Faculty Bibliography
Searched for:
school:SOM
Department/Unit:Neurology
Total Results:
23143
A safety review of approved intrathecal analgesics for chronic pain management
INTRODUCTION/BACKGROUND:Intrathecal (IT) drug therapy has been established as an effective treatment option for patients with chronic pain of malignant or non-malignant origin, with an established safety profile and fewer adverse effects compared to oral or parenteral pain medications. Morphine (a μ-opioid receptor agonist) and ziconotide (a non-opioid calcium channel antagonist) are the only IT agents approved by the US Food and Drug Administration for the treatment of chronic pain. Although both are considered first-line IT therapies, each drug has unique properties and considerations. Areas Covered: This review will evaluate the pivotal trials that established the use of morphine and ziconotide as first-line IT therapy for patients with chronic pain, as well as safety and efficacy data generated from various retrospective and prospective studies. Expert Opinion: Morphine and ziconotide are effective IT therapies for patients with chronic malignant or non-malignant pain that is refractory to other interventions. IT ziconotide is recommended as first-line therapy due to its efficacy and avoidance of many adverse effects commonly associated with opioids. The use of IT morphine is also considered first-line; however, the risks of respiratory depression, withdrawal with drug discontinuation or pump malfunction, and the development of tolerance require careful patient selection and management.
PMID: 33583318
ISSN: 1744-764x
CID: 4786332
Sufficient sampling for kriging prediction of cortical potential in rat, monkey, and human µECoG
Objective. Large channel count surface-based electrophysiology arrays (e.g. µECoG) are high-throughput neural interfaces with good chronic stability. Electrode spacing remains ad hoc due to redundancy and nonstationarity of field dynamics. Here, we establish a criterion for electrode spacing based on the expected accuracy of predicting unsampled field potential from sampled sites.Approach. We applied spatial covariance modeling and field prediction techniques based on geospatial kriging to quantify sufficient sampling for thousands of 500 ms µECoG snapshots in human, monkey, and rat. We calculated a probably approximately correct (PAC) spacing based on kriging that would be required to predict µECoG fields at≤10% error for most cases (95% of observations).Main results. Kriging theory accurately explained the competing effects of electrode density and noise on predicting field potential. Across five frequency bands from 4-7 to 75-300 Hz, PAC spacing was sub-millimeter for auditory cortex in anesthetized and awake rats, and posterior superior temporal gyrus in anesthetized human. At 75-300 Hz, sub-millimeter PAC spacing was required in all species and cortical areas.Significance. PAC spacing accounted for the effect of signal-to-noise on prediction quality and was sensitive to the full distribution of non-stationary covariance states. Our results show that µECoG arrays should sample at sub-millimeter resolution for applications in diverse cortical areas and for noise resilience.
PMCID:8058280
PMID: 33326943
ISSN: 1741-2552
CID: 4851932
The impact of medications and medical comorbidities on sexual function in people with epilepsy
OBJECTIVE:People with epilepsy experience increased rates of sexual dysfunction, often affecting quality of life. Sexual dysfunction may result from the underlying disorder, antiseizure or other medications, or comorbid psychosocial factors. This study evaluated the incidence and clinical associations of sexual dysfunction in adult epilepsy patients. METHODS:89 epilepsy patients 18 years and older admitted to the New York University Comprehensive Epilepsy Center epilepsy monitoring unit between 2016 and 2018 completed a survey on sexual functioning. The survey included demographic, clinical, and sexual functioning information with a validated measure of sexual function (the Arizona Sexual Experiences Scale (ASEX). RESULTS:Of 89 surveys completed, 15 (16.9 %) patients had discussed sexual functioning with a medical professional and 20 (22.5 %) reported sexual dysfunction. For the group, the mean ASEX score was 13.6 (SD 4.8). 59 (66.3 %) participants reported not being asked about sexual health by their doctor or nurse practitioner in the last year. The two independent predictors of sexual dysfunction were self-identifying as overweight/obese (OR 6.1, CI 1.4-26.5, P = 0.02) or taking strong enzyme-inducing antiseizure medications (OR 7.8, CI 1.4-44.9, P = 0.02). Other factors such as age, relationship status, duration of epilepsy, the presence of depression or anxiety, cardiovascular risk factors, and opioid/stimulant use, did not predict sexual dysfunction. SIGNIFICANCE/CONCLUSIONS:Our study showed that sexual dysfunction is common in epilepsy patients but infrequently discussed by medical professionals. Two modifiable risk factors, being overweight or taking strong enzyme-inducing antiseizure medications, were independently associated with sexual dysfunction, suggesting interventions to potentially improve sexual health.
PMID: 33711710
ISSN: 1872-6844
CID: 4809692
Risk Factors for Intracerebral Hemorrhage in Patients With Atrial Fibrillation on Non-Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention
BACKGROUND AND PURPOSE/OBJECTIVE:-VASc and HAS-BLED scores in the same setting. METHODS:-VASc and HAS-BLED scores there are some risk factors in common, several multivariable logistic regression models were performed to identify independent prespecified predictors for ICH events. RESULTS:-VASc scores performed poorly in predicting ICH with areas under the curves of 0.496 (95% CI, 0.468-0.525) and 0.530 (95% CI, 0.500-0.560), respectively. CONCLUSIONS:-VASc scores.
PMID: 33657853
ISSN: 1524-4628
CID: 4801602
The association between systemic autoimmune disorders and epilepsy and its clinical implications
Systemic autoimmune disorders occur more frequently in patients with epilepsy than in the general population, suggesting shared disease mechanisms. The risk of epilepsy is elevated across the spectrum of systemic autoimmune disorders but is highest in systemic lupus erythematosus and type 1 diabetes mellitus. Vascular and metabolic factors are the most important mediators between systemic autoimmune disorders and epilepsy. Systemic immune dysfunction can also affect neuronal excitability, not only through innate immune activation and blood-brain barrier dysfunction in most epilepsies but also adaptive immunity in autoimmune encephalitis. The presence of systemic autoimmune disorders in subjects with acute seizures warrants evaluation for infectious, vascular, toxic and metabolic causes of acute symptomatic seizures, but clinical signs of autoimmune encephalitis should not be missed. Immunosuppressive medications may have antiseizure properties and trigger certain drug interactions with antiseizure treatments. A better understanding of mechanisms underlying the co-existence of epilepsy and systemic autoimmune disorders is needed to guide new antiseizure and anti-epileptogenic treatments. This review aims to summarize the epidemiological evidence for systemic autoimmune disorders as comorbidities of epilepsy, explore potential immune and non-immune mechanisms, and provide practical implications on diagnostic and therapeutic approach to epilepsy in those with comorbid systemic autoimmune disorders.
PMID: 33221878
ISSN: 1460-2156
CID: 4680102
Reply: Reference values for the Cerebellar Cognitive Affective Syndrome Scale: age and education matter [Comment]
PMID: 33313688
ISSN: 1460-2156
CID: 5454342
Building the Neurology Pipeline With Undergraduate Students in Research and Clinical Practice
There is currently a shortage of neurologists in the United States. Multiple efforts are underway to increase the strength of the neurology workforce. One potential approach is early exposure to neurology research and clinical care to pique interest and promote the specialty as a career choice. This study details the rewarding experience of working with undergraduate students, both in clinical research and clinical care. The logistics, benefits to students, and positive aspects for neurologists are outlined. Examples provided by undergraduate students who have participated in neurology research and clinical care are presented. The ultimate goals of this work are to encourage and inspire academic neurologists to involve undergraduate students in research and clinical care, to facilitate this process by outlining the steps needed to make this pairing successful, and to ultimately promote a pathway to build the neurology pipeline.
PMID: 33293387
ISSN: 1526-632x
CID: 4828582
Amyloid A amyloidosis secondary to immunoglobulin G4-related disease [Case Report]
PMID: 33040142
ISSN: 1462-0332
CID: 4930572
Editors' Note: Acute Hypokinetic-Rigid Syndrome After SARS-CoV-2 Infection [Comment]
PMID: 33649084
ISSN: 1526-632x
CID: 5092832
Practical Approach to the Tele-Neuro-Ophthalmology and Neuro-Otology Visits: Instructional Videos
ABSTRACT/UNASSIGNED:A collection of instructional videos that illustrate a step by step approach to tele-neuro-ophthalmology and neuro-otology visits. These videos provide instruction for patient preparation for their video visit, patient and provider interface with an electronic medical record associated video platform, digital applications to assist with vision testing, and practical advice for detailed remote neuro-ophthalmologic and neuro-otologic examinations.
PMID: 33587534
ISSN: 1536-5166
CID: 4786512
