Neurology Commons^™

Allostatic Load Predicts Racial Disparities In Intracerebral Hemorrhage Cognitive Outcomes, Jennifer Harris, Amelia Boehme, Luisa Chan, Harmon Moats, Rachelle Dugue, Chigozirim Izeogu, Marykay A Pavol, Imama A Naqvi, Olajide Williams, Randolph S Marshall

Faculty, Staff and Student Publications

A large portion of stroke disparities remains unexplained, even after adjusting for demographic, comorbidity, and health care access variables. There is a critical need to close this knowledge gap by investigating novel factors that may contribute to stroke disparities. Allostatic load (AL) is the lifetime adverse physiologic impact of needing to adjust to socially structured stressors such as racism. AL has been shown to increase health vulnerability and worsen outcomes in marginalized populations. We sought to assess the differential impact of AL on cognitive outcomes post intracerebral hemorrhage (ICH) across race-ethnicity. The Intracerebral Hemorrhage Outcomes Project (ICHOP) prospectively collected data …

Competency-Based Eeg Education: A List Of “Must-Know” Eeg Findings For Adult And Child Neurology Residents, Fábio A Nascimento, Jin Jing, Roy Strowd, Irfan S Sheikh, Dan Weber, Jay R Gavvala, Atul Maheshwari, Adriana Tanner, Marcus Ng, K P Vinayan, Saurabh R Sinha, Elza M Yacubian, Vikram R Rao, M Scott Perry, Nathan B Fountain, Ioannis Karakis, Elaine Wirrell, Fang Yuan, Daniel Friedman, Hatice Tankisi, Stefan Rampp, Rebecca Fasano, Jo M Wilmshurst, Cormac O'Donovan, Donald Schomer, Peter W Kaplan, Michael R Sperling, Selim Benbadis, M Brandon Westover, Sándor Beniczky

Faculty, Staff and Student Publications

No abstract provided.

Neurologic Complications Of Cancer, David Green

Conference Presentation Abstracts

No abstract provided.

The Modified Rankin Scale Can Accurately Be Derived From The Electronic Medical Record, Derek Isenberg, Nelson Prus, Frederick Ramsey, Nina T. Gentile

Transformative Medicine

Abstract

Introduction

The modified Rankin Scale (mRS) is used to assess functional outcomes after a stroke and is the primary outcome in many stroke trials. For retrospective stroke research or stroke research in which patients are lost to study follow up, review of the electronic medical record (EMR) may be the sole way to estimate a patient’s functional outcome. The purpose of this study is to determine if a mRS can be accurately derived from the electronic medical record EMR.

Methods

This study used data from completed stroke studies in which in-person 90-day mRS were collected as part of the …

Barriers, Access And Management Of Paediatric Epilepsy With Telehealth., Kari Gali, Sucheta Joshi, Sarah Hueneke, Alexis Katzenbach, Linda Radecki, Trisha Calabrese, Linda Fletcher, Cristina Trandafir, Carey Wilson, Monisha Goyal, Courtney J. Wusthoff, Jean-Baptist Lepichon, Rhonda Corvalan, April Golson, Jessica Hardy, Michael Smith, Elizabeth Cook, Joshua L. Bonkowsky

Manuscripts, Articles, Book Chapters and Other Papers

Access to paediatric neurology care is complex, resulting in significant wait times and negative patient outcomes. The goal of the American Academy of Pediatrics National Coordinating Center for Epilepsy's project, Access Improvement and Management of Epilepsy with Telehealth (AIM-ET), was to identify access and management challenges in the deployment of telehealth technology. AIM-ET organised four paediatric neurology teams to partner with primary-care providers (PCP) and their multidisciplinary teams. Telehealth visits were conducted for paediatric epilepsy patients. A post-visit survey assessed access and satisfaction with the telehealth visit compared to an in-person visit. Pre/post surveys completed by PCPs and neurologists captured …

Practical Needs And Considerations For Refugees And Other Forcibly Displaced Persons With Neurological Disorders: Recommendations Using A Modified Delphi Approach, Shawheen Rezaei, Foksouna Sakadi, Fu-Liong Hiew, Ildefonso Rodriguez-Leyva, Jera Kruja, Mohammad Wasay, Osheik Abuasha Seidi, Saad Abdel-Aziz, Shahriar Nafissi, Farrah Mateen

Section of Neurology

Background: There are >70 million forcibly displaced people worldwide, including refugees, internally displaced persons, and asylum seekers. While the health needs of forcibly displaced people have been characterized in the literature, more still needs to be done globally to translate this knowledge into effective policies and actions, particularly in neurology.
Methods: In 2020, a global network of published experts on neurological disease and refugees was convened. Nine physician experts from nine countries (2 low, 1 lower-middle income, 5 upper-middle, 1 high income) with experience treating displaced people originating from 18 countries participated in three survey and two discussion rounds in …

Gender Parity In Authorship Of Published Randomized Clinical Trials In Stroke Neurology From 2000 To 2021., Noor F Shaik, Ali A Saherwala, Diana L Tzeng

Department of Neurology Faculty Papers

Gender parity is a crucial goal in clinical medicine so that women have equal access and representation. Although approximately half (46%) of US neurology residents and fellows are female, proportions of female assistant, associate, and full professors are 49%, 41%, and 23%, respectively. This has far-reaching effects, from clinical publications to invited speakerships.Although a study noted increasing trends in female authorship in high-impact neurology journals the current literature lacks evidence on a more informative benchmark—first and last authorship in randomized clinical trials (RCTs), which is typically considered for career advancement. This study assessed annual proportions and trends of female first …

Adult-Onset Alexander Disease Uncovered In A Previously Healthy Patient Presenting With Acute Stroke-Like Symptoms, Usaamah M. Khan, Matthew Barrett, Alex Dworetz Do

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Alexander Disease is a rare, often fatal, leukoencephalopathy of early childhood associated with a heterozygous mutation of the glial fibrillary acid protein (GFAP) gene. Adult-Onset Alexander Disease (AOAD) is an exceptionally rare leukoencephalopathy that often presents with slowly progressive brainstem and cervical cord dysfunction features. Acute onset of AOAD has only ever been reported three times in the literature. We report a case of acute onset AOAD in a patient that presented with bulbar symptoms and left hemiplegia initially concerning for acute stroke.

Pediatric Partnership: Drs. Aaron & Metta Cardon Join Unm Child Neurology Faculty, Michael Haederle

HSC Newsroom

No abstract provided.

An Educational Workshop To Improve Neurology Resident Understanding Of Burnout, Substance Abuse, And Mood Disorders., Ryan Donaghy, Shiori Tomatsu, Patrick Kerns, Courtney White, Jeffrey Ratliff

Department of Neurology Faculty Papers

Introduction: Burnout, substance abuse, and mood disorders are prevalent among neurology residents. Increased recognition of concerning behaviors might encourage more access to mental health resources and reduce burnout.

Methods: We created an educational resource reviewing burnout, substance abuse, and mood disorders for neurology residents. This resource included an online module (control) and a role-play scenario offered only to one cohort (intervention). Online surveys assessed knowledge as well as confidence in the ability to recognize concerning behaviors. A practical assessment using a previously published "Stressed Resident" video was also conducted among resident cohorts.

Results: Of neurology residents, 18 participated in the …

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 …

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

Cooper Neurological Institute, Kayla Cupano

Department of Occupational Therapy Entry-Level Capstone Projects

No abstract provided.

Essential Tremor: A Review, Grant S. Taylor

Honors Projects

Essential tremor (ET) is one of the most prevalent movement disorders globally: approximately 1% of the population is affected (Haubenberger & Hallet, 2018). In the past, ET has been grossly oversimplified clinically and pathologically and only through recent study has the complexity of the disease process and presentation been made apparent. Despite the recent advances in research regarding ET, the general public is still largely unfamiliar with the various aspects of the disease (Cristal et al., 2018). Perhaps even more surprising is the similar lack of knowledge that ET patients have regarding their own disease (Cristal et al., 2018). Recent …

A Case Of Diastematomyelia Presenting With Minimal Neurologic Deficits In A Middle-Aged Patient, Gabriella Mamo, Rishu Batra, Jeffrey Steinig

Transitional Year Resident Research

Diastematomyelia is a rare congenital deformity of the spine in which the spinal cord is split into two hemicords along the sagittal plane. This condition belongs to the group of spinal dysraphisms, is more common in females, and is usually diagnosed prenatally or during childhood; rarely is it diagnosed in adults. We report a male patient in his 50s in which diastematomyelia of the thoracic spine was incidentally encountered after receiving a CT scan of the chest for shortness of breath. Although most patients with this condition are symptomatic, the patient did not display any significant acute neurological complaints at …

Axonal Blockage With Microscopic Magnetic Stimulation, Hui Ye

Biology: Faculty Publications and Other Works

Numerous neurological dysfunctions are characterized by undesirable nerve activity. By providing reversible nerve blockage, electric stimulation with an implanted electrode holds promise in the treatment of these conditions. However, there are several limitations to its application, including poor bio-compatibility and decreased efficacy during chronic implantation. A magnetic coil of miniature size can mitigate some of these problems, by coating it with biocompatible material for chronic implantation. However, it is unknown if miniature coils could be effective in axonal blockage and, if so, what the underlying mechanisms are. Here we demonstrate that a submillimeter magnetic coil can reversibly block action potentials …

Telehealth Care And Its Role In Undergraduate Medical Education In The Covid-19 Era., Peter J. Gonzalez, Dustin J. Paul

MEDI 9331 Scholarly Activities Clinical Years

Background

On March 17, 2020, the American Association of Medical Colleges issued a statement which “strongly supports medical schools pausing all student clinical rotations, effective immediately, until at least March 31.” The University of Texas Rio Grande Valley School of Medicine immediately withdrew third- and fourth-year students from clinical rotation sites, and developed alternative, online-based clerkship curricula to complete for the remainder of the academic year. The COVID-19 pandemic has brought about many challenges to Undergraduate Medical Education, and has deprived upper-level students of foundational, in-person, clinical experiences. The UTRGV School of Medicine Department of Neurology is among the first …

Early Follow-Up Phone Calls To Reduce 30-Day Readmissions For Stroke Patients Discharged To Home, Olivia Gruder, Md, John Allred, Md, Frank Anzelmi, Md, Judy Diep, Md, Belle English, Md, Aniket Natekar, Md, Priyadarshee Patel, Md, Louis Porreca, Md, Sanskruti Patel, Md, Shaista Alam, Md, Rodney Bell, Md, Robin Dharia, Md, Elan Miller, Md, Diana Tzeng, Md, Fred Rincon, Md< Msc, Facp

Health Equity and Quality Improvement (HEQI) Summit

Patients admitted to the acute stroke unit with minor neurologic deficits are frequently discharged directly to home rather than to a rehabilitation center. Data from our tertiary care comprehensive stroke center has shown that in a 7-month period, 37% of patients admitted to the stroke unit were discharged home versus discharged to rehab or other location. Our average 30-day readmission rate for home discharges is 5.14%. More than 30% of these readmitted patients had been discharged on a Thursday or Friday on their index admission. When discharged home, patients typically are tasked with several responsibilities including but not limited to …

Perceived Impact Of Non-Contact Boxing On Daily Life And Occupational Participation At Home Among Individuals With Parkinson's Disease, Kristen E. Bignal

Student Capstone Papers

The aim of this project was to determine whether individuals with Parkinson's disease perceive an impact on their daily life and occupational participation at home secondary to participation in non-contact boxing.

Semi-structured open-ended interview questions were conducted with 17 participants (3 female) who have been diagnosed with Parkinson's disease for(i.e., self-care, home and health maintenance, sleep, intimacy, social and leisure interests, etc.) in the home environment. Interviews were transcribed and analyzed utilizing thematic analysis.

Data analysis derived three overarching themes including psychological benefits, sense of community, and framework to develop routines. Subsequent research exploring how non-contact boxing directly impacts specific …

Toxic Leukoencephalopathy Presenting As Agitation And Social Withdrawal In A Patient With Substance Use Disorder: A Case Report, Andrew R. Beauchesne, Brian F. King

Journal of Maine Medical Center

Introduction: Toxic leukoencephalopathy (TLE) is characterized by damage to myelin of cerebral white matter and is caused by a number of offending agents, including drugs of abuse. The clinical presentation of TLE is variable and not fully understood.

Clinical Findings: A 51-year-old male presented with pneumonia, parapneumonic effusion, and acute kidney injury. His medical course was complicated by neurobehavioral changes, including aggression and social withdrawal.

Diagnoses, interventions, and outcomes: The patient was diagnosed with acute toxic leukoencephalopathy based on diffuse subcortical T2-weighted-fluid-attenuated inversion recovery (T2/FLAIR) on brain MRI, bilateral frontal arrhythmic delta waves on encephalogram, and a …

Simulation Of Status Epilepticus Is Effective Teaching For Junior Neurology Residents, Pankhuri Jha, Navya George, Jeffrey Ratliff

Phase 1

Purpose: Status Epilepticus (SE) represents a potentially fatal neurologic emergency. At Jefferson, acute management of SE falls to the inpatient neurologist, requiring early competency.

Methods: During a 2 week educational “bootcamp”, 9 PGY2 residents participated in a 2 hour simulation of acute SE with two clinical scenarios. Scenarios included a patient with SE requiring adequate benzodiazepine dosing and another with seizures requiring IV anticonvulsant therapy. Prior to and following the simulation, residents took a survey to gauge their knowledge and confidence in managing SE.

Results and Conclusions: There was an increase in the number of residents expressing confidence in their …

Simulating Status Epilepticus Management For Junior Neurology Trainees, Navya George, Pankhuri Jha, Frank Anzelmi, Md, Allyson Pickard, Md, Jeffrey Ratliff, Md

Phase 1

Purpose/Methods: Status Epilepticus (SE) represents a potentially fatal neurologic emergency. We aimed to create an educational simulation of SE for 9 PGY2 neurology residents. Scenarios included a patient with SE requiring adequate benzodiazepine dosing and another with seizures requiring IV anticonvulsant therapy. Subjects were dichotomized to groups who did and did not feel confident in clinical skills around SE. Knowledge was assessed with a multiple choice quiz. Confidence groups were analyzed with Fisher’s exact test. Quiz scores means were assessed with paired t-test.

Results: There was a trend towards significance in the proportion of residents expressing confidence in their ability …

The Comparative Efficacy Of Amantadine Vs. Lcig Therapy For The Treatment Of Levodopa-Induced Dyskinesia In Patients With Advanced Parkinson's Disease, Katelynn Timony

Capstone Showcase

Introduction: Though levodopa-carbidopa therapy remains the gold standard of Parkinson’s disease (PD) treatment to this day, patients often experience increased dyskinetic activity as a result of long-term treatment; known as levodopa-induced dyskinesia (LID); the mechanism of which is not completely understood. In this review, the efficacy of two adjunct treatments for LID are compared: 1) the concomitant administration of amantadine, an antiviral medication with antidyskinetic properties; and 2) a new form of levodopa administration in the form of an intestinal gel delivered straight via a device much like an insulin pump.

Methods: Two systematic literature searches of primary, peer-reviewed articles …

An Educational Workshop To Improve Neurology Resident Knowledge And Understanding Of Burnout, Substance Abuse, And Mood Disorders, Shiori Tomatsu, Ryan Donaghy, Patrick Kerns, Md, Phd, Courtney White, Md

Phase 1

Problem: Many medical residents are at risk for burnout, mood disorders, and substance abuse. We created an educational activity composed of an online module (OM), an interactive role-playing session (AL), and a video practicum (VP) to inform neurology residents on the aforementioned risks and available support resources. This project evaluates the efficacy of these tools.

Methods: PGY2 and PGY3 neurology residents were given OM. In addition, the PGY2 residents participated in AL. Three surveys were given to assess their knowledge about burnout before completing the module (Sur1), after AL session (Sur2), and after watching VP(Sur3).

Outcomes: More PGY2 residents scored …

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 …

Testosterone Levels In Men With Chronic Migraine, Lisa B. E. Shields, Tad Seifert, Brent J. Shelton, Brian M. Plato

Markey Cancer Center Faculty Publications

Chronic migraine is a frequent and debilitating condition affecting 14% of the general population. This prospective observational pilot study investigated whether men with chronic migraine have lower than expected total serum testosterone levels. We identified 14 men ages 26-51 at our Institution who fulfilled the ICHD-3b criteria for chronic migraine and obtained serum total testosterone levels. The mean total testosterone level in our 14 patients was 322 ng/dL (range: 120-542 ng/dL) which is in the lower 5% of the reference range for our laboratory (300-1080 ng/dL). Men with chronic migraine had lower total testosterone levels compared to published agematched normative …

Coordination Of Inpatient And Outpatient Care For Neurology Patients Undergoing Epilepsy Monitoring, Sara Schrock, Michelle Beane, Kathryn Cope, Mark Parker, Suneela Nayak, Ruth Hanselman, Stephen Tyzik, Amy Sparks, Brendan Lilley

Operations Transformation

ORGANIZING A SYSTEM TO CONSOLIDATE EPILEPSY REFERRALS TO AN OUTPATIENT NEUROLOGY PRACTICE

An outpatient neurology practice was experiencing delayed or lost referrals for epilepsy monitoring. This delay was leading many patients to suffer unnecessary and unmanaged seizures and, in some cases, frequent trips to the emergency department.

As a result, a team consisting of the neurology practice and neuro-navigators used baseline metrics to demonstrate the current state of the problem and conducted a root cause analysis that outlined several causes. A number of countermeasures were initiated with the goal of decreasing referral misses.

Post the initiation of two KPIs, a …

Improving Medical And Endovascular Management For Acute Ischemic Stroke Through Multidisciplinary Education And Simulation, Richard F. Schmidt, Md, Megan Margiotta, Md, Elan Miller, Md, Robin D'Ambrosio, Bsn, Scrn, Robin Dharia, Md, Maria Aini, Md, Diana Tzeng, Md, Fred Rincon, Md, Pascal Jabbour, Md, Nabeel Herial, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Primary goals:

1. Reduce door to treatment times (both DTN and DTP) to meet and exceed existing guidelines metrics.
2. Educate residents about acute stroke management, including national guidelines and new institutional protocols to improve efficiency during stroke alerts.

Genetic Testing Practices Of Genetic Counselors, Geneticists, And Pediatric Neurologists With Regard To Childhood-Onset Neurogenetic Conditions, Sara Wofford

Dissertations and Theses (Open Access)

Identifying genetic diagnoses for neurological conditions with a considerable hereditary component, such as autism spectrum disorder (ASD), intellectual disability, and epilepsy, is critical to providing proper medical management for these patients and their families. However, many patients with these conditions are not tested appropriately or receive no genetic testing at all. The current study was designed to characterize the genetic testing practices of the providers most likely to evaluate or order genetic testing for these patients: pediatric neurologists, geneticists, and genetic counselors. The study noted significant variance between the testing strategies selected by pediatric neurologists compared to those of geneticists …

Widespread Theta Synchrony And High-Frequency Desynchronization Underlies Enhanced Cognition., E. A. Solomon, J. E. Kragel, Michael R. Sperling, Ashwini Sharan, G. Worrell, M. Kucewicz, C. S. Inman, B. Lega, K. A. Davis, J. M. Stein, B. C. Jobst, K. A. Zaghloul, S. A. Sheth, D. S. Rizzuto, M. J. Kahana

Department of Neurology Faculty Papers

The idea that synchronous neural activity underlies cognition has driven an extensive body of research in human and animal neuroscience. Yet, insufficient data on intracranial electrical connectivity has precluded a direct test of this hypothesis in a whole-brain setting. Through the lens of memory encoding and retrieval processes, we construct whole-brain connectivity maps of fast gamma (30-100 Hz) and slow theta (3-8 Hz) spectral neural activity, based on data from 294 neurosurgical patients fitted with indwelling electrodes. Here we report that gamma networks desynchronize and theta networks synchronize during encoding and retrieval. Furthermore, for nearly all brain regions we studied, …