Neurology Commons^™

Teaching Pediatric Procedural Pain And Anxiety Management To Residents: Early Outcomes Of A Newly Developed Curriculum, Jennifer J. Dilts, Brian R. Lee, Shobhit Jain, Ross Newman, Sarah Fouquet, Michael Brancato, Kadriye O. Lewis

Posters

Background: Poorly managed pediatric pain has negative long-term outcomes, including needle phobia, increased pain and anxiety with subsequent procedures, and healthcare avoidance in adulthood. Evidence-based interventions to reduce procedural pain and anxiety are vastly underutilized, and a literature search revealed no specific curriculum to teach residents optimal skills for pain and anxiety management in minor procedures (e.g. venipuncture, laceration repair). Thus, we developed a multimedia-based lecture with PowerPoint, utilizing results from a focus group interview (conducted with 7 pediatric residents, to determine educational content and identify residents’ needs and learning preferences).


Objective: To measure residents’ learning outcomes (knowledge, attitudes, perceived …

Virtual Child Neurology Education During Covid-19 And Beyond, Jennifer J. Dilts, Rose N. Gelineau-Morel

Posters

Background: Even prior to the Coronavirus Disease 2019 (COVID-19) pandemic, Children’s Mercy Kansas City’s large neurology division struggled to engage learners in educational conferences. With 113 division members across 5 locations, attending conferences was challenging. While some conferences were live-streamed, we offered no recorded lectures, and most conferences were attended solely by trainees and 3-4 select faculty. COVID-19 eliminated in-person group learning opportunities.


Objective: We aimed to rapidly develop and implement a comprehensive and inclusive virtual child neurology curriculum and assess its impact.


Design/Methods: We created a neurology education “team” using Microsoft® Teams. Within 1 week of beginning social distancing, …

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 …

Behavioral Adverse Events With Brivaracetam, Levetiracetam, Perampanel, And Topiramate: A Systematic Review., Bernhard J Steinhoff, Pavel Klein, Henrik Klitgaard, Cédric Laloyaux, Brian D Moseley, Kristen Ricchetti-Masterson, Felix Rosenow, Joseph I Sirven, Brien Smith, John M Stern, Manuel Toledo, Patricia A Zipfel, Vicente Villanueva

Neuroscience Articles

PURPOSE: To understand the currently available post-marketing real-world evidence of the incidences of and discontinuations due to the BAEs of irritability, anger, and aggression in people with epilepsy (PWE) treated with the anti-seizure medications (ASMs) brivaracetam (BRV), levetiracetam (LEV), perampanel (PER), and topiramate (TPM), as well as behavioral adverse events (BAEs) in PWE switching from LEV to BRV.

METHODS: A systematic review of published literature using the Cochrane Library, PubMed/MEDLINE, and Embase was performed to identify retrospective and prospective observational studies reporting the incidence of irritability, anger, or aggression with BRV, LEV, PER, or TPM in PWE. The incidences of …

Investigating Diffusion Tensor Imaging Correlates Of Cognitive Impairment In Idiopathic Normal Pressure Hydrocephalus And Alzheimer's Disease, Omar Hasan, Omar Hasan

Dissertations and Theses (Open Access)

Modest expansion of the human brain cerebrospinal fluid (CSF)-filled ventricles is normal with aging, and because of this, it can be difficult for physicians to accurately diagnose and treat enlarged ventricles (ventriculomegaly), called hydrocephalus¹ (fluid or water in the brain) Ventriculomegaly occurs due to an obstruction (such as a blood clot or tumor), or a change in CSF absorption². Primary hydrocephalus, also called idiopathic normal pressure hydrocephalus (iNPH), is non-obstructive and may be comorbid with other neurodegenerative diseases such as Alzheimer’s disease (AD) or frontotemporal dementia (FTD). Clinically, it can be difficult to tell whether the pathophysiological …

Hyperglycemia Followed By An Abrupt Decrease Of Blood Glucose Is A Rare Cause Of Posterior Reversible Encephalopathy Syndrome (Pres), Liza Garabet Diramerian, Nabila Ashraf, Admir Syla, Armen Malkhasian, Jason Madey

HCA Healthcare Journal of Medicine

Introduction

Posterior Reversible Encephalopathic Syndrome (PRES) is a clinical syndrome of headache, confusion or decreased level of consciousness, visual changes, seizures and focal neurologic signs associated with characteristic neuroimaging findings of posterior cerebral white matter edema. In most cases, PRES is precipitated by sudden increase in blood pressure; however, in the case presented here, the etiology was different as it was secondary to extreme changes in glucose levels.

Case Presentation

A 49-year-old female with a past medical history of hypertension and diabetes mellitus, type 2 was brought to the emergency room with a chief complaint of visual changes for 1 …

Guillain-Barré Syndrome In A Patient With Sickle Cell Anemia, Kunjan Udani, Pooja Patel, Dveet Patel, Hajra Awwab, Nino Balanchivadze

HCA Healthcare Journal of Medicine

A 24-year-old African American male with a history of sickle cell anemia (Hb S/S) presented to an outside hospital with acute colitis, acute renal failure and sickle cell crisis and was treated with supportive measures. On day 3 of hospitalization, he developed bilateral ascending paralysis with sacral numbness. Magnetic resonance imaging (MRI) demonstrated epidural lipomatosis, which was attributed as the cause of his paralysis. He was transferred to our facility for neurosurgery evaluation. Based on the physical examination, Guillain-Barré Syndrome (GBS) was suspected. This conclusion lead to a lumbar puncture with cerebrospinal fluid (CSF) analysis that confirmed the diagnosis. He …

Cross-Sectional Exploration Of Plasma Biomarkers Of Alzheimer's Disease In Down Syndrome: Early Data From The Longitudinal Investigation For Enhancing Down Syndrome Research (Life-Dsr) Study, James A. Hendrix, David C. Airey, Angela Britton, Anna D. Burke, George T. Capone, Ronelyn Chavez, Jacqueline Chen, Brian Chicoine, Alberto C. S. Costa, Jeffrey L. Dage, Eric Doran, Anna Esbensen, Casey L. Evans, Kelley M. Faber, Tatiana M. Foroud, Sarah Hart, Kelsey Haugen, Elizabeth Head, Suzanne Hendrix, Hampus Hillerstrom, Frederick A. Schmitt

Sanders-Brown Center on Aging Faculty Publications

With improved healthcare, the Down syndrome (DS) population is both growing and aging rapidly. However, with longevity comes a very high risk of Alzheimer’s disease (AD). The LIFE-DSR study (NCT04149197) is a longitudinal natural history study recruiting 270 adults with DS over the age of 25. The study is designed to characterize trajectories of change in DS-associated AD (DS-AD). The current study reports its cross-sectional analysis of the first 90 subjects enrolled. Plasma biomarkers phosphorylated tau protein (p-tau), neurofilament light chain (NfL), amyloid β peptides (Aβ_1-40, Aβ_1-42), and glial fibrillary acidic protein (GFAP) were undertaken with …

A Systematic Review And Meta-Analysis On The Efficacy Of Repeated Transcranial Direct Current Stimulation For Migraine, Guoshuai Cai, Zhu Xia, Leigh Charvet, Feifei Xiao, Abhishek Datta, X Michelle Androulakis

Publications and Research

Purpose: Transcranial direct current stimulation (tDCS) may have therapeutic potential in the management of migraine. However, studies to date have yielded conflicting results. We reviewed studies using repeated tDCS for longer than 4 weeks in migraine treatment, and performed meta-analysis on the efficacy of tDCS in migraine.

Methods: In this meta-analysis, we included the common outcome measurements reported across randomized controlled trials (RCTs). Subgroup analysis was performed at different post-treatment endpoints, and with different stimulation intensities and polarities.

Results: Five RCTs were included in the quantitative meta-analysis with a total of 104 migraine patients. We found a significant reduction of …

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 …

Efficacy Of Advanced Prehospital Communication In Acute Ischemic Stroke Treatment, Dylan Horinek

MSN Capstone Projects

Ischemic stroke outcomes are directly affected by time to treatment. This intervention demonstrates promise in decreasing time to treatment by optimizing pres-hospital communication, basically giving a report to providers and registration information before the patient arrives at the facility. The use of an advanced digital application has demonstrated in multiple studies significant difference in time to treatment in ischemic stroke, and ultimately leads to improved patient outcomes, increased staff satisfaction, and increased facility revenue.

Characterizing Subtypes And Neural Correlates Of Receptive Aprosodia In Acute Right Hemisphere Stroke, Shannon M. Sheppard, Erin L. Meier, Alexandra Zezinka Durfee, Alex Walker, Jennifer Shea, Argye E. Hillis

Communication Sciences and Disorders Faculty Articles and Research

Introduction: Speakers naturally produce prosodic variations depending on their emotional state. Receptive prosody has several processing stages. We aimed to conduct lesion-symptom mapping to determine whether damage (core infarct or hypoperfusion) to specific brain areas was associated with receptive aprosodia or with impairment at different processing stages in individuals with acute right hemisphere stroke. We also aimed to determine whether different subtypes of receptive aprosodia exist that are characterized by distinctive behavioral performance patterns.

Methods: Twenty patients with receptive aprosodia following right hemisphere ischemic stroke were enrolled within five days of stroke; clinical imaging was acquired. Participants completed …

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 …

Exploring The Role Of Occupational Therapy In Long-Term Telerehabilitation For Stroke Survivors, Alexandra N. Murguido, Pam Kasyan-Howe, Kristin Domville

Spring 2021 Virtual OTD Capstone Symposium

Strokes are the second leading cause of death and leading cause of long-term disability worldwide and incidence is on the rise (Katan & Luft, 2018). In the past 25 years, the burden of disability from neurological disorders, including strokes, have increased exponentially due to the increase in the aging population and decrease in mortality rates (Raghavan, 2019). Out of the 795,000 new victims of stroke annually, 26% remain disabled during activities of daily living (ADLs) and 50% experience a reduction in mobility due to hemiparesis (Katan & Luft, 2018). Although stroke survivors do receive rehabilitation services after the onset of …

Gait And Balance Changes With Investigational Peripheral Nerve Cell Therapy During Deep Brain Stimulation In People With Parkinson’S Disease, Geetanjali Gera, Zain Guduru, Tritia R. Yamasaki, Julie A. Gurwell, Monica Chau, Anna Krotinger, Frederick A. Schmitt, John T. Slevin, Greg A. Gerhardt, Craig G. Van Horne, Jorge E. Quintero

Physical Therapy Faculty Publications

Background: The efficacy of deep brain stimulation (DBS) and dopaminergic therapy is known to decrease over time. Hence, a new investigational approach combines implanting autologous injury-activated peripheral nerve grafts (APNG) at the time of bilateral DBS surgery to the globus pallidus interna. Objectives: In a study where APNG was unilaterally implanted into the substantia nigra, we explored the effects on clinical gait and balance assessments over two years in 14 individuals with Parkinson’s disease. Methods: Computerized gait and balance evaluations were performed without medication, and stimulation was in the off state for at least 12 h to best assess the …

C25: The “Spot Sign”: A Predictor Of Hematoma Expansion, Mckenzie Merritt

Annual Research Symposium

No abstract provided.

Obstructive Sleep Apnea And Dementia-Common Gene Associations Through Network-Based Identification Of Common Driver Genes, Hyun-Hwan Jeong, Arvind Chandrakantan, Adam C Adler

Faculty, Staff and Students Publications

BACKGROUND: Obstructive Sleep Apnea (OSA) occurs in 7% of the adult population. The relationship between neurodegenerative diseases such as dementia and sleep disorders have long attracted clinical attention; however, no comprehensive data exists elucidating common gene expression between the two diseases. The objective of this study was to (1) demonstrate the practicability and feasibility of utilizing a systems biology approach called network-based identification of common driver genes (NICD) to identify common genomic features between two associated diseases and (2) utilize this approach to identify genes associated with both OSA and dementia.

METHODS: This study utilized 2 public databases (PCNet, DisGeNET) …

Support For Family Members Who Are Caregivers To Relatives With Acquired Brain Injury, Janet Walker, Lourens Schlebusch, Bernhard Gaede

Journal of Mind and Medical Sciences

Objectives. Family members caring for a patient with acquired brain injury (ABI) are coping with inordinate levels of stress partially due to their lack of understanding of the neuropsychological effects of acquired brain injury in the patient. The objective of this research is to show that as the caregivers’ stress levels increase, there is an increase in suicidal ideation. This highlights the causal relationship between unhealthy stress and reduced psychological well-being in these caregivers. In addition, qualitative research evidence regarding the caregivers’ views of their main sources of stress are presented. Methods. The participants were a random sample of 80 …

Method Of Intra-Arterial Drug Administration In A Rat: Sex Based Optimization Of Infusion Rate, Sarah J. Messmer, Justin F. Fraser, Keith R. Pennypacker, Jill M. Roberts

Center for Advanced Translational Stroke Science Faculty Publications

BACKGROUND: Endovascular thrombectomy is the process of removing a blood clot and re-establishing blood flow in patients with emergent large vessel occlusion. The technique provides an opportunity to deliver therapeutics directly to the site of injury. The intra-arterial (IA) route of drug administration in the mouse was developed to bridge the gap between animal stroke treatments and clinical stroke therapy. Here, we adapted the IA method for use in rats, by investigating various flow rates to optimize the IA injection through the internal carotid artery (ICA).

METHODS: Male and female Sprague-Dawley rats (∼4 months of age) were subjected to placement …

Management Of Paediatric Intracranial Ependymoma, Syeda Kubra Kishwar Jafri, Saqib Kamran Bakhshi, Muhammad Shahzad Shamim

Section of Neurosurgery

Intracranial ependymoma are relatively common paediatric brain tumours, but their eloquent location and high recurrence rate pose a significant challenge. Gross total resection or maximum safe resection followed by adjuvant radiotherapy are currently the standard recommended treatment, although there is still nearly 50% recurrence risk at 5 years. Chemotherapy has shown some promising results after recent advances in molecular understanding of ependymomas, but needs further evaluation before it could be added to the treatment regime.