NeurologyLive® Top Expert Interviews: June 2022

WATCH TIME: 6 minutes

Anxiety and Depression in Children and Adolescents With Migraine: Serena L. Orr, MD, MSc

“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.

REFERENCE
1. Orr SL, Fall K, Kuziek J, Mahnaz SR, Noel M, Ronksley PE. OR-19: Anxiety and Depressive Symptoms and Disorders in Children and Adolescents with Migraine: A Systematic Review and Meta-Analysis. Presented at: AHS Annual Scientific Meeting; June 9-11, 2022; Denver, CO. OR-19

WATCH TIME: 3 minutes

Highlights of the Advanced Therapeutics in Movement and Related Disorders Congress: Jean Hubble, MD

“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

Using Primseq to Simplify the Complexities of Rehabilitation Intervention Dosing: Heidi Schambra, MD

"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.

REFERENCES
1. Computer tool can track stroke rehabilitation to boost recovery. News release. NYU Langone Health. June 16, 2022. Accessed June 23, 2022. https://www.prnewswire.com/news-releases/computer-tool-can-track-stroke-rehabilitation-to-boost-recovery-301567501.html
2. Parnandi A, Kaku A, Venkatesan A, et al. PrimSeq: A deep learning-based pipeline to quantitate rehabilitation training. PLOS Digital Health. Published online June 16, 2022. doi:10.1371/journal.pdig.0000044

WATCH TIME: 8 minutes

Assessing Psychedelics for Therapeutic Potential in Cluster Headache: Bryan Roth, MD, PhD

“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 read more of Roth’s work on psychedelics, he and Tristan D. McClure-Begley, PhD, recently published on the topic in Nature Reviews: Drug Discovery, which you can read here: The promises and perils of psychedelic pharmacology for psychiatry.