Nervous System Diseases Commons^™

The Revised Cdc Chronic Pain Guidelines And Payer Opioid Analgesic Policies In Michigan, Victoria Tutag Lehr, Cynthia L. Arfken

Michigan Journal of Public Health

Abstract

The 2016 publication of A Guideline for Prescribing Opioids for Chronic Pain by the Centers for Disease Control and Prevention motivated commercial and Medicaid payers to restrict their opioid prescribing policies including the imposition of hard limits on opioid daily dosages and duration. One result of these policies was an increase in abrupt opioid discontinuation and rapid tapering events for patients receiving long-term opioid therapy. Responding to this misapplication of the 2016 guideline, the 2022 revised guidelines emphasized individualized opioid therapy and exclusion of certain chronic diseases. However, it is not known if the payers changed their policies to …

Unilateral Hemicraniectomy With Titanium Cranioplasty For The Treatment Of High Intracranial Pressure In A Pediatric Patient With Camurati-Engelmann Disease: Illustrative Case, Roboan Guillen-Arguello, Nicholas Sader, J. Gordon Mccomb

School of Medicine Faculty Publications

BACKGROUND Camurati-Engelmann disease (CED) is an extremely rare autosomal dominant genetic disorder that can cause increased intracranial pressure (ICP) secondary to cranial hyperostosis, which decreases intracranial volume. Surgical procedures to reduce ICP in medically refractory cases include intracranial volume expansion and ventriculoperitoneal shunting. OBSERVATIONS The authors present the case of a pediatric patient with CED and medically refractory increased ICP who underwent unilateral hemicraniectomy with titanium cranioplasty, resulting in a complete long-term resolution of symptoms. LESSONS Unilateral hemicraniectomy with titanium cranioplasty is a feasible surgical treatment for CED in pediatric patients with medically refractory increased ICP and papilledema.

Training Staff Members And Caregivers On Utilizing Allen Cognitive Levels To Aid Individuals Living With Alzheimer's And Dementia To Maintain Activities Of Daily Living, Kristy Boyd, Cassandra Nelson, Jennifer Summers

Fall 2024 OTD Capstone Symposium

This capstone project is about training staff members and caregivers on utilizing the Allen's cognitive levels to aid individuals living with Alzheimer's and dementia to maintain their activities of daily living by creating a program that consists of modules, physical demonstration, and a deliverable for staff members and caregivers as well as therapeutic activities and sensory regulation activities for the participants.

Bile Duct Ligation-Induced Cirrhosis Does Not Alter The Blood-Brain Barrier Permeability To Sucrose In Rats, Mohammad K. Miah, Ulrich Bickel, Reza Mehvar

Pharmacy Faculty Articles and Research

Contradictory results have been reported about the effects of liver diseases on the blood-brain barrier (BBB) permeability to markers. For instance, both an increase and no change in the BBB permeability to BBB markers sodium fluorescein and Evans blue have been reported in experimental cholestasis induced by bile duct ligation (BDL) in rats. These contradictory effects might be due to inherent limitations of these markers and/or methodological issues. Here, we investigated the time course of the impact of BDL in rats on BBB permeability using a recently developed stable isotope labeled marker [¹³C]sucrose, which is expected to be …

Review Of The Diagnosis, Pathophysiology, And Treatment Of Naegleria Fowleri-Induced Primary Amoebic Meningoencephalitis, Terrance Zhang

MCB Articles

Naegleria fowleri is a thermophilic, ubiquitous, free-living amoeba, but is also known as the “brain-eating” amoeba. This is the etiological agent of a rare and fulminant waterborne disease known as Primary Amoebic Meningoencephalitis (PAM) that is acutely fatal in 90-99% of reported cases. Those who come into contact with infested waters are at risk of introducing the amoeba into their upper nasal canal, whence the trophozoite form is known to migrate along the olfactory nerve, through the cribriform plate, and enter the central nervous system. Although the exact pathogenesis of N. fowleri is not known, studies have demonstrated contact-dependent and …

Rings Of Power: Controlling Sod Mimic Activity By The Addition Of Pyridine Rings Within The Pyridinophane Scaffold, Katherine J. Smith, Timothy M. Schwartz, David M. Freire, Cameron Bowers, Sarah K. Dunn, Jackson F. Bonnell, Magy A. Mekhail, Giridhar Akkaraju, Kayla N. Green

Biology, Chemistry, and Environmental Sciences Faculty Articles and Research

Superoxide dismutase enzymes are a major defense against superoxide, which is a potent reactive oxygen species. Misregulation of reactive oxygen species and subsequent neuronal damage are etiological hallmarks of neurodegenerative disease. Macrocyclic small molecules have offered inroads toward functional SOD1 mimics. Herein, we report a series of five tetra-aza macrocyclic ^RPy₂N₂ ligands, varied by 4-position substitution of the pyridine ring with both electron-donating (R = OMe) and withdrawing groups (R = Cl, I, and CF₃) to offer the first comparison to well-studied ^RPyN₃ congeners and other mimics in the literature. New ligands …

Understanding Orthopaedic Infections: A Conceptual Approach, Gregory Laborde, Christopher Bloise, George Karam

School of Medicine Faculty Publications

BACKGROUND: Memorizing mounds of facts without having an effective conceptual framework to store them is often an unsuccessful learning style because memory frequently fails without understanding. To accomplish this goal, we offer a framework of ideas called "concept maps". Of the many strategies for metacognition (that is, thinking about thinking), concept mapping is proven to improve meaningful and independent learning. We used this approach to guide understanding of common orthopaedic infections. This paper is not meant to serve as an approach on how to treat, but rather as a storage system with the ability to assist in understanding orthopaedic infections. …

D101n: A Unique And Ill-Understood Familial Als-Related Sod1 Mutant, Analisa Lott

Honors Program Theses and Research Projects

Background: Amyotrophic Lateral Sclerosis (ALS) is a fatal neurodegenerative disease, with 90% of documented cases considered sporadic and about 10% showing a hereditary link; such cases are deemed as familial ALS (fALS). Superoxide dismutase (SOD), a copper-zinc binding enzyme that protects cells from damaging free radicals, has been linked to fALS with certain toxic gain of function mutations, such as the D101N mutant. The human SOD1 D101N mutant has been shown to be associated with rapidly progressing neurodegeneration yet is less prone to aggregation than similar mutants, but its deviation from wild-type (WT) SOD1 remains misunderstood.

Objective: Although the D101N …

Ecological And Pathological Applications Of The Heat Shock Response, Taylor Rae Stanley

Theses and Dissertations

The heat shock response (HSR) is a cytoprotective stress response pathway that regulates cellular proteostasis. The HSR is an evolutionarily conserved pathway that is essential for normal cellular functioning. Here, we explore the broad ecological and pathological impacts of the HSR. In an ecological context, we perform gene level analysis of the transcriptomes of two closely related sunfish. We found that the more invasive bluegill sunfish has gene expansions in two HSR gene families, the HSP70 family and the HSP90 family compared to the redear sunfish. These gene expansions were also observed in several other teleost fish species and were …

Defining The Peripheral Plasticity Of Nociceptive Afferents Following Spinal Cord Injury And Physical Therapy Intervention., Morgan Julianna Forston

Electronic Theses and Dissertations

The focus of this dissertation is to explore the peripheral plasticity of nociceptive afferents following spinal cord injury (SCI) and whether it is exacerbated or induced when physical therapy-based muscle stretching, a therapy we have shown to be detrimental to locomotor recovery in rodents, is implemented post-SCI. Chapter I provides a brief introduction on sensory afferents with particular emphasis on nociceptive afferents and their multifaceted role within the peripheral and central nervous systems. Chapter II describes SCI epidemiology and common sensory related complications that occur in patients as well and pharmaco- and physical therapies that are employed post-SCI. Chapter III …

Discordance Between Balance Ability And Perception Is Associated With Falls In Parkinson’S Disease: A Coordinated Analysis, Jason K. Longhurst, Andrew Hooyman, Merrill R. Landers, Martina Mancini, Erika Franzén, Breiffni Leavy, Hanna Johansson, Daniel Peterson

Physical Therapy Faculty Articles and Research

Background: The congruence or discordance between actual and perceived balance ability has been proposed to be linked to functional outcomes such as falls. However, gaps remain in our ability to quantify discordance, and its relationship to relevant outcomes.

Objective: To investigate a novel quantification of concordance/discordance between balance performance and perception and determine the relationship to falls among people with Parkinson’s disease (PwPD).

Methods: Data from 244 PwPD were aggregated from 5 previously conducted studies. Variables extracted included age, sex, Activities-Specific Balance Confidence scale (ABC; perceived balance), Timed Up and Go (TUG; balance performance), Movement Disorder Society Unified Parkinson Disease …

Transcutaneous Electrical Nerve Stimulation For Prevention And Treatment Of Post-Herpetic Neuralgia: A Narrative Review, Alan D. Kaye, Rahib K. Islam, Victoria T. Tong, Brynne E. Tynes, Kelly R. Sala, Brennan Abbott, Chandni R. Patel, Isabella B. Lentz, Raju Behara, Shilpadevi Patil, Uzayr Wasif, Sahar Shekoohi, Giustino Varrassi

School of Medicine Faculty Publications

The present investigation evaluated transcutaneous electrical nerve stimulation (TENS) for the non-pharmacological treatment of post-herpetic neuralgia (PHN). PHN is the most common complication of the Herpes Zoster virus, affecting one in every five patients with shingles, and presents as intense neuropathic pain that can persist for 90 days or longer after the initial onset of symptoms. Current pharmacological treatment options are mainly limited to symptom management, including oral medications such as tricyclic antidepressants and gabapentinoid preparations, as well as topical options such as lidocaine or capsaicin. TENS is a minimally invasive, non-pharmacological electrical nerve stimulation device currently approved for the …

Association Between Polygenic Scores For Brain Structure And Alzheimer's Disease, Eunjae Lee, Faria Tavacoli, Tingwei Liu, Brittany Diaz Ruiz, Hayley Ho, Alice Lee, Jingchun Chen

Undergraduate Research Symposium Posters

Alzheimer’s disease (AD) is a progressive neurodegenerative condition and the most common type of dementia. Research has shown that volumetric changes in subcortical brain structures, which make up roughly 25% of the brain's total volume and affect many physiological functions. This research project aims to investigate the genetic association between brain structures and AD. GWAS data of eight different brain structures (ICV, accumbens, amygdala, caudate, hippocampus, pallidum, putamen, and thalamus) were used to create polygenic scores (PGSs) in a discovery (cases/controls = 2,651/2,768) and replication dataset (cases/controls = 553/644). We utilized PRSice-2 software to generate PGSs and assess genetic correlations …

Endovascular Removal Of A Symptomatic Intracranial Foreign Body Via Contact Aspiration: Illustrative Case, Jared M. Robichaux, Sarah E. Lawhon, Taylor W. Girolamo, Kapland Q. Owens, Lucido L. Ponce Mejia

School of Medicine Faculty Publications

BACKGROUND: With the growing utilization of general endovascular techniques, iatrogenic endovascular foreign bodies have become more prevalent. Contact aspiration has proven to be a valuable technique in treating ischemic strokes by removing the intraluminal thrombus causing cerebral perfusion deficits and neurological symptoms. The authors present a case of the removal of a foreign body from the vasculature via contact aspiration, which had embolized in a delayed fashion after aortic valve replacement. OBSERVATIONS: A 54-year-old male developed intermittent left-sided weakness 8 days after aortic valve replacement. A head computed tomography scan showed a metallic foreign body within the origin of the …

Ansa Cervicalis-To-Phrenic Nerve Transfer: Technical Note With Potential Application For Diaphragmatic Reanimation In Patients With High Cervical Spinal Cord Injury, Jonathan Melnick, Mohammadali M. Shoja, Gary B. Schwartz

HCA-NSU MD Research Day

Objective. This study was conducted to determine whether utilization of the superior root of ansa cervicalis (SRAC) as the donor for phrenic nerve (PN) transfer is technically feasible. Background. In patients with high cervical spinal cord injury resulting in diaphragmatic paralysis, another donor, the spinal accessory nerve, has been used successfully to reinnervate the PN and restore diaphragmatic function. Methods. Eight neck sides underwent cadaveric surgery. The sternocleidomastoid muscle was retracted posteriorly, the SRAC and PN were isolated, and the SRAC was cut near its distal end and transposed to the ipsilateral PN as it crossed the anterior scalene muscle. …

Impact Of Rapid Eye Movement Sleep Disturbances In The Pathogenesis Of Alzheimer's Disease: A Scoping Review, Daniel Malak, Paul Mikhail, Joseph Mikhail, Joseph Swaress, Khavir Sharieff

HCA-NSU MD Research Day

Background: Rapid eye movement (REM) sleep disturbances have been implicated in accelerating cognitive decline in aging individuals and those with Alzheimer’s disease (AD). This review explores the relationship between REM sleep disruptions and the progression of AD. Methods: A comprehensive literature review was conducted in June 2024 across PubMed, Embase, Scopus, and Google Scholar using terms, “Alzheimer’s,” “REM,” and “sleep disturbances.” Articles focused on REM sleep disturbances in AD patients, excluding those with underlying sleep disorders, comorbidities, or genetic predispositions, were selected. Key data on tau pathology, beta-amyloid accumulation, cognitive decline, and neuroimaging findings were independently extracted and analyzed by …

A Qualitative Evaluation Of Huntington’S Disease Perspectives On Social Media, Paige Conrad, Heather Sterchele, Ryan Wong, Sahar Sarrami Amini

HCA-NSU MD Research Day

A Qualitative Evaluation of Huntington’s Disease Perspectives on Social Media Paige Conrad OMS-III Nova Southeastern University Kiran C. Patel College of Osteopathic Medicine, Heather Sterchele OMS-III Nova Southeastern University Kiran C. Patel College of Osteopathic Medicine, Ryan Wong OMS-III Nova Southeastern University Kiran C. Patel College of Osteopathic Medicine, Sahar S Amini D.O. Objective: The objective of this study is to qualitatively examine the content of the most watched videos related to HD on the social media application Tik Tok and explore how social media is being utilized to discuss the disease. Background: Huntington’s Disease (HD) is a neurodegenerative disorder …

The Importance Of Including Maternal Immune Activation In Animal Models Of Hypoxic-Ischemic Encephalopathy, Bailey Collins, Elise A. Lemanski, Elizabeth Wright-Jin

Department of Medicine Faculty Papers

Hypoxic-ischemic encephalopathy (HIE) is a perinatal brain injury that is the leading cause of cerebral palsy, developmental delay, and poor cognitive outcomes in children born at term, occurring in about 1.5 out of 1000 births. The only proven therapy for HIE is therapeutic hypothermia. However, despite this treatment, many children ultimately suffer disability, brain injury, and even death. Barriers to implementation including late diagnosis and lack of resources also lead to poorer outcomes. This demonstrates a critical need for additional treatments for HIE, and to facilitate this, we need translational models that accurately reflect risk factors and interactions present in …

Transcutaneous Electrical Nerve Stimulation For Fibromyalgia-Like Syndrome In Patients With Long-Covid: A Pilot Randomized Clinical Trial, Alejandro Zulbaran-Rojas, Rasha O Bara, Myeounggon Lee, Miguel Bargas-Ochoa, Tina Phan, Manuel Pacheco, Areli Flores Camargo, Syed Murtaza Kazmi, Mohammad Dehghan Rouzi, Dipaben Modi, Fidaa Shaib, Bijan Najafi

Faculty, Staff and Students Publications

This study investigated the effect of Transcutaneous Electrical Nerve Stimulation (TENS) for fibromyalgia-like symptoms including chronic widespread musculoskeletal pain, fatigue, and/or gait impairment in twenty-five individuals with long-COVID. Participants were randomized to a high dose (intervention group, IG) or low dose (placebo group, PG) TENS device. Both groups received daily 3-5 h of TENS therapy for 4-weeks. The Brief Pain Inventory assessed functional interference from pain (BPI-I), and pain severity (BPI-S). The global fatigue index (GFI) assessed functional interference from fatigue. Wearable technology measured gait parameters during three 30-feet consecutive walking tasks. At 4-weeks, the IG exhibited a greater decrease …

A Case Of Cecal Volvulus In The Setting Of Multiple Sclerosis, S. Jiaming Lin, Paige M. Kieper, Michael Mullinax, Jake W. Vogel, Kimberly Syres

Advances in Clinical Medical Research and Healthcare Delivery

This case report describes a patient with a history of multiple sclerosis (MS) and optic neuritis, who presented with acute onset of generalized abdominal pain. The patient was ultimately diagnosed with cecal volvulus requiring emergent laparotomy and right hemicolectomy. This case highlights the relationship between neurogenic bowel dysfunction (NBD) associated constipation in patients with MS and intestinal volvulus. Additionally, this case demonstrates the importance of NBD associated constipation management through various modalities including laxative regimens, behavioral and diet modification, and reduction of polypharmacy, with an emphasis on individualized patient management.