Expert clinicians offer their insight on the sleep disorder landscape, the state of mental health in pediatric migraine, an inaugural movement disorders congress, a novel stroke rehabilitation tool, and psychedelics in cluster headache.
The NeurologyLive® team has been as busy as always bringing you the latest clinical news and research updates in neurology over the last month, including conducting several interviews with experts across a number of different and varying topics.
Among these included conversations on the impact of sodium oxybate formulations on the sleep disorder landscape with Richard Bogan, MD, FCCP, FAASM; the state of mental health among pediatric patients with migraine with Serena L. Orr, MD, MSc; the highlights of the inaugural Advanced Therapeutics in Movement and Related Disorders Congress with Jean Hubble, MD; the potential of a novel stroke rehabilitation tool with Heidi Schambra, MD; and the assessment of psychedelics in cluster headache with Byran Roth, MD, PhD.
Click through the slides to see and read more from each expert’s exclusive conversation with NeurologyLive® in June 2022.
WATCH TIME: 3 minutes
"I take to mind the fact that the FDA said this is a clinically superior drug. It’s a safer drug, it has lower sodium, and it’s still oxybate, the same moiety. Now, we’ve got clinical experience with the drug in terms of transitioning patients from Xyrem to Xywav, the lower sodium moiety. For most people, it’s gram-for-gram and fairly easy for patients to understand."
In July 2020, the FDA approved JZP-258 (Xywav; Jazz Pharmaceutical), an oral solution of calcium, magnesium, potassium, and sodium oxybates, for the treatment of cataplexy or excessive daytime sleepiness (EDS) in patients 7 years of age or older with narcolepsy. A little more than a year later, the FDA approved an expanded indication of the drug to include patients with idiopathic hypersomnia, becoming the first treatment approved for this indication.
Since its original approval, the therapeutic has been featured in numerous analyses further demonstrating its efficacy and safety in both populations, including some presented at this year’s 2022 SLEEP Annual Meeting, June 4-8, in Charlotte, North Carolina. Richard Bogan, MD, FCCP, FAASM, was the lead investigator for the phase 3 study that led to JZP-258’s approval in narcolepsy. He sat down with NeurologyLive® at the meeting to discuss the advantages of low-sodium oxybate, and the improved overall knowledge of the drug since it first hit the market.
WATCH TIME: 6 minutes
“What we found is that children and adolescents with migraine have a much higher burden of anxiety symptoms. When we looked at that at the meta-analysis level, the effect size was very large, and there was also a doubling of the odds of having an anxiety disorder in this population compared to healthy controls. [We saw] similar findings for depressive symptoms.”
Recently, a systematic review and meta-analyses were conducted that showed that children and adolescents with migraine were in fact at higher risk for anxiety and depressive symptoms—with moderate to large effect sizes—and, notably, had almost double the odds of having these disorders compared with those without migraine. The group screened 4277 studies, finding a large association between migraine and anxiety symptoms when assessing data from 16 of the studies and a moderate association between migraine and depressive symptoms when assessing data from 17 of the studies.
These data were presented at the 2022 American Headache Society (AHS) Annual Scientific Meeting, June 9-11, in Denver, Colorado, by Serena L. Orr, MD, MSc, pediatric neurologist, and headache specialist, University of Calgary. She explained to NeurologyLive® in a conversation at the meeting that these results open the door for additional work to be done to help address this challenge for patients.
WATCH TIME: 3 minutes
“Being in the room at this congress with APPs, fellows, and senior residents has just been so exciting. I’ve learned so much from them, as well, particularly the APPs because they see medicine and the care of these individuals in a much different way than I do, either in my role back as an academician or in industry.”
At the 2022 Advanced Therapeutics in Movement and Related Disorders (ATMRD) Congress in Washington, DC, June 17-19, hundreds of clinicians—physicians, advanced practice providers (APPs), residents, and the like—came together to learn and share updates on the latest therapeutic advances in care for patients with disorders such as Parkinson disease or essential tremor.
For Jean Hubble, MD, semiretired neurologist and consultant, PMD Alliance, this experience was particularly helpful. She highlighted the importance of having a variety of care team members involved, and the insight that can be gleaned from hearing about the management paradigm from the various perspectives and approaches these individuals take to these patients.
WATCH TIME: 3 minutes
"The typical major approaches have been time in therapy to measure dose or to measure intensity, which we know is not precise. The flip side of that is just sitting there and counting the repetitions, or using video analysis afterwards, but it’s just incredibly laborious and cost personnel time, personnel costs, and the feedback is slow."
The literature has shown inconsistent results as to personalizing rehabilitation methods for patients with neurological disorders, including those with stroke. One new method using a novel digital tool called Primseq, was shown to aid patients’ recovery from stroke by accurately tracking movement intensity during their rehabilitation therapy.1,2
In recently published data, the sensor-equipped computer program was effective in identifying and counting arm motions prescribed to patients as part of their stroke rehabilitation exercises. To learn more about how it may improve this aspect of care, NeurologyLive® sat down with lead investigator Heidi Schambra, MD. She discussed the current complexities of stroke rehabilitation dosing and the steps needed to improve personalized treatment regimens going forward.
WATCH TIME: 8 minutes
“One of the things that has intrigued me recently is whether the psychedelic experience is essential for the action of psychedelic drugs. There is currently a huge debate about this, about whether you could ‘microdose’ psychedelics and might that, ultimately, be as effective as taking a large dose at once; or, you could potentially create drugs that are not psychedelic that interact with the same serotonin receptors in the brain and outside the brain in such a way that they don’t create a psychedelic experience.”
At this year’s American Headache Society (AHS) Annual Scientific Meeting, June 9-11, in Denver, Colorado, the keynote address on the first day of the meeting covered the topic of the therapeutic potential of psychedelics in the treatment of headache disorders. Specifically, Bryan Roth, MD, PhD, covered their clinical history and the possibility of their use for the treatment of cluster headache.
Roth, the Michael Hooker Distinguished Professor and director of the NIMH psychoactive drug screening program at the University of North Carolina School of Medicine, sat down with NeurologyLive® while at the meeting to share his insight on the topic. He spoke about the possibility of psychedelic-type therapies to treat migraine and headache disorders—namely cluster headache, offering insight into data from a small trial in cluster headache.
To hear more insight from experts in the clinical care of patients and leading researchers in neurology, check out more of NeurologyLive®'s videos.