Neurology Times Staff

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For 2021, the TS Alliance will host monthly educational webinars on a variety of TSC related topics of interest featuring known experts in the TSC community. These free 1-hour presentations include an open question-and-answer period. This series is composed of educational webinars focusing on four topic areas:

Life Stages of TSC (epilepsy, tumor growth, skin manifestations and education)

TSC-Associated Neuropsychiatric Disorders (TAND)

For more information and to register online, visit 

Articles

A look into the numerous education series upcoming in 2021 by the Tuberous Sclerosis Alliance

TS Alliance E-Webinar Series

Slideshows

What does compensation for neurologists look like these days? Would you choose neurology all over again?

Neurologist Compensation: Where Do You Stand?

The FDA has approved Emgality (galcanezumab-gnlm) injection (300 mg) for the treatment of episodic cluster headache in adults, announced the drug’s manufacturer, Eli Lilly and Company, in a 

“Emgality provides patients with the first FDA-approved drug that reduces the frequency of attacks of episodic cluster headache, an extremely painful and often debilitating condition,” said Eric Bastings, MD, Deputy Director of the Division of Neurology Products in the FDA’s Center for Drug Evaluation and Research, in a 

Emgality is the first calcitonin gene-related peptide antibody approved by the FDA for two distinct headache disorders. It was initially approved in 2018 for the preventive treatment of migraine in adults.

After patients receive training from a health care professional, they can administer Emgality at home through subcutaneous injections at the onset of a cluster headache period, and then monthly until the end of a cluster period. The drug is contraindicated in patients with serious hypersensitivity to galcanezumab-gnlm or to any of the excipients.

The effectiveness of Emgality for the treatment of episodic cluster headache was demonstrated in a clinical trial that compared the drug with placebo in 106 patients. The trial measured the average number of cluster headaches per week for 3 weeks and compared the average changes from baseline in the Emgality and placebo groups. During the 3-week period, patients taking Emgality experienced 8.7 fewer weekly cluster headache attacks than they did at baseline, versus 5.2 fewer attacks for patients receiving placebo (

FDA approves Emgality® (galcanezumab-gnlm) as the first and only medication for the treatment of episodic cluster headache that reduces the frequency of attacks

 [press release]. Indianapolis, IN: Eli Lilly and Company; June 4, 2019.

FDA approves first treatment for episodic cluster headache that reduces the frequency of attacks

 [press release]. Silver Spring, MD: US Food and Drug Administration; June 4, 2019.

Emgality (galcanezumab-gnlm) is the first FDA-approved drug that reduces the frequency of headache attacks.

FDA Gives Nod to New Treatment for Episodic Cluster Headache

Medical cannabis may provide relief of chronic pain, sleep disorders, neuropathy, and anxiety in older adults, according to the results of a 

American Academy of Neurology (AAN) Annual Meeting

Laszlo Mechtler, MD, and colleagues at the 

 conducted a retrospective chart review in patients aged 75 years and older who used cannabis from New York State’s Medical Marijuana Program.

The study included 204 patients (average age, 81 years). For an average of 4 months, the participants received medical cannabis as a liquid extract tincture or capsule or in an electronic vaporizer. The ratios of tetrahydrocannabinol (THC) to cannabidiol (CBD) in the cannabis varied.

Symptomatic benefit was reported by 69% of participants; the most common conditions that improved were chronic pain (49%), sleep problems (18%), neuropathy (15%), and anxiety (10%). Dosages of opioid pain medication were reduced in 32% of patients who received cannabis.

Initially, 34% of participants experienced adverse effects (AEs); after the dosages were adjusted, 13% reported AEs. Somnolence (13%), disequilibrium (7%), and gastrointestinal disturbance (7%) were the most common AEs associated with medical cannabis. Euphoria was reported by 3% of participants. Seven patients (3.4%) discontinued treatment because of AEs. Among those who had no AEs, a balanced THC to CBD tincture (1:1) was the most commonly used formulation.

“Our findings show that medical marijuana is well-tolerated in people age 75 and older and may improve symptoms like chronic pain and anxiety,” said Dr Mechtler in a press statement. “Future research should focus on symptoms like sleepiness and balance problems, as well as efficacy and optimal dosing.”

The study was supported by the Dent Family Foundation.

1. Bargnes V, Paul Hart P, Gupta S, Mechtler L. 

Safety and efficacy of medical cannabis in elderly patients: a retrospective review in a neurological outpatient setting

. Presented at: American Academy of Neurology (AAN) Annual Meeting; May 4-10, 2019; Philadelphia, PA.

Chronic pain, sleep disorders, neuropathy, and anxiety were the most common conditions that showed improvement in the study.

Medical Cannabis May Be Safe, Effective Option for Older Patients

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Do you want to make your voice heard? Then join the Neurology Times Advisory Board!

Opinionated Neurologists Wanted

If you were stranded on a desert island and could bring only one book or film with you, what would it be? 

s is compiling a list of noteworthy books or films that neurologists are reading (or watching) to share with their colleagues. If selected, your comments may be included in an end-of-year slideshow (sample 

The criteria may be a book or film of any genre or a must-read clinical text. It need not be new, but perhaps it helped you think about things in a different way! Please send us the title of the book, its author, and a short blurb-about 40 to 50 words-with a brief bio. We’d love to hear from you! Email Digital Managing Editor of 

If you could bring only one book or film with you to a desert island, what would it be?

Reading While Stranded

Dr Pratico is Professor of Pharmacology, Immunology and Microbiology, Center for Translational Medicine, Temple University, Philadelphia, PA.

Nutrition and lifestyle are increasingly being explored to prevent and combat 

. Dr. Domenico Pratico and colleagues have published a new study exploring the link between extra virgin olive oil (EVOO) and Alzheimer disease that indicates it might be protective against the disease. 

 invited Dr. Pratico to share highlights from the study and implications for prevention and clinical practice.

: Your study explored the effects of extra virgin olive oil on an Alzheimer disease-like phenotype in a mouse model. Can you briefly describe the study?

 We divided the triple transgenic mice aged 6 months (equivalent of 40-45 years for humans) into 2 groups: one was given a regular diet and the other the same regular diet that also contained EVOO for 6 months (which made their age equivalent of 60-65 years for humans). There was no difference between the groups in terms of the amount of food they ate and their body weight by the end of the study.

After 6 months, the animals were tested for memory and learning ability in 3 different tests: y-maze, fear conditioning, and Morris water maze. Next, they were euthanized, their brains isolated to study the nerve cells, the nerve connections called “synapses,” the amyloid plaques, and the tau fibrillary tangles (all of these are parameters used for measuring Alzheimer pathology in mice as well as in humans).

: Among your findings was a dramatic increase in nerve cell autophagy activation as well as reduced levels of amyloid plaques and phosphorylated tau. What are the implications of these results?

: Autophagy is a mechanism by which the nerve cells protect themselves from the presence and possible accumulation of toxic proteins and unwanted material (ie, cell garbage). Autophagy actually works like the garbage disposal in a sink. In Alzheimer disease, it is known that the activity and function of this system are reduced; as a result, the nerve cells in the patient’s brain have a progressive accumulation of amyloid proteins and tau tangles.

The group of animals receiving EVOO had a significant increase in the 

, which explains the reduced amount of amyloid plaques and tau phosphorylated/tangles. The results are remarkable because for the first time we discovered that a natural product-EVOO-is able to do something that in the past only chemicals (some of which are very toxic) could do: activate autophagy.

Another remarkable result was the protective effect that the EVOO had on the synapse. Animals on the regular diet had a significant reduction in the synapse integrity/number, while animals receiving the EVOO had their synapse intact. In other words, the EVOO kept these connections healthy and functional so that learning and memory were well preserved.

: Why do you suppose EVOO has this effect? What are the potential mechanisms of action?

: Previous work has shown that EVOO can act as an antioxidant by blocking free radicals. Our study unveiled a new and important facet of EVOO-as an activator of autophagy. This new action can now better explain the benefits of EVOO that we are familiar with in population studies for dementia and Alzheimer disease in Mediterranean countries.

: Should clinicians recommend EVOO in patients as part of a prevention/treatment regimen?

: The clinical implication is that a daily intake of 2 tablespoons of EVOO could and probably should be recommended to patients as part of a prevention regimen. This intake should be seen as is a lifestyle change; it should be implemented for a long period of time (chronic use). Patients should be informed that EVOO could be used as source of fat intake instead of other fats such as butter (ie, dietary lifestyle change).

: Do you have follow-up research planned? If so, can you share what you’d like to further explore?

: Our study is focused on prevention; we started the treatment with EVOO in our animals when they were young/adult (6 months). Next, we want to test whether daily intake of EVOO has the same beneficial effects when it is started at a later (ie, 12months) after the disease is well established. This new study will more closely mimic the clinical scenario in which the typical Alzheimer patient presents, ie, after the disease has already started.

: If your patient manifests signs that are compatible with Alzheimer or is at risk for developing the disease, it would be appropriate to recommend the daily use of EVOO as part of a regular diet. After all, EVOO has been used for more than 2000 years so that EVOO, and its benefits are well established. In fact, it probably is a good idea to recommend its use to anybody, at risk for dementia or not.

Extra-virgin olive oil ameliorates cognition and neuropathology of the 3xTg mice: role of autophagy

If your patient manifests signs that are compatible with Alzheimer disease, should you recommend olive oil as part of a prevention and treatment regimen? This and other questions answered by Domenico Pratico, MD.

Can Extra Virgin Olive Oil Protect Against Alzheimer Disease?

 specializes in comparative analytics of structured healthcare data for medical providers, offering reimbursement and business intelligence solutions.

This month, RemitDATA's vice president of product management Aaron Hood, provides commentary for the data, with a specific focus on neurology, including recommendations to help your practice avoid future denials.

This infographic spotlights the most common unexpected claim denials in medicine nationwide, with a special focus on neurology.