Neurology Commons^™

Current Approaches And New Developments In The Pharmacological Management Of Tourette Syndrome., Julio Quezada, Keith A. Coffman

Manuscripts, Articles, Book Chapters and Other Papers

Tourette syndrome (TS) is a neurodevelopmental disorder of unknown etiology characterized by spontaneous, involuntary movements and vocalizations called tics. Once thought to be rare, TS affects 0.3-1% of the population. Tics can cause physical discomfort, emotional distress, social difficulties, and can interfere with education and desired activities. The pharmacologic treatment of TS is particularly challenging, as currently the genetics, neurophysiology, and neuropathology of this disorder are still largely unknown. However, clinical experience gained from treating TS has helped us better understand its pathogenesis and, as a result, derive treatment options. The strongest data exist for the antipsychotic agents, both typical …

Intra-Arterial Nitroglycerin As Directed Acute Treatment In Experimental Ischemic Stroke, Michael E. Maniskas, Jill M. Roberts, Rebecca Trueman, Annastazia E. Learoyd, Amanda A. Gorman, Justin F. Fraser, Gregory J. Bix

Neuroscience Faculty Publications

BACKGROUND: Nitroglycerin (also known as glyceryl trinitrate (GTN)), a vasodilator best known for treatment of ischemic heart disease, has also been investigated for its potential therapeutic benefit in ischemic stroke. The completed Efficacy of Nitric Oxide in Stroke trial suggested that GTN has therapeutic benefit with acute (within 6 hours) transdermal systemic sustained release therapy.

OBJECTIVE: To examine an alternative use of GTN as an acute therapy for ischemic stroke following successful recanalization.

METHODS: We administered GTN IA following transient middle cerebral artery occlusion in mice. Because no standard dose of GTN is available following emergent large vessel occlusion, we …

Genotype-Phenotype Study In Patients With Valosin-Containing Protein Mutations Associated With Multisystem Proteinopathy, Ebaa Al-Obeidi, Sejad Al-Tahan, Abhilasha Surampalli, Namita Goyal, Annabel K. Wang, Andreas Hermann, Molly Omizo, Charles D. Smith, Tahseen Mozaffar, Virginia Kimonis

Neurology Faculty Publications

Mutations in valosin‐containing protein (VCP), an ATPase involved in protein degradation and autophagy, cause VCP disease, a progressive autosomal dominant adult onset multisystem proteinopathy. The goal of this study is to examine if phenotypic differences in this disorder could be explained by the specific gene mutations. We therefore studied 231 individuals (118 males and 113 females) from 36 families carrying 15 different VCP mutations. We analyzed the correlation between the different mutations and prevalence, age of onset and severity of myopathy, Paget's disease of bone (PDB), and frontotemporal dementia (FTD), and other comorbidities. Myopathy, PDB and FTD was present in …

Brain-Derived Neurotrophic Factor As A Biomarker For Aging And Dementia, Krishna Lajwanti Bharani

MUSC Theses and Dissertations

The number of people with dementia due to Alzheimer’s disease (AD) is increasing worldwide. Although AD pathology begins well before clinical symptoms are apparent, identifying individuals at risk of developing AD to provide early interventions is still a challenge. Brain-derived neurotrophic factor (BDNF) is produced by neurons and glial cells and has complex interactions with AD pathology. BDNF also crosses the blood-brain barrier and can be measured in serum or plasma. In this dissertation, I investigated the biomarker potential of serum BDNF for AD using post mortem human samples, an aged rat model of cognitive impairment, and blood samples from …

Managing The Complex Patient With Degenerative Cervical Myelopathy: How To Handle The Aging Spine, The Obese Patient, And Individuals With Medical Comorbidities., Geoffrey Stricsek, John Gillick, George Rymarczuk, James Harrop

Farber Institute for Neuroscience Faculty Papers

Degenerative cervical myelopathy (DCM) is the most common cause of nontraumatic spinal cord injury worldwide. Even relatively mild impairment in functional scores can significantly impact daily activities. Surgery is an effective treatment for DCM, but outcomes are dependent on more than technique and preoperative neurologic deficits.

Timing Of Vessel Imaging For Suspected Large Vessel Occlusions Does Not Affect Groin Puncture Time In Transfer Patients With Stroke., John W. Liang, Laura Stein, Natalie Wilson, Johanna T. Fifi, Stanley Tuhrim, Mandip S. Dhamoon

Department of Neurology Faculty Papers

BACKGROUND: Access to endovascular therapy (ET) in cases of acute ischemic stroke may be limited, and rapid transfer of eligible patients to hospitals with endovascular capability is needed.

OBJECTIVE: To determine the optimal timing of diagnostic CT angiography to confirm large vessel occlusion (LVO).

METHODS: Of 57 emergency department transfers to Mount Sinai Hospital (MSH) for possible ET from January 2015 through March 2016, 39 (68%) underwent ET, among whom 22 (56%) had CT angiography before transfer and 17 (44%) had CT angiography on arrival. We compared mean outside hospital arrival to groin puncture (OTG) time between the two groups …

Advances In The Diagnosis, Immunopathogenesis And Therapies Of Igm-Anti-Mag Antibody-Mediated Neuropathies., Marinos Dalakas

Department of Neurology Faculty Papers

Polyneuropathy with immunoglobulin M (IgM) monoclonal gammopathy is the most common paraproteinemic neuropathy, comprising a clinicopathologically and immunologically distinct entity. The clinical spectrum spans from distal paresthesias and mild gait imbalance to more severe sensory ataxia, with falls and a varying degree of distal sensorimotor deficits. In approximately 75% of patients, the monoclonal IgM immunoreacts with myelin-associated glycoprotein (MAG) and sulfoglucuronyl glycosphingolipid (SGPG), or other peripheral nerve glycolipids that serve as antigens. These antibodies are considered pathogenic because IgM and complement are deposited on the myelin sheath, splitting the myelin lamellae, while adoptive transfer of patients' IgM into susceptible host …

Manipulation Of Human Verticality Using High-Definition Transcranial Direct Current Stimulation, Taiza E.G. Santos, Diandra B. Favoretto, Iman Ghodratti Toostani, Diego C. Nascimento, Brunna P. Rimoli, Eduardo Bergonzoni, Tenysson Will Lemos, Dennis Q. Truong, Alexandre C.B. Delbem, Bahador Makkiabadi, Renato Moraes, Francisco Louzada, Marom Bikson, Joao P. Leite, Dylan J. Edwards

Research outputs 2014 to 2021

Background: Using conventional tDCS over the temporo-parietal junction (TPJ) we previously reported that it is possible to manipulate subjective visual vertical (SVV) and postural control. We also demonstrated that high-definition tDCS (HD-tDCS) can achieve substantially greater cortical stimulation focality than conventional tDCS. However, it is critical to establish dose-response effects using well-defined protocols with relevance to clinically meaningful applications.

Objective: To conduct three pilot studies investigating polarity and intensity-dependent effects of HD-tDCS over the right TPJ on behavioral and physiological outcome measures in healthy subjects. We additionally aimed to establish the feasibility, safety, and tolerability of this stimulation protocol.

Methods: …

The Prevalence And Awareness Of Sleep Apnea In Patients Suffering Chronic Pain: An Assessment Using The Stop-Bang Sleep Apnea Questionnaire., Gregory S Tentindo, Scott M Fishman, Chin-Shang Li, Qinlu Wang, Steven D Brass

Articles, Abstracts, and Reports

Purpose: Some patient subsets are at higher risk of sleep apnea, including patients with chronic pain. However, it is unclear whether patients and their caregivers are aware of the possibly increased risk of sleep apnea in this population. Chronic pain is often treated with opioids which may decrease both the central respiratory drive and the patency of the upper airway, potentially contributing to this sleep disorder. Using a self-reporting questionnaire approach in the chronic pain population, this study surveyed patient and caregiver awareness surrounding the risk of sleep apnea. In addition, we looked at the influence of opioid therapy on …

Pilot Data On Responsive Epilepsy Neurostimulation, Measures Of Sleep Apnea And Continuous Glucose Measurements., Katie M Kinnear, Nicole M Warner, Anand Gersappe, Michael J Doherty

Articles, Abstracts, and Reports

Objectives: To match responsive neurostimulator (RNS) and polysomnographic data to determine if RNS detections and stimulations correlate with measurements of sleep disordered breathing and continuous glucose measurements (CGM).

Materials and methods: In a patient with an RNS with detection/stimulation leads implanted bi-temporally detection-stimulation counts were matched by time with coinciding polysomnogram and CGM data.

Results: Temporal dispersion of RNS DSC were independent of measures of sleep apnea, hypopnea or glucose.

Conclusion: Hippocampal nighttime responsive neurostimulation therapies did not appear to worsen measures of normal or abnormal sleep.

Development Of Novel Models To Study Deep Brain Effects Of Cortical Transcranial Magnetic Stimulation, Farheen Syeda

Theses and Dissertations

Neurological disorders require varying types and degrees of treatments depending on the symptoms and underlying causes of the disease. Patients suffering from medication-refractory symptoms often undergo further treatment in the form of brain stimulation, e.g. electroconvulsive therapy (ECT), transcranial direct current stimulation (tDCS), deep brain stimulation (DBS), or transcranial magnetic stimulation (TMS). These treatments are popular and have been shown to relieve various symptoms for patients with neurological conditions. However, the underlying effects of the stimulation, and subsequently the causes of symptom-relief, are not very well understood. In particular, TMS is a non-invasive brain stimulation therapy which uses time-varying magnetic …

Role Of Microbes In The Development Of Alzheimer's Disease: State Of The Art - An International Symposium Presented At The 2017 Iagg Congress In San Francisco., Tamàs Fülöp, Ruth F Itzhaki, Brian J. Balin Phd, Judith Miklossy, Annelise E Barron

PCOM Scholarly Works

This article reviews research results and ideas presented at a special symposium at the International Association of Gerontology and Geriatrics (IAGG) Congress held in July 2017 in San Francisco. Five researchers presented their results related to infection and Alzheimer's disease (AD). Prof. Itzhaki presented her work on the role of viruses, specifically HSV-1, in the pathogenesis of AD. She maintains that although it is true that most people harbor HSV-1 infection, either latent or active, nonetheless aspects of herpes infection can play a role in the pathogenesis of AD, based on extensive experimental evidence from AD brains and infected cell …

Inter-Rater Agreement And Validity Of A Tackling Performance Assessment Scale In Youth American Football, Eric Schussler, Richard J. Jagacinski, Susan E. White, Ajit M. Chaudhari, John A. Buford, James A. Onate

Rehabilitation Sciences Faculty Publications

Background: Long term neurologic injury and concussion have been identified as risks from participation in American football. Altering tackling form has been recommended to reduce the risk of neurologic injury caused by head accelerations when tackling. The purpose of this research is to determine the inter-rater agreement and validity of the Qualitative Youth Tackling System (QYTS), a six-item feedback scale to correct tackling form, when utilized by novice and expert raters.

Hypothesis: Experienced raters will have higher levels of agreement with each other and with motion capture when compared to novice raters. Methods: Both novice and experienced raters viewed video …

Sex Differences In Outcomes After Stroke In Patients With Diabetes In Ontario, Canada., Mandip S. Dhamoon, John W. Liang, Limei Zhou, Melissa Stamplecoski, Moira K. Kapral, Baiju R. Shah

Department of Neurology Faculty Papers

BACKGROUND: Outcomes after stroke in those with diabetes are not well characterized, especially by sex and age. We sought to calculate the sex- and age-specific risk of cardiovascular outcomes after ischemic stroke among those with diabetes.

METHODS: Using population-based demographic and administrative health-care databases in Ontario, Canada, all patients with diabetes hospitalized with index ischemic stroke between April 1, 2002, and March 31, 2012, were followed for death, stroke, and myocardial infarction (MI). The Kaplan-Meier survival analysis and Fine-Gray competing risk models estimated hazards of outcomes by sex and age, unadjusted and adjusted for demographics and vascular risk factors.

RESULTS: …

Chlamydia Pneumoniae: An Etiologic Agent For Late-Onset Dementia, Brian J. Balin Phd, Christine Hammond, Christopher S. Little, Susan Hingley, Zein Al-Atrache, Denah Appelt, Judith A Whittum-Hudson, Alan P Hudson

PCOM Scholarly Works

The disease known as late-onset Alzheimer's disease is a neurodegenerative condition recognized as the single most common form of senile dementia. The condition is sporadic and has been attributed to neuronal damage and loss, both of which have been linked to the accumulation of protein deposits in the brain. Significant progress has been made over the past two decades regarding our overall understanding of the apparently pathogenic entities that arise in the affected brain, both for early-onset disease, which constitutes approximately 5% of all cases, as well as late-onset disease, which constitutes the remainder of cases. Observable neuropathology includes: neurofibrillary …

Outcome Of Traumatic Brain Injury In Children By Using Rotterdam Score On Computed Tomography, Anwarul Haque, Zehra Dhanani, Amin Ali, Basit Salam, Qalab Abbas, Gohar Javed, Humaira Jurair

Department of Paediatrics and Child Health

Background: The Rotterdam Score (RS) on CT head is a new evolving clinical tool as a predictor of mortality in Traumatic Brain Injury (TBI). The objective of this study is to assess the outcome of children with TBI admitted in paediatric intensive care unit (PICU) of a tertiary-care, university hospital by using RS.
Methods: This was a prospective observational study conducted on children (age: 1mo -16yr) with TBI admitted in PICU of Aga Khan University Hospital from 2013 to 2016. RS on CT was calculated by a radiologist. All patients were managed according to according to Paediatric Brain Trauma Foundation …

Central Hypoventilation: A Rare Complication Of Wallenberg Syndrome, Keithan Sivakumar Md, Mba, Manveer Garcha, Dev Mehta, Megan Leary Md, Hussam A. Yacoub Md

Department of Medicine

Central alveolar hypoventilation disorders denote conditions resulting from underlying neurologic disorders affecting the sensors, the central controller, or the integration of those signals leading to insufficient ventilation and reduction in partial pressures of oxygen. We report a patient who presented with a left lateral medullary ischemic stroke after aneurysm repair who subsequently developed a rare complication of CAH. Increased awareness of this condition’s clinical manifestations is crucial to make an accurate diagnosis and understand its complications and prognosis.

Cdc Grand Rounds: National Amyotrophic Lateral Sclerosis (Als) Registry Impact, Challenges, And Future Directions, Paul Mehta, D. Kevin Horton, Edward J. Kasarskis, Ed Tessaro, M. Shira Eisenberg, Susan Laird, John Iskander

Neurology Faculty Publications

Amyotrophic lateral sclerosis (ALS), commonly known as Lou Gehrig’s disease, is a rapidly progressive fatal neurologic disease. Currently, there is no cure for ALS and the available treatments only extend life by an average of a few months. The majority of ALS patients die within 2–5 years of diagnosis, though survival time varies depending on disease progression (1,2). For approximately 10% of patients, ALS is familial, meaning it and has a genetic component; the remaining 90% have sporadic ALS, where etiology is unknown, but might be linked to environmental factors such as chemical exposures (e.g., heavy …

Lacosamide And Levetiracetam Have No Effect On Sharp-Wave Ripple Rate, Jan Kudlacek, Jan Chvojka, Antonin Posusta, Lubica Kovacova, Seung Bong Hong, Shennan A. Weiss, Md, Phd, Kamila Volna, Petr Marusic, Jakub Otahal, Premysl Jiruska

Department of Neurology Faculty Papers

Pathological high-frequency oscillations are a novel marker used to improve the delineation of epileptogenic tissue and, hence, the outcome of epilepsy surgery. Their practical clinical utilization is curtailed by the inability to discriminate them from physiological oscillations due to frequency overlap. Although it is well documented that pathological HFOs are suppressed by antiepileptic drugs (AEDs), the effect of AEDs on normal HFOs is not well known. In this experimental study, we have explored whether physiological HFOs (sharp-wave ripples) of hippocampal origin respond to AED treatment. The results show that application of a single dose of levetiracetam or lacosamide does not …

Iron Deficiency Anemia As A Risk Factor For Simple Febrile Seizures, Tipu Sultan, Abdul Islam Hanif Hanif, Shaila Ali

Pakistan Journal of Neurological Sciences (PJNS)

To determine the association of iron deficiency anemia with simple febrile seizures in children presenting in a tertiary care hospital.