Neurology Commons^™

Collaborative International Research In Clinical And Longitudinal Experience Study In Nmosd., Lawrence J Cook, John W Rose, Jessica S Alvey, Anna Marie Jolley, Renee Kuhn, Brie Marron, Melissa Pederson, Rene Enriquez, Jeff Yearley, Stephen Mckechnie, May H Han, Anna J Tomczak, Michael Levy, Maureen A Mealy, Jessica Coleman, Jeffrey L Bennett, Ruth Johnson, Myka Barnes-Garcia, Anthony L Traboulsee, Robert L Carruthers, Lisa Eunyoung Lee, Julia J Schubert, Katrina Mcmullen, Ilya Kister, Zoe Rimler, Allyson Reid, Nancy L Sicotte, Sarah M Planchon, Jeffrey A Cohen, Diane Ivancic, Jennifer L Sedlak, Ilana Katz Sand, Pavle Repovic, Lilyana Amezcua, Ana Pruitt, Erika Amundson, Tanuja Chitnis, Devin S Mullin, Eric C Klawiter, Andrew W Russo, Claire S Riley, Kaho B Onomichi, Libby Levine, Katherine E Nelson, Nancy M Nealon, Casey Engel, Mason Kruse-Hoyer, Melanie Marcille, Leticia Tornes, Anne Rumpf, Angela Greer, Megan Kenneally Behne, Renee R Rodriguez, Daniel W Behne, Derek W Blackway, Brian Coords, Terrence F Blaschke, Judy Sheard, Terry J Smith, Jacinta M Behne, Michael R Yeaman

Articles, Abstracts, and Reports

Objective: To develop a resource of systematically collected, longitudinal clinical data and biospecimens for assisting in the investigation into neuromyelitis optica spectrum disorder (NMOSD) epidemiology, pathogenesis, and treatment.

Methods: To illustrate its research-enabling purpose, epidemiologic patterns and disease phenotypes were assessed among enrolled subjects, including age at disease onset, annualized relapse rate (ARR), and time between the first and second attacks.

Results: As of December 2017, the Collaborative International Research in Clinical and Longitudinal Experience Study (CIRCLES) had enrolled more than 1,000 participants, of whom 77.5% of the NMOSD cases and 71.7% of the controls continue in active follow-up. Consanguineous …

Reported Quality Of Life In Those On High Efficacy Compared To First Line Disease Modifying Therapies In A Community Cohort, Tamela Stuchiner, Lindsay Lucas, Elizabeth Baraban, Chiayi Chen, Stanley Cohan

Articles, Abstracts, and Reports

Introduction: In recent years, more high efficacy disease modifying treatments (DMT) have been approved and patients are placed on high efficacy DMT earlier in their disease course. Few studies have assessed the impact of high efficacy DMT on patients’ quality of life (QoL).

Objective: The study objective was to determine whether participants on high efficacy DMT reported greater impact of MS on their physical and psychological QoL than those on first line DMT using survey data from the Pacific Northwest Multiple Sclerosis Registry (PNWMSR).

Methods: This was a cross-sectional study using participants’ last annual follow up survey submitted between 2013 …

Three Pillars Of Expectation Management In Spine Surgery: Trust, Communication, And Patient Education., Karsten Wiechert, Jeffrey C Wang, Jens R Chapman

Articles, Abstracts, and Reports

No abstract provided.

The Impact Of Ocrelizumab On Immunoglobulin Levels And The Risk Of Infection., Kyle Smoot

Articles, Abstracts, and Reports

Background: Ocrelizumab (OCR), a CD20 antibody, was approved in the US in 2017 for the treatment of relapsing MS (RMS) and primary progressive MS (PPMS). In clinical trials, infection rates are higher in patients receiving OCR. Rituximab, which is very similar to OCR, has been reported to be associated with higher risk of infection particularly in patients with low levels of IgM or IgG.

Objective: To determine if low levels of IgM or IgG increase the risk of infection in patients treated with OCR.

Methods: MS patients in the OCR registry with at least one IgM/IgG value at doses 2, …

Diabetes-Related Amylin Dyshomeostasis: A Contributing Factor To Cerebrovascular Pathology And Dementia, Han Ly, Florin Despa

Pharmacology and Nutritional Sciences Faculty Publications

Type 2 diabetes (T2D) increases the risk for cerebrovascular disease (CVD) and dementia. The underlying molecular mechanisms remain elusive, which hampers the development of treatment or/and effective prevention strategies. Recent studies suggest that dyshomeostasis of amylin, a satiety hormone that forms pancreatic amyloid in patients with T2D, promotes accumulation of amylin in cerebral small blood vessels and interaction with Alzheimer's disease (AD) pathology. Overexpression of human amylin in rodents (rodent amylin does not form amyloid) leads to late-life onset T2D and neurologic deficits. In this Review, we discuss clinical evidence of amylin pathology in CVD and AD and identify critical …

Science Of Lifestyle; Strategies For Change, Raza Ur Rahman

Pakistan Journal of Neurological Sciences (PJNS)

Since the start of 21st century the focus of medical treatment is changing from curative to the preventive medicine and now functional recovery and quality of life are the outcome of curative medicine. These new outcomes of modern medicine can be achieved through adopting the strategies that enhance wellness of patient. The methods of enhancing wellness are in practice since centuries and their effectiveness has been handed down through word of mouth and tradition. They continue to evolve and were first documented in 1970s, by Canyon Ranch1, as a strategy to improve health through the principles of a healthy lifestyle. …

Post-Stroke Seizures: A Clinically Oriented Analysis, Sajid Hameed, Haris Hakeem, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is an important cause of secondary epilepsy, especially in the elderly. Not only does this impact morbidity and mortality in an adverse way, it also prolongs the hospitalization. Various risk factors have been described in literature that increase the risk of seizures in a patient with stroke. Post stroke seizures fall on a spectrum of acute symptomatic and unprovoked seizures with varying pathophysiology and risk of subsequent development of epilepsy. Hence, the treatment approaches are also different. However, randomized controlled trials are lacking to guide monitoring and management strategies in post stroke seizures and the approaches remain individualized to …

An Overview Of Autism: Is It Treatable In Pakistan?, Tania Nadeem, Rabeeka Aftab, Nargis Asad

Pakistan Journal of Neurological Sciences (PJNS)

Autism Spectrum Disorder (ASD) is a clinically complex, pervasive neurodevelopmental disorder with early appearing social communication deficits and repetitive sensory–motor behaviors.1 Although affected individuals differ significantly from one another, typically the disorder is characterized by impairment in social reciprocity and communication. Children usually have speech delays or lack of social interaction including: lack of eye contact, limited response to name, decreased interest in peers, and restricted shared attention with parents.1 Autistic individuals also exhibit repetitive behaviors like flapping, lining, or stacking objects and narrowly focused rigid interests such as paying particular attention to spinning objects.1 It usually manifests before 3 …

What, When And For Whom Model Of Nutrition: A Health Management Approach, Muhammad Rafiq

Pakistan Journal of Neurological Sciences (PJNS)

Studies have shown that nutrition plays an important role in the pathophysiology of different health issues either physiological, or psychological. Nutrition is implicated in the development of health issues in different ways. The purpose of this mini review was to suggest a comprehensive model of nutrition, “What, When and for Whom Model of Nutrition”, in the light of existing literature. For this purpose, existing literature was explored to study the role of nutrition on mental health in perspective to, what type of nutrition, when it is consumed and/or who consumes it. Researchers concluded that it is not only what we …

Diagnostic Dilemmas Of Progressive Supranuclear Palsy, Humera Saeed, Qurat Ul Ain Khan, Syeda Masharab Jilani, Syeda Maheen Batool

Pakistan Journal of Neurological Sciences (PJNS)

In this report authors discuss similarities between psychiatric phenomenon i.e. catatonia and neuropsychiatric syndromes such as progressive supranuclear palsy (PSP) in a 51 years old male, known case of hypertension and diabetes, who presented to the psychiatric services with mutism, stereotypical movements of upper limbs, echolalia, anteriorly flexed neck, swallowing difficulty, decreased oral intake, urinary and fecal incontinence for a period of 1 year worsened for 6 months. Patient was initially treated for catatonia with benzodiazepines and electroconvulsive therapy but did not improve. A neuropsychiatric consultation was sought and a diagnosis of possible PSP was made according to the National …

The Natural Predominant Sleeping Positions In Cerebral Palsy; Does It Correlate With The Type Of Cerebral Palsy?, Sarah Razaq, Muhammad Aleem Arshad, Tahira Amjad

Pakistan Journal of Neurological Sciences (PJNS)

To see the natural positions of cerebral palsy subjects during sleep and their correlation with the particular type of cerebral palsy.

Tacrolimus-Associated Posterior Reversible Encephalopathy Syndrome In Allogenic Hematopoietic Stem Cell Transplant, Hina Imtiaz, Maryam Jamil Syed, Dureshahwar Kanwar, Bushra Taimuri, Sajid Hameed

Pakistan Journal of Neurological Sciences (PJNS)

Tacrolimus is an immunosuppressive drug used to lower the risk of transplant rejection in individuals after solid organ or hematopoietic transplantation. Cases of posterior reversible encephalopathy syndrome (PRES) as a complication of tacrolimus therapy are infrequently documented. The pathogenesis of this phenomenon is not well understood. Here, we report a case of an 18-year-old female with a history of acute myeloid leukemia that developed PRES after undergoing an allogeneic stem cell transplant and subsequent immunosuppressive therapy with tacrolimus.

Cross-Sectional Study Of Knowledge Of Stroke Management Amongst Doctors Of A Tertiary Care Hospital; Peshawar, Pakistan, Muhammad Fozan Khan, Farzana Behttani, Omer Nasim, Muhammad Shahid Iqbal, Sohail Khan, Muhammad Khizar Hayat

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is one of the leading causes of mortality and neurological disability worldwide. ‘Time is brain’ and prompt management of stroke is vital to improve the outcomes. Knowledge of stroke management is important for clinicians working in various specialties and this study focused on evaluation of this vital aspect.

Ossification Of The Posterior Longitudinal Ligament: Surgical Approaches And Associated Complications., Jeffery Head, George Rymarczuk, Geoffrey Stricsek, Lohit Velagapudi, Christopher Maulucci, Christian Hoelscher, Md, James Harrop

Department of Neurosurgery Faculty Papers

Ossification of the posterior longitudinal ligament (OPLL) is a rare but potentially devastating cause of degenerative cervical myelopathy (DCM). Decompressive surgery is the standard of care for OPLL and can be achieved through anterior, posterior, or combined approaches to the cervical spine. Surgical correction of OPLL via any approach is associated with higher rates of complications and the presence of OPLL is considered a significant risk factor for perioperative complications in DCM surgeries. Potential complications include dural tear (DT) and subsequent cerebrospinal fluid leak, C5 palsy, hematoma, hardware failure, surgical site infections, and other neurological deficits. Anterior approaches are technically …

Pituitary Adenoma With Calcifications: A Case Report, Yakoot Khan, Noor Malik, Saba Iqbal Awan, Syed Hassan Khalid, Altaf Ali Laghari

Section of Neurosurgery

Pituitary adenomas and Rathke’s cleft cyst with calcification are rarely seen and craniopharyngioma still remains the common sellar suprasellar space occupying lesion with calcification. Presence of calcification is reported in pituitary adenoma in only 0.2% to 8% cases. The pituitary adenoma with calcification is a rare radiological finding and it must be distinguished from other lesions of the pituitary gland as the management and prognosis differs significantly. We report a case of a 29-year-old gentleman presented electively with the complaints of deterioration of vision for four months. CT-scan without contrast examination revealed pituitary adenoma with calcification. The patient underwent transsphenoidal …

Assessing General Cognitive And Adaptive Abilities In Adults With Down Syndrome: A Systematic Review, Sarah Hamburg, Bryony Lowe, Carla Marie Startin, Concepcion Padilla, Antonia Coppus, Wayne Silverman, Juan Fortea, Shahid Zaman, Elizabeth Head, Benjamin L. Handen, Ira Lott, Weihong Song, André Strydom

Sanders-Brown Center on Aging Faculty Publications

BACKGROUND: Measures of general cognitive and adaptive ability in adults with Down syndrome (DS) used by previous studies vary substantially. This review summarises the different ability measures used previously, focusing on tests of intelligence quotient (IQ) and adaptive behaviour (AB), and where possible examines floor effects and differences between DS subpopulations. We aimed to use information regarding existing measures to provide recommendations for individual researchers and the DS research community.

RESULTS: Nineteen studies reporting IQ test data met inclusion for this review, with 17 different IQ tests used. Twelve of these IQ tests were used in only one study while …

Smart Lighting Clinical Testbed Pilot Study On Circadian Phase Advancement, Joseph D. Gleason, Meeko Oishi, Michelle Simkulet, Arunas Tuzikas, John P. Hanifin, George C. Brainard, S. R.J. Brueck, Robert F. Karlicek, Jr., Lee K. Brown

Department of Neurology Faculty Papers

Objective: Lighting is a strong synchronizer for circadian rhythms, which in turn drives a wide range of biological functions. The objective of our work is a) to construct a clinical in-patient testbed with smart lighting, and b) evaluate its feasibility for use in future clinical studies.

Methods: A feedback capable, variable spectrum lighting system was installed at the University of New Mexico Hospital. The system consists of variable spectrum lighting troffers, color sensors, occupancy sensors, and computing and communication infrastructure. We conducted a pilot study to demonstrate proof of principle, that 1) this new technology is capable of providing continuous …

Modeling Interval Timing By Recurrent Neural Nets, Theodore Raphan, Eugene Dorokhin, Andrew R. Delamater

Publications and Research

The purpose of this study was to take a new approach in showing how the central nervous system might encode time at the supra-second level using recurrent neural nets (RNNs). This approach utilizes units with a delayed feedback, whose feedback weight determines the temporal properties of specific neurons in the network architecture. When these feedback neurons are coupled, they form a multilayered dynamical system that can be used to model temporal responses to steps of input in multidimensional systems. The timing network was implemented using separate recurrent “Go” and “NoGo” neural processing units to process an individual stimulus indicating the …

Mice Exposed To Combined Chronic Low-Dose Irradiation And Modeled Microgravity Develop Long-Term Neurological Sequelae, Amber M. Paul, Eliah G. Overbey, William A. Da Silveira, Candice G.T. Tahimic, Sigrid S. Reinsch, Nathaniel Szewczyk, Seta Stanbouly, Charles Wang, Jonathan M. Galazka, Xiao Wen Mao

Publications

Spaceflight poses many challenges for humans. Ground-based analogs typically focus on single parameters of spaceflight and their associated acute effects. This study assesses the long-term transcriptional effects following single and combination spaceflight analog conditions using the mouse model: simulated microgravity via hindlimb unloading (HLU) and/or low-dose γ-ray irradiation (LDR) for 21 days, followed by 4 months of readaptation. Changes in gene expression and epigenetic modifications in brain samples during readaptation were analyzed by whole transcriptome shotgun sequencing (RNA-seq) and reduced representation bisulfite sequencing (RRBS). The results showed minimal gene expression and cytosine methylation alterations at 4 months readaptation within single …

First-In-Human Study Of Tk-Positive Oncolytic Vaccinia Virus Delivered By Adipose Stromal Vascular Fraction Cells., Boris R Minev, Elliot Lander, John F Feller, Mark Berman, Bernadette M Greenwood, Ivelina Minev, Antonio F Santidrian, Duong Nguyen, Dobrin Draganov, Mehmet O Killinc, Anna Vyalkova, Santosh Kesari, Edward Mcclay, Gabriel Carabulea, Francesco M Marincola, Lisa H Butterfield, Aladar A Szalay

Articles, Abstracts, and Reports

BACKGROUND: ACAM2000, a thymidine kinase (TK)-positive strain of vaccinia virus, is the current smallpox vaccine in the US. Preclinical testing demonstrated potent oncolytic activity of ACAM2000 against several tumor types. This Phase I clinical trial of ACAM2000 delivered by autologous adipose stromal vascular fraction (SVF) cells was conducted to determine the safety and feasibility of such a treatment in patients with advanced solid tumors or acute myeloid leukemia (AML).

METHODS: Twenty-four patients with solid tumors and two patients with AML participated in this open-label, non-randomized dose-escalation trial. All patients were treated with SVF derived from autologous fat and incubated for …

Human Polyomavirus Jcpyv And Its Role In Progressive Multifocal Leukoencephalopathy And Oncogenesis, Luis Del Valle, Sergio Piña-Oviedo

School of Medicine Faculty Publications

The human neurotropic virus JCPyV, a member of the family, is the opportunistic infectious agent of Progressive Multifocal Leukoencephalopathy (PML), a fatal disease seen in severe immunosuppressive conditions and, during the last decade, in patients undergoing immunotherapy. JCPyV is a ubiquitous pathogen with up to 85% of the adult population word-wide exhibiting antibodies against it. Early experiments demonstrated that direct inoculation of JCPyV into the brain of different species resulted in the development of brain tumors and other neuroectodermal-derived neoplasias. Later, several reports showed the detection of viral sequences in medulloblastomas and glial tumors, as well as expression of the …

Analysis Of Manganese Accumulation In The Pituitary Gland And Hippocampus Of Smelters Using High Resolution 3-D T1-Weighted Mri, Alison Jeffries, Zeinab Aly, Molly Cromer

The Journal of Purdue Undergraduate Research

No abstract provided.

The Effects Of Aging On Sleep Parameters In A Healthy, Melatonin-Competent Mouse Model, Jiffin K. Paulose, Chanung Wang, Bruce F. O'Hara, Vincent M. Cassone

Biology Faculty Publications

Background: Sleep disturbances are common maladies associated with human age. Sleep duration is decreased, sleep fragmentation is increased, and the timing of sleep onset and sleep offset is earlier. These disturbances have been associated with several neurodegenerative diseases. Mouse models for human sleep disturbances can be powerful due to the accessibility to neuroscientific and genetic approaches, but these are hampered by the fact that most mouse models employed in sleep research have spontaneous mutations in the biosynthetic pathway(s) regulating the rhythmic production of the pineal hormone melatonin, which has been implicated in human sleep.

Purpose and method: The present study …

Timing Of Postoperative Magnetic Resonance Imaging (Mri) Following Glioma Resection: Shattering The 72 Hour Window, Syed Sarmad Bukhari, Muhammad Shahzad Shamim, Fatima Mubarak

Section of Neurosurgery

Extent of enhancing tumour resection is correlated with progression free survival following glioma surgery. Historically, a contrast enhanced MRI has been recommended within 72 hours following surgery to evaluate for residual disease. This theoretical window was established amidst conflicting evidence to avoid reactive enhancement. Recent studies with better designs and better imaging quality have sought to challenge this window with a more pragmatic method of evaluating residual disease.

Commentary: Recognizing Pupillary Dysfunction In Diabetic Autonomic Neuropathy, Padmaja Sudhakar

Ophthalmology and Visual Science Faculty Publications

No abstract provided.

Moving Toward The Future: Online Only., Jeffrey C Wang, Jens R Chapman, Karsten Wiechert

Articles, Abstracts, and Reports

No abstract provided.

Oxidative Phosphorylation: A Critical Feature And Novel Therapeutic Target In Melanoma Brain Metastases, Grant Fischer

Dissertations and Theses (Open Access)

We recently showed via RNA-sequencing (RNA-seq) analysis of clinical samples that melanoma brain metastases (MBMs) have higher expression of oxidative phosphorylation (OXPHOS) genes (including PPARGC1A or PGC1α) than patient-matched extracranial metastases (ECMs). Thus, the central hypothesis of this dissertation is that OXPHOS plays a critical role in the pathogenesis of MBMs.

RNA-seq analysis identified increased expression of OXPHOS genes in intracranial (ICr) vs. subcutaneous (SQ) xenografts of 4 different human melanoma cell lines. Increased OXPHOS in the ICr xenografts was confirmed by direct metabolite analysis and [U-¹³C]-glucose tracing analysis. Together, these studies indicate that the brain TME …

Spectrum Of Neurological Disorders In Neurology Outpatients Clinics In Urban And Rural Sindh, Pakistan: A Cross Sectional Study, Safia Awan, Alam Ibrahim Siddiqi, Ahmed Asif, Naveeduddin Ahmed, Hazim Brohi, Sajad Jalban, Mohammad Wasay

Section of Neurology

Background: Neurological disorders are the most common cause of morbidity and mortality in developing countries. Available evidence on urban–rural differences on neurological diseases is scare in such countries. Our study objective was to determine the prevalence of neurological diseases in urban and rural tertiary care hospitals of Sindh, Pakistan.

Methods: This was a cross sectional study conducted in selected urban and rural region of tertiary care hospitals of Sindh, Pakistan. The outpatients medical records of adults (18 years and above) was obtained from January 1st, 2014 to December 31st, 2014.

Results: A total of 10,786 outpatients visit were recorded in …

Association Of Office And Ambulatory Blood Pressure With Mortality And Cardiovascular Outcomes, Wen-Yi Yang, Jesus D. Melgarejo, Lutgarde Thijs, Zhen-Yu Zhang, José Boggia, Fang-Fei Wei, Tine W. Hansen, Kei Asayama, Gladys E. Maestre, Takayoshi Ohkubo

School of Medicine Publications

Importance Blood pressure (BP) is a known risk factor for overall mortality and cardiovascular (CV)-specific fatal and nonfatal outcomes. It is uncertain which BP index is most strongly associated with these outcomes.

Objective To evaluate the association of BP indexes with death and a composite CV event.

Design, Setting, and Participants Longitudinal population-based cohort study of 11 135 adults from Europe, Asia, and South America with baseline observations collected from May 1988 to May 2010 (last follow-ups, August 2006-October 2016).

Exposures Blood pressure measured by an observer or an automated office machine; measured for 24 hours, during the day or …

Prevalence Of Dyskinesia And Off By 30-Minute Intervals Through The Day And Assessment Of Daily Episodes Of Dyskinesia And Off: Novel Analyses Of Diary Data From Gocovri Pivotal Trials., Robert A. Hauser, Daniel Kremens, Lawrence W. Elmer, David L. Kreitzman, Ryan R. Walsh, Reed Johnson, Robert Howard, Jack T. Nguyen, Rajiv Patni

Department of Neurology Faculty Papers

BACKGROUND: Parkinson's disease (PD) patients using levodopa commonly develop dyskinesia and OFF episodes that reduce quality of life.

OBJECTIVE: Evaluate prevalence of troublesome dyskinesia and OFF through the day, assessed by 30-minute intervals, as well as the mean number and duration of troublesome dyskinesia and OFF episodes, transitions between PD states, and effects of Gocovri® (amantadine) extended release capsules on these episodes.

METHODS: Evaluate diary data from pooled Gocovri phase 3, placebo-controlled trials-analyzed for 17 hours following wake-up-at baseline and week 12.

RESULTS: Diaries were evaluable for 162 patients. At baseline, 67% of patients woke up OFF, with prevalence decreasing …