our outpatient …

Evaluating Advance Care Planning In Patients With Amyotrophic Lateral Sclerosis: A Retrospective Chart Review, Zachary Klock, Md, Stephanie Dobak, Rd, Gail Houseman, Rn, Margaret Kreher, Md, Facp

Health Equity and Quality Improvement (HEQI) Summit

• ALS is a progressive, degenerative neurologic disorder with inevitable decline in function and ultimately death.
• Most patients and families will be faced with decisions regarding mechanical ventilation and artificial nutrition.
• Prior studies have showed low rates of ACP completion in this population (<50%) and high rates of opt out in programs to aid ACP (nearly 40%).
• By reviewing charts of patients with ALS, we can analyze the impact of ACP on care utilization including artificial nutrition, mechanical ventilation and hospice utilization to help to guide efforts regarding ACP in the outpatient setting.

Alteplase Administration For Acute Ischemic Stroke (Ais) In Er - A 5-Year Review, Ali A. Saherwala, Md, Diana Tzeng, Md, Robin Dharia, Md

Health Equity and Quality Improvement (HEQI) Summit

• ER visits for AIS grown in last 10 years by 25%
• Ongoing effort by AHA/ASA to improve access to care with early stroke recognition and awareness
• Time is brain; rate of thrombolysis with alteplase (ALT) should increase with better EMS systems, awareness, and education

Improving Understanding Of And Compliance With Anti-Shivering Protocols During Therapeutic Hypothermia With Just-In-Time Training, Brittany Heckel, Md, Eunice Lee, Md, Courtney Curran, Md, Kasun Navarathna, Md, Henry Lee, Md, Lucy Maguire, Md, Phd, Malissa Pynes, Md, Shyam Majmundar, Md, Alexander Buslov, Md, Syed Shah, Md, Mba, Matthew Vibbert, Md

Health Equity and Quality Improvement (HEQI) Summit

• Therapeutic hypothermia after cardiac arrest has been demonstrated to improve neurologic outcomes and survival rates following cardiac arrest.
• Shivering during hypothermia increases metabolic demand, increases oxygen consumption and increases difficulty maintaining desired temperatures.
• Gaps in knowledge can lead to inadequate management of shivering, leading

Aims for Improvement

To improve understanding of and compliance with anti-shivering protocols during therapeutic hypothermia post-cardiac arrest.

Long Term Safety, Tolerability, And Efficacy Of Intracutaneous Zolmitriptan (M207) In The Acute Treatment Of Migraine., Stephanie J. Nahas, Nada Hindiyeh, Deborah I. Friedman, Nada Elbuluk, Donald J. Kellerman, Pamela K. Foreman, Peter Schmidt

Department of Neurology Faculty Papers

OBJECTIVE: To determine the long-term safety and tolerability profile of M207 in the acute treatment of migraine.

BACKGROUND: M207 is an investigational microneedle-based system for intracutaneous delivery of zolmitriptan for the treatment of migraine attacks. Following on the positive results of a Phase 2/3 placebo-controlled efficacy study (ZOTRIP), this study was designed to evaluate the safety of this novel product during repeated use for the treatment of migraine attacks.

METHODS: In this 6-12 month open-label, multicenter observational study, participants used an eDiary to record headache symptoms and adverse events at specified intervals up to 48 h following treatment of a …

Lessons Learned After 760 Neurointerventions Via The Upper Extremity Vasculature: Pearls And Pitfalls., Ahmad Sweid, Joshua H. Weinberg, Omaditya Khanna, Somnath Das, Julie Kim, Darcy Curtis, Batoul Hammoud, Kareem El Naamani, Rawad Abbas, Shyam Majmundar, Kalyan C. Sajja, Nohra Chalouhi, Fadi Al Saiegh, Nikolaos Mouchtouris, Elias Atallah, M. Reid Gooch, Nabeel A. Herial, Stavropoula Tjoumakaris, Victor Romo, Robert H. Rosenwasswer, Pascal Jabbour

Department of Neurosurgery Faculty Papers

BACKGROUND: The radial approach has been gaining more widespread use by neurointerventionalists fueled by data from the cardiology literature showing better safety and overall reduced morbidity.

OBJECTIVE: To present our institution's experience with the radial approach for neuroendovascular interventions in 614 consecutive patients who underwent a cumulative of 760 procedures.

METHODS: A retrospective analysis was performed and identified neuroendovascular procedures performed via the upper extremity vasculature access site.

RESULTS: Amongst 760 procedures, 34.2% (260) were therapeutic, and 65.7% (500) were nontherapeutic angiograms. Access sites were 71.5% (544) via a conventional radial artery, 27.8% (211) via a distal radial artery, 0.5% …

Automated Analysis Of Risk Factors For Postictal Generalized Eeg Suppression, Xiuhe Zhao, Laura Vilella, Liang Zhu, M R Sandhya Rani, Johnson P Hampson, Jaison Hampson, Norma J Hupp, Rup K Sainju, Daniel Friedman, Maromi Nei, Catherine Scott, Luke Allen, Brian K Gehlbach, Stephan Schuele, Ronald M Harper, Beate Diehl, Lisa M Bateman, Orrin Devinsky, George B Richerson, Guo-Qiang Zhang, Samden D Lhatoo, Nuria Lacuey

Department of Neurology Faculty Papers

Rationale: Currently, there is some ambiguity over the role of postictal generalized electro-encephalographic suppression (PGES) as a biomarker in sudden unexpected death in epilepsy (SUDEP). Visual analysis of PGES, known to be subjective, may account for this. In this study, we set out to perform an analysis of PGES presence and duration using a validated signal processing tool, specifically to examine the association between PGES and seizure features previously reported to be associated with visually analyzed PGES. Methods: This is a prospective, multicenter epilepsy monitoring study of autonomic and breathing biomarkers of SUDEP in adult patients with intractable epilepsy. We …

Comparison Of Radiomic Feature Aggregation Methods For Patients With Multiple Tumors., Enoch Chang, Marina Z. Joel, Hannah Y. Chang, Justin Du, Omaditya Khanna, Antonio Omuro, Veronica Chiang, Sanjay Aneja

Department of Neurosurgery Faculty Papers

Radiomic feature analysis has been shown to be effective at analyzing diagnostic images to model cancer outcomes. It has not yet been established how to best combine radiomic features in cancer patients with multifocal tumors. As the number of patients with multifocal metastatic cancer continues to rise, there is a need for improving personalized patient-level prognosis to better inform treatment. We compared six mathematical methods of combining radiomic features of 3,596 tumors in 831 patients with multiple brain metastases and evaluated the performance of these aggregation methods using three survival models: a standard Cox proportional hazards model, a Cox proportional …

Lack Of Observed Tolerance To Diazepam Nasal Spray (Valtoco®) After Long-Term Rescue Therapy In Patients With Epilepsy: Interim Results From A Phase 3, Open-Label, Repeat-Dose Safety Study., Gregory D. Cascino, Daniel Tarquinio, James W. Wheless, R. Edward Hogan, Michael R. Sperling, Kore Liow, Jay Desai, Charles Davis, Adrian L. Rabinowicz, Enrique Carrazana

Department of Neurology Faculty Papers

OBJECTIVE: Tolerance is a known consideration for maintenance use of benzodiazepines and other antiseizure drugs; however, clinical experience suggests that tolerance may not be anticipated with long-term intermittent use of benzodiazepines as rescue therapy. Diazepam nasal spray (Valtoco®) is a proprietary intranasal formulation approved for the acute treatment of intermittent, stereotypic episodes of frequent seizure activity (ie, seizure clusters, acute repetitive seizures) in patients with epilepsy aged ≥6 years. Reported here are exploratory analyses investigating whether there was evidence of development of tolerance in an interim analysis of a long-term, phase 3, open-label safety study of diazepam nasal spray.

METHODS: …

Dabigatran Reduces Thrombin-Induced Neuroinflammation And Ad Markers In Vitro: Therapeutic Relevance For Alzheimer's Disease, Syed Waseem Bihaqi, Haripriya Vittal Rao, Abhik Sen, Paula Grammas

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Background: Vascular risk factors such as atherosclerosis, diabetes, and elevated homocysteine levels are strongly correlated with onset of Alzheimer's disease (AD). Emerging evidence indicates that blood coagulation protein thrombin is associated with vascular and non-vascular risk factors of AD. Here, we examined the effect of thrombin and its direct inhibitor dabigatran on key mediators of neuro-inflammation and AD pathology in the retinoic acid (RA)-differentiated human neuroblastoma cell line SH-SY5Y. Methods: SH-SY5Y cells exposed to thrombin concentrations (10–100 nM) +/- 250 nM dabigatran for 24 h were analyzed for protein and gene expression. Electrophoretic mobility shift assay (EMSA) was used to …

Gray Matter Sampling Differences Between Subdural Electrodes And Stereoelectroencephalography Electrodes., Mohamed Tantawi, Jingya Miao, Caio Matias, Christopher T. Skidmore, Michael R. Sperling, Ashwini Sharan, Chengyuan Wu

Department of Neurosurgery Faculty Papers

Objective: Stereoelectroencephalography (SEEG) has seen a recent increase in popularity in North America; however, concerns regarding the spatial sampling capabilities of SEEG remain. We aimed to quantify and compare the spatial sampling of subdural electrode (SDE) and SEEG implants.

Methods: Patients with drug-resistant epilepsy who underwent invasive monitoring were included in this retrospective case-control study. Ten SEEG cases were compared with ten matched SDE cases based on clinical presentation and pre-implantation hypothesis. To quantify gray matter sampling, MR and CT images were coregistered and a 2.5mm radius sphere was superimposed over the center of each electrode contact. The estimated recording …

Proceedings Of The Eighth Annual Deep Brain Stimulation Think Tank: Advances In Optogenetics, Ethical Issues Affecting Dbs Research, Neuromodulatory Approaches For Depression, Adaptive Neurostimulation, And Emerging Dbs Technologies, Vinata Vedam-Mai, Karl Deisseroth, James Giordano, Gabriel Lazaro-Munoz, Winston Chiong, Nanthia Suthana, Jean-Philippe Langevin, Jay Gill, Wayne Goodman, Nicole R Provenza, Casey H Halpern, Rajat S Shivacharan, Tricia N Cunningham, Sameer A Sheth, Nader Pouratian, Katherine W Scangos, Helen S Mayberg, Andreas Horn, Kara A Johnson, Christopher R Butson, Ro'ee Gilron, Coralie De Hemptinne, Robert Wilt, Maria Yaroshinsky, Simon Little, Philip Starr, Greg Worrell, Prasad Shirvalkar, Edward Chang, Jens Volkmann, Muthuraman Muthuraman, Sergiu Groppa, Andrea A Kühn, Luming Li, Matthew Johnson, Kevin J Otto, Robert Raike, Steve Goetz, Chengyuan Wu, Peter Silburn, Binith Cheeran, Yagna J Pathak, Mahsa Malekmohammadi, Aysegul Gunduz, Joshua K Wong, Stephanie Cernera, Aparna Wagle Shukla, Adolfo Ramirez-Zamora, Wissam Deeb, Addie Patterson, Kelly D Foote, Michael S Okun

Department of Neurosurgery Faculty Papers

We estimate that 208,000 deep brain stimulation (DBS) devices have been implanted to address neurological and neuropsychiatric disorders worldwide. DBS Think Tank presenters pooled data and determined that DBS expanded in its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. The DBS Think Tank was founded in 2012 providing a space where clinicians, engineers, researchers from industry and academia discuss current and emerging DBS technologies and logistical and ethical issues facing the field. The emphasis is on cutting edge research and collaboration aimed to advance the DBS field. The Eighth Annual DBS …

Collaboration Therapy: Telehealth Principles And Case Studies, Elliot Cole, Phd, Larry M. Starr, Phd

School of Continuing and Professional Studies Faculty Papers

While conventional in-clinic Traumatic Brain Injury (TBI) rehabilitation serves the needs of the vast majority of patients many of whom go on to resume their lives a significant percentage of patients continue to have enduring cognitive disabilities despite long-term and skilled therapy. However, these patients can rapidly achieve gains which typically continue to increase toward substantial self-sufficiency when engaged in Collaboration Therapy (CT). CT is directed toward patient populations appropriate for a telehealth service who meet the following criteria: 1) patients have plateaued in conventional in-clinic therapy; 2) in-patients are too distant from an appropriate outpatient facility; and 3) individuals …

Bundled Payment Models In Spine Surgery., Kevin Hines, Nikolaos Mouchtouris, Charles Getz, Glenn Gonzalez, Thiago Montenegro, Adam Leibold, James Harrop

Department of Neurosurgery Faculty Papers

STUDY DESIGN: The following is a narrative discussion of bundled payments in spine surgery.

OBJECTIVE: The cost of healthcare in the United States has continued to increase. To lower the cost of healthcare, reimbursement models are being investigated as potential cost saving interventions by driving incentives and quality improvement in fields such a spine surgery.

METHODS: Narrative overview of literature pertaining to bundled payments in spine surgery synthesizing findings from computerized databases and authoritative texts.

RESULTS: Spine surgery is challenging to define payment modes because of high cost variability and surgical decision-making nuances. While implementing bundled care payments in spine …

Achieving Value In Spine Surgery: 10 Major Cost Contributors., Lucas R. Philipp, Adam Leibold, Aria Mahtabfar, Thiago Montenegro, Glenn Gonzalez, James Harrop

Department of Neurosurgery Faculty Papers

STUDY DESIGN: Narrative Review.

OBJECTIVES: The increasing cost of healthcare overall and for spine surgery, coupled with the growing burden of spine-related disease and rising demand have necessitated a shift in practice standards with a new emphasis on value-based care. Despite multiple attempts to reconcile the discrepancy between national recommendations for appropriate use and the patterns of use employed in clinical practice, resources continue to be overused-often in the absence of any demonstrable clinical benefit. The following discussion illustrates 10 areas for further research and quality improvement.

METHODS: We present a narrative review of the literature regarding 10 features in …

Gad Antibody-Spectrum Disorders: Progress In Clinical Phenotypes, Immunopathogenesis And Therapeutic Interventions., Popianna Tsiortou, Harry Alexopoulos, Marinos Dalakas

Department of Neurology Faculty Papers

Antibodies against glutamic acid decarboxylase (GAD), originally linked to stiff person syndrome (SPS), now denote the “GAD antibody-spectrum disorders” (GAD-SD) that also include autoimmune epilepsy, limbic encephalitis, cerebellar ataxia and nystagmus with overlapping symptomatology highlighting autoimmune neuronal excitability disorders. The reasons for the clinical heterogeneity among GAD-antibody associated syndromes remain still unsettled, implicating variable susceptibility of GABAergic neurons to anti-GAD or other still unidentified autoantibodies. Although anti-GAD antibody titers do not correlate with clinical severity, very high serum titers, often associated with intrathecal synthesis of anti-GAD-specific IgG, point to in-situ effects of GAD or related autoantibodies within the central nervous …

Intradural Extramedullary Capillary Hemangioma Of The Cauda Equina: Case Report Of A Rare Spinal Tumor., Liam P Hughes, Garrett Largoza, Thiago S Montenegro, Caio M Matias, Anthony Stefanelli, Mark T Curtis, James S Harrop

Department of Neurosurgery Faculty Papers

INTRODUCTION: Intradural extramedullary capillary hemangiomas of the cauda equina are exceedingly rare, with only 20 previous cases reported. In the adult population, these tumors are rare and can arise in the central and peripheral nervous systems from the dura or spinal nerve roots. Intradural capillary hemangiomas of the cauda equina can yield symptoms such as lower extremity weakness, pain, and bladder and bowel dysfunction. The clinical symptomology and surgical management of this rare spinal lesion are reviewed in this case report.

CASE PRESENTATION: A 50-year-old male presented with progressive bilateral lower extremity weakness for 2 years, with recent bladder and …

Crispr-Mediated Rapid Generation Of Neural Cell-Specific Knockout Mice Facilitates Research In Neurophysiology And Pathology., Dan Xiao, Weifeng Zhang, Qing Wang, Xing Li, Yuan Zhang, Javad Rasouli, Giacomo Casella, Bogoljub Ciric, Mark Curtis, A M Rostami, Guang-Xian Zhang

Department of Neurology Faculty Papers

Inducible conditional knockout mice are important tools for studying gene function and disease therapy, but their generation is costly and time-consuming. We introduced clustered regularly interspaced short palindromic repeats (CRISPR) and Cre into an LSL-Cas9 transgene-carrying mouse line by using adeno-associated virus (AAV)-PHP.eB to rapidly knockout gene(s) specifically in central nervous system (CNS) cells of adult mice. NeuN in neurons and GFAP in astrocytes were knocked out 2 weeks after an intravenous injection of vector, with an efficiency comparable to that of inducible Cre-loxP conditional knockout. For functional testing, we generated astrocyte-specific Act1 knockout mice, which exhibited a phenotype …

Cardiovascular Disease Risk, Awareness, And Treatment In People With Epilepsy, Samuel W Terman, Carole E Aubert, Chloe E Hill, Jeremy Skvarce, James F Burke, Scott Mintzer

Department of Neurology Faculty Papers

OBJECTIVE: To evaluate whether cardiovascular risk, risk awareness, and guideline concordant treatment differ in individuals with versus without epilepsy.

METHODS: This was a retrospective cross-sectional study using the National Health and Nutrition Examination Survey. We included participants ≥18 years for 2013-2018. We classified participants as having epilepsy if reporting ≥1 medication treating seizures. We calculated 10-year atherosclerotic cardiovascular disease (ASCVD) risk using the revised pooled cohort equation. We compared unadjusted and adjusted risk for participants with versus without epilepsy. We then assessed hypertension and diabetes disease awareness and control, plus statin guideline-concordance. We assessed mediators for both ASCVD risk and …

Capturing Initial Understanding And Impressions Of Surgical Therapy For Parkinson's Disease, Somnath Das, Caio Matias, Sunihidi Ramesh, Lohit Velagapudi, Julie Barbera, Samantha Katz, Michael Baldassari, Mohammad Rasool, Daniel Kremens, Jeffrey Ratliff, Md, Tsao-Wei Liang, Chengyuan Wu

Department of Neurosurgery Faculty Papers

Background: Deep Brain Stimulation (DBS) is an underutilized surgical therapy for Parkinson's Disease (PD). Both physician and patient hesitancies have been described as potential barriers to DBS, but the specifics of patient perceptions of DBS have not been well-characterized in the general PD population. Objective: To characterize the understanding and impressions of surgical therapy in PD patients prior to formal surgical evaluation. Methods: A 30-question survey assessing impressions of surgical therapy for PD and understanding of DBS for PD was administered to PD patients seen at an urban movement disorders clinic. Results: One hundred and two patients completed the survey. …

Declining Intensive Care Unit Mortality Of Covid-19: A Multi-Center Study, Sohaib Roomi, Syed Omar Shah, Waqas Ullah, Shan Abedin, Karyn L. Butler, Chiers, Kelly, Benjamin A. Kohl, Erika J. Yoo, Matthew Vibbert, Jack Jallo

Department of Surgery Faculty Papers

Background: Coronavirus disease 2019 (COVID-19) mortality has waned significantly over time; however, factors contributing towards this reduction largely remain unidentified. The purpose of this study was to evaluate the trend in mortality at our large tertiary academic health system and factors contributing to this trend. Methods: This is a retrospective cohort study of intensive care unit (ICU) patients diagnosed with COVID-19 between March and August 2020 admitted across 14 hospitals in the Philadelphia area. Collected data included demographics, comorbidities, admission risk of mortality score, laboratory values, medical interventions, survival outcomes, hospital and ICU length of stay (LOS) and discharge disposition. …

Biomechanics Of Circumferential Cervical Fixation Using Posterior Facet Cages: A Cadaveric Study., Bernardo De Andrada Pereira, Joshua Pelta-Heller, Jennifer N Lehrman, Anna G U Sawa, Brian P Kelly

Department of Neurosurgery Faculty Papers

OBJECTIVE: Anterior cervical discectomy and fusion (ACDF) is a common procedure for the treatment of cervical disease. Circumferential procedures are options for multilevel pathology. Potential complications of multilevel anterior procedures are dysphagia and pseudarthrosis, whereas potential complications of posterior surgery include development of cervical kyphosis and postoperative chronic neck pain. The addition of posterior cervical cages (PCCs) to multilevel ACDF is a minimally invasive option to perform circumferential fusion. This study evaluated the biomechanical performance of 3-level circumferential fusion with PCCs as supplemental fixation to anteriorly placed allografts, with and without anterior plate fixation.

METHODS: Nondestructive flexibility tests (1.5 Nm) …

Can Early Treatment Of Twitcher Mice With High Dose Aavrh10-Galc Eliminate The Need For Bmt?, Mohammad Rafi, Paola Luzi, David A Wenger

Department of Neurology Faculty Papers

Introduction: Krabbe disease (KD) is an autosomal recessive disorder caused by mutations in the galactocerebrosidase (GALC) gene resulting in neuro-inflammation and defective myelination in the central and peripheral nervous systems. Most infantile patients present with clinical features before six months of age and die before two years of age. The only treatment available for pre-symptomatic or mildly affected individuals is hematopoietic stem cell transplantation (HSCT). In the animal models, combining bone marrow transplantation (BMT) with gene therapy has shown the best results in disease outcome. In this study, we examine the outcome of gene therapy alone.

Methods: Twitcher (twi) mice …

Glioma Stem Cells As Immunotherapeutic Targets: Advancements And Challenges, Keenan Piper, Lisa Depledge, Michael Karsy, Charles Cobbs

Department of Neurosurgery Faculty Papers

Glioblastoma is the most common and lethal primary brain malignancy. Despite major investments in research into glioblastoma biology and drug development, treatment remains limited and survival has not substantially improved beyond 1–2 years. Cancer stem cells (CSC) or glioma stem cells (GSC) refer to a population of tumor originating cells capable of self-renewal and differentiation. While controversial and challenging to study, evidence suggests that GCSs may result in glioblastoma tumor recurrence and resistance to treatment. Multiple treatment strategies have been suggested at targeting GCSs, including immunotherapy, posttranscriptional regulation, modulation of the tumor microenvironment, and epigenetic modulation. In this review, we …

Anti-Sars-Cov-2 Antibodies Within Ivig Preparations: Cross-Reactivities With Seasonal Coronaviruses, Natural Autoimmunity, And Therapeutic Implications, Marinos Dalakas, Kleopatra Bitzogli, Harry Alexopoulos

Department of Neurology Faculty Papers

Introduction: Cross-reactivity to SARS-CoV-2 antigenic peptides has been detected on T-cells from pre-pandemic donors due to recognition of conserved protein fragments within members of the coronavirus's family. Further, preexisting antibodies recognizing SARS-CoV-2 with conserved epitopes in the spike region have been now seen in uninfected individuals. High-dose Intravenous Immunoglobulin (IVIg), derived from thousands of healthy donors, contains natural IgG antibodies against various antigens which can be detected both within the IVIg preparations and in the serum of IVIg-receiving patients. Whether IVIg preparations from pre-pandemic donors also contain antibodies against pre-pandemic coronaviruses or autoreactive antibodies that cross-react with SARS-CoV-2 antigenic epitopes, …

Seizure Clusters, Seizure Severity Markers, And Sudep Risk., Manuela Ochoa-Urrea, Nuria Lacuey, Laura Vilella, Liang Zhu, Shirin Jamal-Omidi, M R Sandhya Rani, Johnson P Hampson, Mojtaba Dayyani, Jaison Hampson, Norma J Hupp, Shiqiang Tao, Rup K Sainju, Daniel Friedman, Maromi Nei, Catherine Scott, Luke Allen, Brian K Gehlbach, Victoria Reick-Mitrisin, Stephan Schuele, Jennifer Ogren, Ronald M Harper, Beate Diehl, Lisa M Bateman, Orrin Devinsky, George B Richerson, Guo-Qiang Zhang, Samden D Lhatoo

Department of Neurology Faculty Papers

Rationale: Seizure clusters may be related to Sudden Unexpected Death in Epilepsy (SUDEP). Two or more generalized convulsive seizures (GCS) were captured during video electroencephalography in 7/11 (64%) patients with monitored SUDEP in the MORTEMUS study. It follows that seizure clusters may be associated with epilepsy severity and possibly with SUDEP risk. We aimed to determine if electroclinical seizure features worsen from seizure to seizure within a cluster and possible associations between GCS clusters, markers of seizure severity, and SUDEP risk. Methods: Patients were consecutive, prospectively consented participants with drug-resistant epilepsy from a multi-center study. Seizure clusters were defined as …

Rapid Decline In Telestroke Consults In The Setting Of Covid-19., Syed O. Shah., Robin Dharia, Jaime Stazi, Maureen Deprince, Robert H. Rosenwasswer

Farber Institute for Neuroscience Faculty Papers

Background and Purpose: As coronavirus disease 2019 (COVID-19) continues to be a global pandemic, there is a growing body of evidence suggesting that incidence of diseases that require emergent care, particularly myocardial infarction and ischemic stroke, has declined rapidly. The objective of this study is to quantify our experience of telestroke (TS) consults at a large tertiary comprehensive stroke center during the COVID-19 pandemic.

Methods: We retrospectively reviewed TS consults of patients presenting to our neuroscience network. Those with a confirmed diagnosis of acute ischemic stroke or transient ischemia attack were included. Data were compared from April 1, 2019, to …

Management Of Gliomas In Patients With Lynch Syndrome., Iyad Alnahhas, Appaji Rayi, Shirley Ong, Pierre Giglio, Vinay Puduvalli

Department of Neurology Faculty Papers

No abstract provided.