Posts Tagged neurology

[NEWS] New guidance on use of valproate in women, girls of child bearing age with epilepsy published

Apr 2 2019

 

New guidance to support regulations around the use of valproate in women and girls of child bearing age with epilepsy has been published by specialists from 13 UK healthcare bodies including seven Royal Colleges.

And NICE has published a summary of updated guidance for healthcare professionals bringing together all its recommendations and other safety advice on the drug valproate.

The use of sodium valproate during pregnancy is associated with up to a 40 per cent risk of neuordevelopmental disorders and a 10 per cent risk of physical disabilities for an unborn child.

In March 2018, the Medicines and Healthcare products Regulatory Agency published guidelines which meant that valproate could no longer be prescribed for girls and women of childbearing age unless no other effective treatment was available.

Any girl or woman prescribed valproate should also be fully informed of the risks associated with the medication and the need for effective contraception.

But a year on, implementation of the guidelines have thrown up specific challenges with complex issues and individual situations where the best interests of the patient did not always appear to be met.

Claire Glazebrook, Director of Fundraising, Marketing and External Affairs at Epilepsy Society, said:

Over the last year our Helpline has received multiple calls from women, parents and healthcare professionals, all struggling to interpret the guidelines and what they mean for them as individuals. And we know that this experience is replicated across other patient organizations and clinics.

I hope this guidance will help to answer some of their questions and provide clarity in what can be a very emotional and challenging decision.

For some girls and women, they have no option but to take sodium valproate as it may be the only drug that will control their seizures. But that of course means there are some very important and potentially heartbreaking issues to consider around planning a family.

All these women and girls deserve consistency in the advice and information that they receive.”

The new pan-college guidance has been drawn up by Judy Shakespeare of the Royal College of General Practitioners and Sanjay Sisodiya of the Association of British Neurologists and Royal College of Physicians. Sanjay Sisodiya is also Director of Genomics at Epilepsy Society and Professor of Neurology at UCL.

He said: This work has come together through much valued contributions from specialists across all the national bodies involved.

“In some cases the new regulations have lead to situations where the best interests of the patients may not appear to be best served. Some of the points raised by the regulations are also complex ethical issues. We do not attempt to address all these issues in this document but hope that it will bring greater clarity for clinicians  leading to better care for women and girls with epilepsy. All women and girls have individual needs and where possible should be involved in the choices they make about their own health and plans to start a family.”

Writing in the guidance, Professor Dame Sally Davies, Chief Medical Officer for England said:

I am very pleased that the Medical Royal Colleges have come together to produce this important and helpful guidance, so that doctors and other healthcare professionals across primary and secondary care are on the same page regarding the use of sodium valproate – including around instances where its use is still appropriate.”

via New guidance on use of valproate in women, girls of child bearing age with epilepsy published

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[WEB SITE] New epilepsy warning device detects more seizures than current methods – Video

epilepsy warning

A recent study developed and evaluated the effectiveness of a new device to detect epileptic seizures and act as an epilepsy warning.

Despite receiving medication, approximately 30% of people with epilepsy continue to have seizures. Seizures occurring during sleep can be especially dangerous and are often unwitnessed. These epileptic patients are also at high risk for sudden unexpected death in epilepsy (SUDEP), a major cause of death in epileptic patients. Also, patients with an intellectual disability and severe therapy-resistant epilepsy have an estimated 20% lifetime risk of dying from epilepsy. Therefore, the development of an epilepsy warning device could help not only improve the quality of care for patients but also help prevent SUDEP.

One of the current techniques to monitor epilepsy at night is a sensor that reacts to vibrations from rhythmic jerks. Despite techniques, many seizures are still being missed. However, a new device developed by scientists from the Netherlands may be the solution to help reduce the number of epileptic patient deaths occurring during the night. This new high-tech device is a bracelet known as Nightwatch.

Bracelet recognizes two warning signs of severe seizures

The researchers developed the bracelet to recognize two important warnings signs of severe epileptic seizures: an abnormally fast heartbeat and rhythmic jolting movements. When these seizure warnings are detected the bracelet will send an alert to the patient’s caretaker or nurse.

The researchers recently conducted a prospective trial to test the bracelet in 28 intellectually handicapped epilepsy patients. They observed the patients wearing the bracelet for an average of 65 nights. In the event of a severe seizure, the bracelet sounded an alarm. Patients were also filmed to see whether any false alarms occurred or if the bracelet missed any attacks. The results of the trial were recently published in Neurology.

The new technology performed better than current methods 

The bracelet was compared to bed sensors, which are the current standard detection method. The findings showed that the bed sensor only detected 21% of serious attacks and on average remained silent once every four nights per patient. In comparison, the Nightwatch bracelet only missed a serious attack every 25 nights (on average) per patient.

The comparison showed the bracelet detected 85% of all serious night-time epilepsy seizures and 96% of the most severe ones. These results show combining patterns that can trigger seizures, such as heart rate and movement, is a reliable method of detection for night-time seizures.  The care staff of patients during the study reported being positive about the use of the bracelet and patients did not experience discomfort from wearing the bracelet at night.

The researchers expect through the use of the bracelet, the number of SUDEP cases may be reduced by two-thirds and applied globally, this epilepsy warning device could save thousands of lives. However, saving the life of the patient also depends on how quickly caretakers or nurses respond to the alarm. The Nightwatch is now available and can be used by adults at home and in institutions.

Written by Lacey Hizartzidis, PhD

References:

  1. Johan Arends, Roland D. Thijs, Thea Gutter, Constantin Ungureanu, Pierre Cluitmans, Johannes Van Dijk, Judith van Andel, Francis Tan, Al de Weerd, Ben Vledder, Wytske Hofstra, Richard Lazeron, Ghislaine van Thiel, Kit C.B. Roes, Frans Leijten, and the Dutch Tele-Epilepsy Consortium. Multimodal nocturnal seizure detection in a residential care setting. Neurology Nov 2018, 91 (21) e2010-e2019; DOI:10.1212/WNL.0000000000006545.
  2. New epilepsy warning device could save thousands of lives. EurekAlert website https://www.eurekalert.org/pub_releases/2018-11/euot-new110518.php. Accessed January 12, 2019.
  3. Photo credit: LivAssured https://www.eurekalert.org/multimedia/pub/185082.php?from=411220

Disclaimer: Not a sponsored post.

via New epilepsy warning device detects more seizures than current methods – Medical News Bulletin | Health News and Medical Research

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[Abstract] Improving walking ability in people with neurological conditions: A theoretical framework for biomechanics driven exercise prescription

Abstract

The purpose of this paper is to discuss how knowledge of the biomechanics of walking can be used to inform the prescription of resistance exercises for people with mobility limitations. Muscle weakness is a key physical impairment that limits walking in commonly occurring neurological conditions such as cerebral palsy, traumatic brain injury and stroke. Few randomised trials to date have shown conclusively that strength training improves walking in people living with these conditions. This appears to be because

1) the most important muscle groups for forward propulsion when walking have not been targeted for strengthening, and

2) strength training protocols have focused on slow and heavy resistance exercises, which do not improve the fast muscle contractions required for walking.

We propose a theoretical framework to improve exercise prescription by integrating the biomechanics of walking with the principles of strength training outlined by the American College of Sports Medicine (ACSM), to prescribe exercises that are specific to improving the task of walking. The high angular velocities that occur in the lower limb joints during walking indicate that resistance exercises targeting power generation would be most appropriate. Therefore, we propose the prescription of plyometric and ballistic resistance exercise, applied using the ACSM guidelines for task-specificity, once people with neurological conditions are ambulating, to improve walking outcomes. This new theoretical framework for resistance training ensures that exercise prescription matches how the muscles work during walking.

via Improving walking ability in people with neurological conditions: A theoretical framework for biomechanics driven exercise prescription – Archives of Physical Medicine and Rehabilitation

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[WEB SITE] New method based on artificial intelligence may help predict epilepsy outcomes

 

Medical University of South Carolina (MUSC) neurologists have developed a new method based on artificial intelligence that may eventually help both patients and doctors weigh the pros and cons of using brain surgery to treat debilitating seizures caused by epilepsy. This study, which focused on mesial temporal lobe epilepsy (TLE), was published in the September 2018 issue of Epilepsia. Beyond the clinical implications of incorporating this analytical method into clinicians’ decision making processes, this work also highlights how artificial intelligence is driving change in the medical field.

Despite the increase in the number of epilepsy medications available, as many as one-third of patients are refractory, or non-responders, to the medication. Uncontrolled epilepsy has many dangers associated with seizures, including injury from falls, breathing problems, and even sudden death. Debilitating seizures from epilepsy also greatly reduce quality of life, as normal activities are impaired.

Epilepsy surgery is often recommended to patients who do not respond to medications. Many patients are hesitant to undergo brain surgery, in part, due to fear of operative risks and the fact that only about two-thirds of patients are seizure-free one year after surgery. To tackle this critical gap in the treatment of this epilepsy population, Dr. Leonardo Bonilha and his team in the Department of Neurology at MUSC looked to predict which patients are likely to have success in being seizure free after the surgery.

Neurology Department Chief Resident Dr. Gleichgerrcht explains that they tried “to incorporate advanced neuroimaging and computational techniques to anticipate surgical outcomes in treating seizures that occur with loss of consciousness in order to eventually enhance quality of life”. In order to do this, the team turned to a computational technique, called deep learning, due to the massive amount of data analysis required for this project.

The whole-brain connectome, the key component of this study, is a map of all physical connections in a person’s brain. The brain map is created by in-depth analysis of diffusion magnetic resonance imaging (dMRI), which patients receive as standard-of-care in the clinic. The brains of epilepsy patients were imaged by dMRI prior to having surgery.

Deep learning is a statistical computational approach, within the realm of artificial intelligence, where patterns in data are automatically learned. The physical connections in the brain are very individualized and thus it is challenging to find patterns across multiple patients. Fortunately, the deep learning method is able to isolate the patterns in a more statistically reliable method in order to provide a highly accurate prediction.

Currently, the decision to perform brain surgery on a refractory epilepsy patient is made based on a set of clinical variables including visual interpretation of radiologic studies. Unfortunately, the current classification model is 50 to 70 percent accurate in predicting patient outcomes post-surgery. The deep learning method that the MUSC neurologists developed was 79 to 88 percent accurate. This gives the doctors a more reliable tool for deciding whether the benefits of surgery outweigh the risks for the patient.

A further benefit of this new technique is that no extra diagnostic tests are required for the patients, since dMRIs are routinely performed with epilepsy patients at most centers.

This first study was retrospective in nature, meaning that the clinicians looked at past data. The researchers propose that an ideal next step would include a multi-site prospective study. In a prospective study, they would analyze the dMRI scans of patients prior to surgery and follow-up with the patients for at least one year after surgery. The MUSC neurologists also believe that integrating the brain’s functional connectome, which is a map of simultaneously occurring neural activity across different brain regions, could enhance the prediction of outcomes.

Dr. Gleichgerrcht says that the novelty in the development of this study lies in the fact that this “is not a question of human versus machine, as is often the fear when we hear about artificial intelligence. In this case, we are using artificial intelligence as an extra tool to eventually make better informed decisions regarding a surgical intervention that holds the hope for a cure of epilepsy in a large number of patients.”

 

via New method based on artificial intelligence may help predict epilepsy outcomes

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[WEB SITE] Virtual Reality Reduces Pain and Increases Performance During Exercise – Neuroscience News

Summary: Researchers report virtual reality can help to lower pain levels and increase performance when undertaking physical activity. Participants using VR reported a pain intensity 10% lower than those not using the technology when performing isometric bicep curls.

Source: University of Kent.

The research, led by PhD candidate Maria Matsangidou from EDA, set out to determine how using VR while exercising could affect performance by measuring a raft of criteria: heart rate, including pain intensity, perceived exhaustion, time to exhaustion and private body consciousness.

To do this they monitored 80 individuals performing an isometric bicep curl set at 20% of the maximum weight they could lift, which they were then asked to hold for as long as possible. Half of the group acted as a control group who did the lift and hold inside a room that had a chair, a table and yoga mat on the floor.

The VR group were placed in the same room with the same items. They then put on a VR headset and saw the same environment, including a visual representation of an arm and the weight (see image below). They then carried out the same lift and hold as the non-VR group.

The results showed a clear reduction in perception of pain and effort when using VR technology. The data showed that after a minute the VR group had reported a pain intensity that was 10% lower than the non-VR group.

Furthermore the time to exhaustion for the VR group was around two minutes longer than those doing conventional exercise. The VR group also showed a lower heart rate of three beats per minute than the non-VR group.

Results from the study also showed no significant effect of private body consciousness on the positive impact of VR. Private body consciousness is the subjective awareness each of us has to bodily sensations.

the vr system

Previous research has shown that individuals who have a high private body consciousness tend to better understand their body and as a result perceive higher pain when exercising. However, the study’s findings revealed that VR was effective in reducing perceived pain and that private body consciousness did not lessen this effect.

As such, the improvements shown by the VR group suggest that it could be a possible way to encourage less active people to exercise by reducing the perceived pain that exercise can cause and improving performance, regardless of private body consciousness.

Lead researcher Maria Matsangidou said: ‘It is clear from the data gathered that the use of VR technology can improve performance during exercise on a number of criteria. This could have major implications for exercise regimes for everyone, from occasional gym users to professional athletes.’

ABOUT THIS NEUROSCIENCE RESEARCH ARTICLE

 

Dr Jim Ang from EDA and Dr Alex Mauger from the School of Sport and Exercise Sciences at Kent were also involved in the research.

Source: Dan Worth – University of Kent
Publisher: Organized by NeuroscienceNews.com.
Image Source: NeuroscienceNews.com image is credited to Maria Matsangidou.
Original Research: Abstract for “Is your virtual self as sensational as your real? Virtual Reality: The effect of body consciousness on the experience of exercise sensations” by Maria Matsangidou, Chee Siang Ang, Alexis R. Mauger, Jittrapol Intarasirisawat, Boris Otkhmezuri, and Marios N. Avraamides in Psychology of Sports and Exercise. Published July 18 2018.
doi:10.1016/j.psychsport.2018.07.004

CITE THIS NEUROSCIENCENEWS.COM ARTICLE
University of Kent”Virtual Reality Reduces Pain and Increases Performance During Exercise.” NeuroscienceNews. NeuroscienceNews, 1 October 2018.
<http://neurosciencenews.com/virtual-reality-pain-exercise-9941/&gt;.

Abstract

Is your virtual self as sensational as your real? Virtual Reality: The effect of body consciousness on the experience of exercise sensations

Objectives
Past research has shown that Virtual Reality (VR) is an effective method for reducing the perception of pain and effort associated with exercise. As pain and effort are subjective feelings, they are influenced by a variety of psychological factors, including one’s awareness of internal body sensations, known as Private Body Consciousness (PBC). The goal of the present study was to investigate whether the effectiveness of VR in reducing the feeling of exercise pain and effort is moderated by PBC.

Design and methods
Eighty participants were recruited to this study and were randomly assigned to a VR or a non-VR control group. All participants were required to maintain a 20% 1RM isometric bicep curl, whilst reporting ratings of pain intensity and perception of effort. Participants in the VR group completed the isometric bicep curl task whilst wearing a VR device which simulated an exercising environment. Participants in the non-VR group completed a conventional isometric bicep curl exercise without VR. Participants’ heart rate was continuously monitored along with time to exhaustion. A questionnaire was used to assess PBC.

Results
Participants in the VR group reported significantly lower pain and effort and exhibited longer time to exhaustion compared to the non-VR group. Notably, PBC had no effect on these measures and did not interact with the VR manipulation.

Conclusions
Results verified that VR during exercise could reduce negative sensations associated with exercise regardless of the levels of PBC.

 

via Virtual Reality Reduces Pain and Increases Performance During Exercise – Neuroscience News

 

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[ARTICLE] Identifying and Quantifying Neurological Disability via Smartphone – Full Text

Embedded sensors of the smartphones offer opportunities for granular, patient-autonomous measurements of neurological dysfunctions for disease identification, management, and for drug development. We hypothesized that aggregating data from two simple smartphone tests of fine finger movements with differing contribution of specific neurological domains (i.e., strength & cerebellar functions, vision, and reaction time) will allow establishment of secondary outcomes that reflect domain-specific deficit. This hypothesis was tested by assessing correlations of smartphone-derived outcomes with relevant parts of neurological examination in multiple sclerosis (MS) patients. We developed MS test suite on Android platform, consisting of several simple functional tests. This paper compares cross-sectional and longitudinal performance of Finger tapping and Balloon popping tests by 76 MS patients and 19 healthy volunteers (HV). The primary outcomes of smartphone tests, the average number of taps (per two 10-s intervals) and the average number of pops (per two 26-s intervals) differentiated MS from HV with similar power to traditional, investigator-administered test of fine finger movements, 9-hole peg test (9HPT). Additionally, the secondary outcomes identified patients with predominant cerebellar dysfunction, motor fatigue and poor eye-hand coordination and/or reaction time, as evidenced by significant correlations between these derived outcomes and relevant parts of neurological examination. The intra-individual variance in longitudinal sampling was low. In the time necessary for performing 9HPT, smartphone tests provide much richer and reliable measurements of several distinct neurological functions. These data suggest that combing more creatively-construed smartphone apps may one day recreate the entire neurological examination.

Introduction

Neurological examination measures diverse functions of the central (CNS) and peripheral nervous systems to diagnose neurological diseases and guide treatment decisions. Thorough neurological examination takes between 30 and 60 min to complete and years of training to master. This poses problem both for developing countries, which often lack neurologists, and for developed countries where cost-hikes and administrative requirements severely limit the time clinicians spend examining patients.

Additionally, clinical scales derived from traditional neurological examination are rather insensitive and prone to biases, which limits their utility in drug development. Therefore, non-clinician administered measurements of physical disability such as timed 25-foot walk (25FW) and 9-hole peg test (9HPT) or measurements of cognitive functions exemplified by paced auditory serial addition test (PASAT) and symbol digit modalities test (SDMT), are frequently used in clinical trials of neurological diseases such as multiple sclerosis (MS) (12). Especially combining these “functional scales” with clinician-based disability scales such as Expanded Disability Status Scale (EDSS)(3) into EDSS-plus (4) or Combinatorial weight-adjusted disability scale (CombiWISE) (5) enhances sensitivity of clinical trial outcomes. However, these sensitive combinatorial scales are rarely, if ever acquired in clinical practice due to time and expense constrains.

Measuring neurological functions by patients via smartphones (68) may pose a solution for all aforementioned problems, while additionally empowering patients for greater participation in their neurological care. We have previously found comparable sensitivity and specificity of simple, smartphone-amenable measurements of finger and foot taps to 9HPT and 25FW, respectively (9). In this study, we explored iterative development/optimization of smartphone-based measurements of neurological functions by: 1. Exploring clinical utility of new features that can be extracted from finger tapping; 2. Development of “balloon popping” smartphone test that builds on finger tapping by expanding neurological functions necessary for task completion to eye movements and cognitive skills, and 3. By decoding app-collected raw data into secondary (derived) features that may better reflect deficits in specific neurological functions.

 

Materials and Methods

Developing the Smartphone Apps

Tapping and Balloon popping tests were written using Java in the Android Studio integrated development environment. Both tests went through iterative development and optimization following beta testing with developers and then clinical trial testing with patients and healthy volunteers. Each of the individual tests are standalone applications and can be downloaded individually to the phone using an Android Package (APK) emailed to phones or directly installed through USB connection with Android Studio. Installation and initial testing of applications were completed on a variety of personal Android phones, with no particular specifications. Testing in the clinic with patients and longitudinal testing was completed on Google Pixel XL 2017 phones. Android 8.1 Oreo operating system was used for the most recent version of the application, with the intention of keeping the operating system the app runs on up to date with the most recent version released by Android.

For the purposes of this study, we created a front-end application that can flexibly incorporate a variety of test apps. The front-end prompts for user profiles where a testing ID, birth month and year, gender, and dominant hand may be entered so data collected is associated with the user profile. Through a cloud-based spreadsheet, “prescriptions” of test app configurations are set for each user such that they may have a unique combination of tests tailored to their disability level.

The tapping test goal was similar to previously validated non-smartphone administered tapping tests (9), where users had to tap as quickly as possible over a 10 s duration and the final score is the average of two attempts. The test uses touch recognition over a rectangular area covering the bottom half of a vertically oriented phone screen (Figure 1A). Users can tap anywhere in a marked off gray area. The total number of taps for each of two trials and the calculated average is displayed immediately afterwards on the screen. In addition to total taps over the duration of the test, the app also records the duration, Android system time, and pressure for each tap as background data. Pressure for app recording is interpreted from the size of the touch area on each tap, where larger tap area corresponds to a higher pressure reading. Because the pressure function was added later and therefore the data are missing for the majority of current cohort, this function is not investigated in current study.

FIGURE 1
www.frontiersin.orgFigure 1. Smartphone Apps. (A) Tapping Test where user can tap repeatedly anywhere in the gray rectangle over the bottom half of the screen. (B) Popping Test where the dark blue circle will disappear and simultaneously reappear randomly across the screen as soon as the user touches it.

The balloon popping test was conceptually envisioned as an extension of tapping test that expands neurological functions necessary for test completion from pure motoric, to motoric, visual, and cognitive (attention and reaction time). The primary goal for this test is to touch as many randomly generated dark blue circles (balloons) moving across the screen in succession over the 26-s test duration as possible. During optimization of the app we tested 3 sizes of the target balloon and a 100-pixel balloon was selected as optimal based on preliminary results. The analyses of the other two circle sizes are provided as part of sensitivity analyses (Supplementary Figure 1), as conclusions from these tests support data presented in the main text of the paper. There is only one balloon to pop on the screen at a time (Figure 1B) and as soon as the user touches anywhere on the circle, another circle will appear in a random location. The random generation of balloon locations was created by random number functions in Java for both the x and y coordinates of the center of the circle, with the constraint of the entire balloon having to be visible on the screen. If the user taps on a background location, the current balloon stays in the same location and is only moved to a new random location after accurately tapping on the balloon. Following app completion, the total number of balloons popped and calculated average (from two trials) is displayed on the phone for the user. The x and y coordinates of all balloon and background hits, the system time, duration, and pressure (in the same manner as tap pressure) for each tap are also recorded as background data and stored in cloud-based data system.

Following the completion of a tapping or balloon popping test trial, an intermediate message displayed on the screen asks if the users would like to submit their results or retake the most recent trial (Supplementary Videos 12). If the user selects the retake option the collected data for the trial is discarded locally on the phone and not sent to any cloud-based database. This was implemented to avoid noise associated with test interruptions or other unforeseen circumstances that affected test performance. Following selection of the submit option, the data is uploaded immediately to a cloud-based database if the smartphone is connected to WiFi. If the phone is not connected to WiFi, then the submitted test trial results are stored locally on the phone and uploaded to the database as soon as the phone is connected to WiFi.

The app development process is in continuation given user and clinician feedback in addition to integration of more tests into the front-end. User feedback, user’s ability to perform Apps in a “practice mode”, and training videos for individual tests (Supplementary Videos 12) are integrated into the front-end dashboard that manages different tests.[…]

Continue —->  Frontiers | Identifying and Quantifying Neurological Disability via Smartphone | Neurology

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[WEB PAGE] Study offers possibility of squelching a focal epilepsy seizure before symptoms appear

Patients with focal epilepsy that does not respond to medications badly need alternative treatments.

In a first-in-humans pilot study, researchers at the University of Alabama at Birmingham have identified a sentinel area of the brain that may give an early warning before clinical seizure manifestations appear. They have also validated an algorithm that can automatically detect that early warning.

These two findings offer the possibility of squelching a focal epilepsy seizure — before the patient feels any symptoms — through neurostimulation of the sentinel area of the brain. This is somewhat akin to the way an implantable defibrillator in the heart can staunch heart arrhythmias before they injure the heart.

In the pilot study, three epilepsy patients undergoing brain surgery to map the source of their focal epilepsy seizures also gave consent to add an investigational aspect to their planned surgeries.

As neurosurgeons inserted long, thin, needle-like electrodes into the brain to map the location of the electrical storm that initiates an epileptic seizure, they also carefully positioned the electrodes to add one more task — simultaneously record the electrical activity at the anterior nucleus of the thalamus.

The thalamus is a structure sitting deep in the brain that is well connected with other parts of the brain. The thalamus controls sleep and wakefulness, so it often is called the “pacemaker” of the brain. Importantly, preclinical studies have shown that focal sources of seizures in the cortex can recruit other parts of the brain to help generate a seizure. One of these recruited areas is the anterior thalamic nucleus.

The UAB team led by Sandipan Pati, M.D., assistant professor of neurology, found that nearly all of the epileptic seizures detected in the three patients — which began in focal areas of the cortex outside of the thalamus — also recruited seizure-like electrical activity in the anterior thalamic nucleus after a very short time lag. Importantly, both of these initial electrical activities appeared before any clinical manifestations of the seizures.

The UAB researchers also used electroencelphalography, or EEG, brain recordings from the patients to develop and validate an algorithm that was able to automatically detect initiation of that seizure-like electrical activity in the anterior thalamic nucleus.

“This exciting finding opens up an avenue to develop brain stimulation therapy that can alter activities in the cortex by stimulating the thalamus in response to a seizure,” Pati said. “Neurostimulation of the thalamus, instead of the cortex, would avoid interference with cognition, in particular, memory.”

“In epilepsy, different aspects of memory go down,” Pati explained. “Particularly long-term memory, like remembering names, or remembering events. The common cause is that epilepsy affects the hippocampus, the structure that is the brain’s memory box.”

Pati said these first three patients were a feasibility study, and none of the patients had complications from their surgeries. The UAB team is now extending the study to another dozen patients to confirm the findings.

“Hopefully, after the bigger group is done, we can consider stimulating the thalamus,” Pati said. That next step would have the goals of improved control of seizures and improved cognition, vigilance and memory for patients.

For epilepsy patients where medications have failed, the surgery to map the source of focal seizures is a prelude to two current treatment options — epilepsy surgery to remove part of the brain or continuous, deep-brain stimulation. If the UAB research is successful, deep brain stimulation would be given automatically, only as the seizure initiates, and it would be targeted at the thalamus, where the stimulation might interfere less with memory.

 

via Study offers possibility of squelching a focal epilepsy seizure before symptoms appear

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[Quiz] 5 Things to Know About Diet and Epilepsy

©VesnaCvorovic/Shutterstock

Neurology Quiz: 5 Things to Know About Diet and Epilepsy

Jul 30, 2018

 

What are the main types of ketogenic diets and what advantages do they hold for epilepsy management? Take the quiz and learn more.

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[WEB SITE] Neuro Physios – check out these fabulous free resources!

Neuro Physios – check out these fabulous free resources!

 

I asked and Twitter answered…how can I keep on top of what’s happening in the world of Neuro Physiotherapy? There seem to be so many (brilliant) resources in the MSK world, from podcasts to blogs, that continually churn out opinion on the latest evidence and techniques, but I’d struggled to find anything similar in the Neuro world. So I did something I’ve not tried before and reached out on Twitter to see if anyone could help…and they did! The answer seems to be that there is a gap for some good general neuro physio online global discussion and commentary on the evidence, but there are some great free resources – and here they are! So take a look, let us know what you think, spread the word and please do let us know if you find any other gems out there.

Podcasts

MDTea Podcasts from Hearing Aid Podcasts
A series of podcasts for healthcare professionals working with older adults.   Each one also has a nice summary infographic and text notes. So they aren’t physio specific, but there are loads of useful ones for physios in there. For me these are everything a podcast should be: short, succinct, packed full of relevant details, and with a fun quiz at the end – what’s not to love?

Evidence-based practice blogs

When EBP meets neurological physiotherapy …
Controversial? apparently so. Evidence based? definitely. Useful? tons of good info and links with specifics of delivering evidence-based interventions from @sarahftyson.

Online resources

MS Practice – For Health Professionals
Website from the MS Society of Australia, with a useful section containing fact sheets for healthcare professionals on symptoms of MS and treatment options based on research evidence

Evidence-Based Review of Stroke Rehabilitation
A huge resource of in-depth reviews of well over 4,500 studies including over 2,300 randomized controlled trial – and all about stroke rehab.

GRASP
Background and detailed ‘how to’ guides (including patient booklets) to the evidence based GRASP (Graded Repetitive Arm Supplementary Program) arm and hand exercise program for people with stroke. A great resource you can take and use straight away with your patients.

FAME
From the same group as GRASP, this time for FAME – fitness and mobility exercise programme. FAME is a community-based exercise program developed for people with stroke who have some standing and walking ability, shown to improved mobility, cardiovascular fitness, arm and hand function.  Again, everything is available for you to pick this up and run yourself.

Enable me
Patient facing website full of resources on living with stroke

Journals

PLoS One
Great for neuro in general with some physio specific stuff

Free online training

Stroke Engine e-learning modules
Check out the module on aerobic exercise recommendations.

Introduction to MS: An Online Course for Fitness & Wellness Professionals
Six modules and a quiz, all about MS symptoms and exercise therapy

Understanding Parkinson’s for health and social care staff
Free online course from Parkinson’s UK and the Open University offers around 24 hours of learning time for health and social care staff

Stroke Training and Awareness Resources (STARS)
Resource based on the Stroke Core Competencies which were published by NHS Education for Scotland (NES) in 2005.

Royal college of GPs e-learning
Once you’ve registered you get access to loads of free resources. Broad range of subject areas, but there’s a well-stocked area on Neurological problems that is worth a look.

Apps

ViaTherapy
Pop in some information about your patient, get out some evidence-based suggestions for their upper limb rehab – it’s that simple!

So loads of really useful stuff – but there’s definitely scope for more in this area so hopefully we’ll see additional things popping up soon. Please get in touch and let us know of any other resources you come across that we could add to this list!

A big thanks to my colleagues @ECTTherapies for some extra resources and to all those who replied to my Twitter plea! All worth a follow: @anniemccluskey2@AVERTtrial@bendotellis@BlaiseDoran@Kath1872@sarahftyson@ScottBuxton_1.

 

via Neuro Physios – check out these fabulous free resources! – Physiospot – Physiotherapy and Physical Therapy in the Spotlight

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[WEB SITE] Study uncovers genetic trigger that may help the brain to recover from stroke, other injuries

Scientists have found a genetic trigger that may improve the brain’s ability to heal from a range of debilitating conditions, from strokes to concussions and spinal cord injuries.

A new study in mice from UT Southwestern’s O’Donnell Brain Institute shows that turning on a gene inside cells called astrocytes results in a smaller scar and – potentially – a more effective recovery from injury.

The research examined spinal injuries but likely has implications for treating a number of brain conditions through gene therapy targeting astrocytes, said Dr. Mark Goldberg, Chairman of Neurology & Neurotherapeutics at UT Southwestern.

“We’ve known that astrocytes can help the brain and spinal cord recover from injury, but we didn’t fully understand the trigger that activates these cells,” Dr. Goldberg said. “Now we’ll be able to look at whether turning on the switch we identified can help in the healing process.”

The study published in Cell Reports found that the LZK gene of astrocytes can be turned on to prompt a recovery response called astrogliosis, in which these star-shaped cells proliferate around injured neurons and form a scar.

Scientists deleted the LZK gene in astrocytes of one group of injured mice, which decreased the cells’ injury response and resulted in a larger wound on the spinal cord. They overexpressed the gene in other injured mice, which stimulated the cells’ injury response and resulted in a smaller scar. Overexpressing the gene in uninjured mice also activated the astrocytes, confirming LZK as a trigger for astrogliosis.

Dr. Goldberg said a smaller scar likely aids the healing process by isolating the injured neurons, similar to how isolating a spreading infection can improve recovery. “But we don’t know under what circumstances this hypothesis is true because until now we didn’t have an easy way to turn the astrocyte reactivity on and off,” he said.

Further study is needed to analyze whether a compact scar tissue indeed improves recovery and how this process affects the neurons’ ability to reform connections with each other.

Dr. Goldberg’s lab will conduct more research to examine the effects of astrogliosis in stroke and spinal cord injuries. The researchers will determine whether turning up LZK in mice in advance of an injury affects its severity. They will then measure how the formation of the compact scar helps or hinders recovery.

“It has been a big mystery whether increasing astrocyte reactivity would be beneficial,” said Dr. Meifan Amy Chen, the study’s lead author and Instructor of Neurology at the Peter O’Donnell Jr. Brain Institute. “The discovery of LZK as an on switch now offers a molecular tool to answer this question.”

 

via Study uncovers genetic trigger that may help the brain to recover from stroke, other injuries

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