Nervous System Diseases Commons^™

Stress And Seizures: The October 7th Experience, Alon Doron, Firas Fahoum, Lilach Goldstein

Department of Neurology Faculty Papers

OBJECTIVE: Stress is a frequently self-reported seizure trigger in patients with epilepsy (PWE), with studies regarding this issue having conflicting results. On October 7th, 2023, a large-scale military invasion accompanied by massive rocket launches against Israel, including Tel Aviv, occurred, providing an opportunity to investigate the role of acute stress in provoking seizures.

METHODS: All adults who presented to the emergency department (ED) of Tel Aviv Sourasky Medical Center between January 1st, 2017, and February 29th, 2024, and were diagnosed with seizures were included. Data were collected using MDClone, a data acquisition tool. The overall seizure-related ED admissions were compared …

Brivaracetam For Spinal Cord Injury-Related Neuropathic Pain: Results Of A Pilot Double-Blinded, Randomized, Placebo-Controlled Clinical Trial, Leslie R. Morse, Ricardo A. Battaglino, Nguyen Nguyen, Brian Devries, Abigail Welch, Ana Lucia Battaglino, Clas Linnman, Michael Stillman, Robert Wudlick, Joda Glossner, Grant Anderton, Richard Goldstein, Scott P. Falci

Department of Medicine Faculty Papers

OBJECTIVE: Assess feasibility, safety, and tolerability of 3 months of oral brivaracetam for severe (9-10/10) spinal cord injury-related neuropathic pain.

METHODS: We conducted a multisite pilot study where adults were randomized to 3 months of brivaracetam (100 mg BID) or placebo. Pain was assessed via the Brief Pain Inventory, the International Spinal Cord Injury Pain Basic Dataset (version 2.0), and a daily pain diary.

RESULTS: We enrolled 24 participants across 2 sites and 14 participants were included in the final analysis (n = 8 placebo, n = 6 brivaracetam). The drug was tolerated with expected, nonserious side effects (nausea if …

How Do Montessori-Based Activities Affect Behaviors For Older People With Dementia: A Literature Review, Isabel Quigley

University Honors Theses

Objectives: This literature review is meant to analyze the development on the research on Montessori-based activities for adults with dementia.

Introduction: Baby Boomers are the largest generation to enter senior age (65+) in history due to the advancement in medicine to increase life expectancy. Dementia is a neurocognitive disease that affects parts of the brain related to memory and signs typically surface around 65 years old. Dementia is not considered healthy aging. Montessori-based activities have been recently developed as an intervention to encourage a feeling of accomplishment and success for adults with dementia.

Methods: Two electronic databases …

Fda Approves Lecanemab-Irmb Maintenance Dosing For Early Alzheimer’S Disease Treatment, Jordyn Linfield, Giang Nguyen, Ashley Jacob, Andrew Johnson, Maria Nguyen, Sara Ha, Joshua Honaker, Samantha Mccord, Kelly Kroustos

Pharmacy and Wellness Review

Alzheimer’s disease (AD) is the most prevalent neurodegenerative disorder and is associated with progressive and irreversible cognitive decline that begins with memory lapses leading to physical and functional impairment. The conventional therapies that have been used for the treatment from Alzheimer's Disease include acetylcholinesterase inhibitors and memantine, but additional therapy options are being developed. Lecanemab, brand name Lequembi, is currently a Food and Drug Administration (FDA) approved humanized monoclonal antibody for the treatment of Alzheimer’s disease and indicated for mild cognitive impairment (MCI) or mild dementia. While there is impactful aid for treatment, lecanemab has three significant adverse reactions, which …

Decompression With Intradural Dissection For The Chiari Malformation Type I: Toward Eliminating Wound Complications, Anna Lin, Lindsey Asti, Marissa Carroll, Jeffrey Campbell, Jospeh Piatt

Department of Neuroscience Faculty Papers

BACKGROUND: There is continuing conversation about surgical technique in the management of the Chiari malformation. Popular options include osseous decompression alone, decompression with dural splitting, and decompression with intradural dissection (DID) and duraplasty. Wound complications after intradural dissection are a persistent problem. The current study of an institutional series examines wound complication rates after intradural dissection without dural closure.

METHODS: A retrospective single-institution chart review was performed for patients < 21 years with Chari malformation type I who underwent DID without dural closure and had at least 6 months of follow-up. Bone removal corresponded to the area of attachment of the rectus capitis posterior minor muscles together with laminectomy of the atlas. The trapezius and semispinalis capitis muscles were retracted but were not separated from the occiput.

RESULTS: A total of 76 patients were treated from May 2010 through May 2024. Thirty-eight (50.0%) patients had syringomyelia. The median age at surgery was 9 years (interquartile range [IQR] 4-13), …

Cenobamate Use In Pregnancy: A Case Report, Tiara Paul, Maromi Nei

Department of Neurology Faculty Papers

No abstract provided.

Imaging Hallmarks Of Idiopathic Intracranial Hypertension And Insights Into Pathogenesis, Albalooshy Basimah, Scott Faro, Hsiangkuo Yuan, Kiran Talekar, Prabath Mondel, Enchao Qiu, Joga Chaganti

Department of Radiology Faculty Papers

Idiopathic Intracranial hypertension (IIH), also referred to as pseudotumor cerebri, is a term used to describe increased intracranial pressure in the absence of a known identifiable secondary cause. Despite advancements of neuroimaging techniques, imaging of the pathological underpinnings in the diagnosis of IIH has been limited. Although the causation of IIH has been ascribed to increased Cerebrospinal Fluid production and disordered drainage through the dural sinuses, new evidence shows that the glymphatic system which is an alternate pathway of drainage is likely to play a pivotal role. In this review, we address the pathophysiological underpinnings in the causation of IIH …

Shilla Growth Guidance System (Sggs) Instrumentation With Pelvic Foundation (Sggs) For Severe Neuromuscular Spine Deformity. Does It Work?, Hannah Geoffroy, Richard Schwend

Research Days

This study evaluates the use of the Shilla Growth Guidance System (SGGS) with a pelvic foundation for treating severe neuromuscular scoliosis in young children. The primary outcomes include revision surgery and complication rates. In a 21-patient cohort (mean age 5.3 years, follow-up 10 years), 57% required only one surgery, while 43% needed revisions. The complication rate was 38%, with a 29% deep infection rate. The procedure improved spinal alignment and growth but carried significant risks. SGGS with pelvic fixation may reduce the need for repeated surgeries in this complex patient population.

Characteristics Of Pediatric Patients With Sports-Related Concussions: A Single Site Retrospective Review, Jose A. Cruz Ayala, Shahrukh Khan, Holly Monk, Emma Cole, Alison Smith, Scott Schultz, Lindsay Elliott, Jessica Zagory

School of Medicine Faculty Publications

PURPOSE: Sports-related concussion (SRC) cases have increased among children in the last decade. Differences in concussion symptoms, presentation, and follow-up care exist when comparing demographics. The aim of this study was to explore SRC within the pediatric population. METHODS: A retrospective chart review of patients ≤ 18 years old diagnosed with SRC at a New Orleans stand-alone children's hospital from January 2007 to December 2021 was performed. T-test and Fisher's exact test were used for relationship between outcomes and sports, demographics, setting, insurance, and follow-up care. RESULTS: Children who sustained SRC at practice were more likely to be male (p …

Advancing Remote Monitoring For Patients With Alzheimer Disease And Related Dementias: Systematic Review, Mohmmad Arif Shaik, Fahim Islam Anik, Md Mehedi Hasan, Sumit Chakravarty, Mary Dioise Ramos, Mohammad Ashiqur Rahman, Sheikh Iqbal Ahamed, Nazmus Sakib

School of Nursing Faculty Publications

BACKGROUND: Using remote monitoring technology in the context of Alzheimer disease (AD) care presents exciting new opportunities to lessen caregiver stress and improve patient care quality. The application of wearables, environmental sensors, and smart home systems designed specifically for patients with AD represents a promising interdisciplinary approach that integrates advanced technology with health care to enhance patient safety, monitor health parameters in real time, and provide comprehensive support to caregivers. OBJECTIVE: The objectives of this study included evaluating the effectiveness of various remote sensing technologies in enhancing patient outcomes and identifying strategies to alleviate the burden on health care professionals …

Optimal Diagnostic Strategies For Concussion-Related Vision Disorders: A Review, Iniya K. Adhan, Kammi B. Gunton

Wills Eye Hospital Papers

Concussions are a mild form of traumatic brain injury (TBI) that is typically self-limited and transient with a high prevalence within our communities. Due to the vast visual network interconnectivity, visual symptoms secondary to a concussion occur about 90% of the time. A gold standard to confirm concussion acutely has not been well established. Visual function testing based on symptoms remains the standard of care in off-site evaluation for diagnosis of oculomotor dysfunction. This review covers the current diagnostic strategies for vision based disorders post-concussion for sideline testing, off-site testing, and research driven testing.

Clinical Value Of Chatgpt For Epilepsy Presurgical Decision-Making: Systematic Evaluation Of Seizure Semiology Interpretation, Yaxi Luo, Meng Jiao, Neel Fotedar, Jun-En Ding, Ioannis Karakis, Vikram R. Rao, Melissa Asmar, Xiaochen Xian, Orwa Aboud, Yuxin Wen, Jack J. Lin, Fang-Ming Hung, Hai Sun, Felix Rosenow, Feng Liu

Engineering Faculty Articles and Research

Background: For patients with drug-resistant focal epilepsy, surgical resection of the epileptogenic zone (EZ) is an effective treatment to control seizures. Accurate localization of the EZ is crucial and is typically achieved through comprehensive presurgical approaches such as seizure semiology interpretation, electroencephalography (EEG), magnetic resonance imaging (MRI), and intracranial EEG (iEEG). However, interpreting seizure semiology is challenging because it heavily relies on expert knowledge. The semiologies are often inconsistent and incoherent, leading to variability and potential limitations in presurgical evaluation. To overcome these challenges, advanced technologies like large language models (LLMs)—with ChatGPT being a notable example—offer valuable tools for …

Covid-19 And Related Adverse Neurological Complications, Hannah A. Wasson

Honors Thesis

Abstract

The COVID-19 pandemic changed the world drastically, and its impact was monumental. COVID-19 or SARS-CoV-2, or severe acute respiratory syndrome, was the virus responsible for causing such mayhem. This contagious virus can enter the body via different routes, live on surfaces for hours, and be transmitted through the air, increasing infection risk. Once it enters the body, it can trick the body into replicating the virus. From this reaction within the body, signs and symptoms follow. While the name indicates a respiratory illness, the virus can inflict injury on other parts of the body. Due to the organ systems …

Impaired Dnajb2 Response To Heat Shock In Fibroblasts From A Neuropathy Patient With Dnajb2/Hsj1 Mutation: Cystamine As A Potential Therapeutic Intervention, Raj K. Pradhan, Nikolas G. Kinney, Brigid K. Jensen, Hristelina Ilieva

Farber Institute for Neuroscience Faculty Papers

Background and Objectives: Neuropathy is a debilitating disorder characterized by peripheral nerve dysfunction and damage to sensory, motor, and autonomic neurons and their axons. While homozygous mutations in DNAJB2/HSJ1 have been linked to early-onset neuropathy, a heterozygous DNAJB2 c.823+6C>T was discovered in an adult patient with severe sensory–motor polyneuropathy. This mutation is predicted to affect both isoforms of the protein. DNAJB2 (HSP40), a key member of the heat shock protein family, plays a critical role in cellular protection and stress, including response to heat shock. DNAJB2 traffics unfolded proteins to another heat shock protein, HSP70, and activates its ATPase …

Valproic Acid Loaded Niosomal In Situ Gel: A Novel Approach For Epilepsy Treatment, Rutuja Bastapure, Akshay Gawali, Gopal Lohiya, Kranti Satpute, Mahesh Birajdar, Sameep Sonvane

International Journal of Health and Allied Sciences

Valproic acid is an antiepileptic medication that is primarily used to treat epilepsy and bipolar disorder. This investigation was designed with three objectives in mind. First, improve the solubility and bioavailability of the BCS class II medicine valproic acid; second, make it easy to give the drug to an epileptic patient during an episode; and third, lower the dosage for long-term treatment. Niosomal formulations were optimized using various Tween and Span range ratios. The formulations were made using the ether injection method. The formulation's morphological characterization, entrapment efficiency, viscosity, and particle size were evaluated. Valproic acid niosomes prepared with Tween …

Development And Assessment Of Liposomal Nasal Spray For The Treatment Epilepsy, Sayali Dongare, Sushmaji Sontakke, Gopal Lohiya, Shoeb Syed, Rohit Sarda

International Journal of Health and Allied Sciences

Abstract:

Background: Levetiracetam is a pyrrolidine class antiepileptic drug mainly used to treat epilepsy and seizures.

Objective: The purpose of this research was to synthesize a liposomal nasal spray incorporating levetiracetam for nose to brain delivery in epilepsy.

Materials and methods: The preparation method employed thin film hydration to prepare liposomes loaded with levetiracetam with lecithin and tween 80 at different concentrations. The liposome formed were characterized in terms of particle size and entrapment efficiency. Finally, the prepared liposomes were converted into nasal spray and characterized for drug content, pH, viscosity, in vitro release profile, clarity, Ex-vivo permeation study. …

Rationally Designed Pentapeptide Analogs Of Aβ19-23 Fragment As Potent Inhibitors Of Aβ42 Aggregation, Sachin B. Baravkar, Yan Lu, Qi Zhao, Hongying Peng, Weilie Zhou, Song Hong

School of Medicine Faculty Publications

Amyloid beta (Aβ42 and Aβ40) aggregation, along with neurofibrillary tangles, is one of the major neurotoxic events responsible for the onset of Alzheimer's disease. Many potent peptide-based inhibitors mainly focusing on central hydrophobic core Aβ16-20 (KLVFF) have been reported in recent years. Herein, we report pentapeptides -, based on the β-turn-inducing fragment Aβ19-23 (FFAED). The synthesis of peptides - was carried out using Fmoc/tBu-based solid-phase peptide synthesis technique, and it was found that pentapeptide potently inhibit the aggregation propensity of Aβ42, when incubated with it at 37 °C for 48 h. The aggregation inhibition study was conducted using thioflavin T-based …

Reduced Vns Settings Paradoxically Decreases Seizure Burden In A Patient Following Resolution Of Sleep Disordered Breathing, Austin Sponaugle, Rebecca Stainman, Christopher M. Carosella

Abington Jefferson Health Papers

Vagus nerve stimulation (VNS) can be a highly effective treatment option for patients with drug resistant epilepsy. Notably, VNS has demonstrated side effects including a unique form of sleep disordered breathing known as vagus nerve stimulator associated sleep disordered breathing (VaS). However, the ways in which VaS interacts with seizure frequency is unknown. We report a case of a 28-year-old woman who presented to our department with complaints of worsening sleep quality 3 years following VNS implantation. Upon polysomnographic (PSG) evaluation, it was discovered that she suffered from VaS. The patient’s VNS output current was then down titrated during a …

Case With Refractory Myasthenia Gravis Caused By Pembrolizumab, Khaled M. Darwesh, Bushra Amer, Lateefah D. Hawshab, Fatima D Hawshab

Journal of Community Hospital Internal Medicine Perspectives

Nowadays, checkpoint inhibitors play a major role in the management of different types of cancers. However, we have seen variants of immune therapy-related adverse events, which usually are variables from fatigue, to neuropathy to severe devastating complications such as respiratory failure due to myasthenia gravis (MG), as we saw in our case. Our patient was started on pembrolizumab, and they developed severe respiratory failure attributed to MG after three weeks from treatment initiation. Also, the patient presented with myositis, mild myocarditis and hepatitis, which were all related to pembrolizumab.

Comparison Of Graft Patency Between Sta, Ra, And Sv Grafts Of Intracranial Aneurysms Of The Internal Carotid Artery, Nassos Tziviskos, Hallie Tiburzi, Susrut Dube

Rowan-Virtua Research Day

Abstract

Background: Patients with intracranial internal carotid artery (ICA) aneurysms that are not amenable to treatments like coiling, stenting, or clipping have limited treatment options. One option is vascular bypass of the aneurysm to introduce a stable route for cerebral perfusion, which can be performed using the superficial temporal artery (STA) or alternatively radial artery (RA) or saphenous vein (SV) grafts, among other vessels.

Methods: The major databases were searched to identify studies that explored graft patency and functional outcome for patients who underwent bypass for intracranial ICA aneurysms with STA, RA, or SV grafts and proportion meta-analysis was performed. …