Expert clinicians offer their perspectives on the ongoing shortage of neurologists, stigmas associated with migraine, diets for those with epilepsy, mesenchymal stem cells in MS, and other topics.
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 a conversation about the ongoing shortage of neurologists and how clinicians can address it with Jennifer Majersik, MD, MS; the importance of educating youths with epilepsy on diets, especially in the transition stages of care with Robyn Blackford, RD, LDN; the array of issues patients with migraine face and why her personal experience may resonate with patients with Courtney White, MD; the use of MSC-NTF cells in progressive MS and the data backing this approach with Jeffrey Cohen, MD; and the use of telehealth and future research efforts for integrative medicine in MS, with Megan Weigel, DNP, APRN-C, APHN-C, MSCN.
Click through the slides to see and read more from each expert’s exclusive conversation with NeurologyLive® in October 2021.
WATCH TIME: 2 minutes
“The 10 neurologists who wrote this paper, all of us were [only] a little unaware of how bad the problem was, until we started digging into the data. And then, through this program we were in, we would meet every month, and we started sharing stories about what we were doing individually to help improve it. That’s when we became aware that there are the small steps that each of us can make.”
The ongoing shortage of neurologists in the US is an area of concern, especially due to the aging population and their increased risk of developing neurologic diseases and conditions. Jennifer Majersik, MD, MS, chief of the division of vascular neurology and professor of neurology at the University of Utah, discussed a recent report commissioned by the American Academy of Neurology, entitled “A Shortage of Neurologists – We Must Act Now,” which she authored alongside 9 colleagues.1
When asked by NeurologyLive about what current neurologists and specialists can do to address the shortage, Majersik suggested speaking to medical students about neurology, and “putting your best face forward” by expressing a love of the field. Piquing interest early on and highlighting how fulfilling a career in the neurosciences is may also be helpful, she said, particularly if invited to speak or present at a high school. Speaking to administrations within the health care field or academic institutions is another area of opportunity, whether that is to ensure that neurologists are receiving fair compensation or to fund educational opportunities for team members.
WATCH TIME: 2 minutes
"I’ve had patients that are 3 and 4 years old that understand their diet. It’s amazing that they do, but I think it’s all in the wording and how you give families the words to use to help their children understand."
One of the most important phases in a patient with epilepsy’s life is the transition of medical care, where they go from a pediatric specialist to an adult neurologist. Pediatric specialists often share a significant bond with these patients, acting as their primary care providers since birth or early in life. The transition phase is a time of education, where a patient can understand more about their seizures, medical history, seizure action plan, and insurance.
Another area of education is dieting. Dieting has been an approach to help reduce and control the frequency of seizures, usually in conjunction with seizure medications. The classic ketogenic diet—a specific high-fat, low-carbohydrate diet—is commonly used to control seizures, especially in those with refractory forms of epilepsy. Robyn Blackford, RD, LDN, registered dietitian, Ann & Robert H. Lurie Children’s Hospital of Chicago, has worked within the field for over 15 years helping patients with epilepsy craft and manage their diets.
WATCH TIME: 3 minutes
"With something [like migraine] that is such a silent disease, it can be helpful in creating that patient-provider connection. Again, you don’t need to have gone through this to be a good clinician—but, through these experiences, I know what it’s like when I have to order an MRI for a patient, for example.”
Advocacy organization Miles for Migraine hosted an event within the Philadelphia area that included 2-mile walk, 5-kilometer run, and post-event brunch, concluding with clinicians answering questions about relevant topics within the migraine space, including diagnosis, treatment options, and health disparities. Among them included Courtney White, MD, a headache specialist at Jefferson Headache Center who most recently graduated from its residency program in 2020.
White delivered a short, but powerful speech at the event, describing her own personal experience when she got her first migraine attack. She discussed the challenges she faced, along with the years of improperly being diagnosed. While she says her experience does not make her a better clinician, she does see why patients feel a sense of comfort knowing she’s been through similar challenges.
WATCH TIME: 3 minutes
"Progressive MS represents a major unmet need in the field. We think that the therapies that are going to be effective will probably have different actions than our currently available therapies. They will have neuroprotective activity or that they promote. Several aspects of mesenchymal stem cell function meet those needs."
At the 37th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), October 13-15, investigators presented key data from a phase 2 study that evaluated autologous mesenchymal stromal cells secreting neurotrophic factors (MSC-NTF) cells in patients with progressive multiple sclerosis (MS). These cells are induced to increase secretion of neuroprotective and immunomodulatory molecules and may address compartmentalized central nervous system inflammation. The trial featured 18 patients with progressive MS who had mean Expanded Disability Status Scale scores of 5.4.2
Lead author Jeffrey Cohen, MD, director, Mellen Center for MS Treatment and Research, Cleveland Clinic, and president, Americas Committee for Treatment and Research in Multiple Sclerosis, sat down with NeurologyLive to discuss the presentation. He provided context on the need for alternative therapies for patients with progressive MS, and why the mechanistic action of MSC-NTF cells pose as an intriguing option.
For more coverage of ECTRIMS 2021, click here.
WATCH TIME: 3 minutes
“I see huge benefits for integrative medicine and multiple sclerosis, particularly because the basic tenet of integrative medicine, by definition, is that healing is possible, even when a cure is not. We don't have a cure for multiple sclerosis yet, and when a patient asks us, ‘When is there going to be a cure?’—15 years ago, I was saying the same thing as I am now: ‘It's right around the corner.’ MS therapeutics is bursting at the seams with new therapies, which is amazing.”
The use of integrative medicine (IM) for patients with multiple sclerosis (MS) was recently explored by Megan Weigel, DNP, APRN-C, APHN-C, MSCN, and colleagues, following a 6-week virtual workshop, which participants joined virtually in light of the COVID-19 pandemic. Weigel, founder of First Coast Integrative Medicine in Jacksonville, presented findings at the 37th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), October 13-15, 2021.3
While the program, entitled “Inspire MS,” was initially developed to be held in-person, Weigel commented on the benefits that telemedicine afforded patients, who were able to join from locations across the country. Additionally, she noted that patients with MS often have to travel longer distances to obtain treatment, but with telehealth, accessibility is increased and programs such as Inspire MS become that much easier to replicate.
For more ECTRIMS coverage, click here.