Expert clinicians offer their perspectives on the ongoing shortage of neurologists, transgender and gender-diverse individuals with migraine, artificial intelligence and neuroimaging, Student Sleep Health Week 2021, and the importance of rehabilitation therapy in multiple sclerosis.
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 an exploration of the ongoing shortage of neurologists and its effect on care, research into the transgender and gender-diverse with migraine, the future of artificial intelligence and neuroimaging, takeaways from Student Sleep Health Week 2021, and the importance of rehabilitation therapy in multiple sclerosis care, among several other topics.
Click through the slides to see and read more from each expert’s exclusive conversation with NeurologyLive in September 2021.
WATCH TIME: 2 minutes
“Transgender individuals want to know more about the effects of gender-affirming hormone therapy—which is relatively new, especially in the US—on their own health, so putting some more study into this understudied population is important. I think it's important to understand that transgender individuals have been stigmatized, and so even their clinical interaction with the medical profession has been somewhat limited by that, it's been disincentivized.”
As a historically stigmatized and underserved population, transgender and gender-diverse patients with headache have not had access to data pertaining to their health, particularly with the effects of gender-affirming hormone therapy (GAHT). Jennifer Hranilovich, MD, assistant professor, pediatrics and neurology, Headache Program, University of Colorado School of Medicine/Children's Hospital Colorado, spoke with NeurologyLive on the importance of research for gender minorities, and the next steps for those in the headache and migraine space.
Hranilovich provided additional comment on the general importance of research, in that studying the effect of GAHT on headache can also inform studies about the effect of hormones in all patients’ brains. Recent steps have been taken she said, including the establishment of the Sexual & Gender Minority Research Office by the National Institutes of Health in 2015.
WATCH TIME: 3 minutes
"The next frontier is to be able to leverage these giant databases we have. Now that we have tools to work on quality clinical scans, we essentially have unlocked these databases for mining these metrics."
The Buffalo Neuroimaging Analysis Center (BNAC) has been at the forefront at developing new precision neuroimaging techniques and reevaluating the standard methods that have been in place for decades. There are several ongoing projects at the center, with therapeutic areas that include, but are not limited to, demyelinating diseases, neuromuscular diseases, and neurodegenative diseases. One notable study, CASA-MS, will compare advanced-stage patients with multiple sclerosis (MS) to age-, sex-, and disease-duration-matched patients with MS, in hopes to establish a comprehensive framework within which to study the unique needs of those severely impacted by MS.
Michael Dwyer, PhD, director of IT and Neuroinformatics Development, BNAC, specializes in quantitative neuroimaging analysis methods, as well as the use of artificial intelligence (AI). His highlights include the development and validation of a method for detecting and quantifying demyelination and remyelination in vivo, the development of a method dramatically improving the precision of conventional tissue-specific atrophy measurement in clinical routine, and the investigation of the MRI “connectome” on cognition in patients with MS.
WATCH TIME: 2 minutes
“What we've noticed as we ask parents and children about their reasonings for not going to sleep at night is [that it is affected by] things like homework, early school start times, other activities, and other fun activities that we definitely want our children to experience. We want to make sure that the parents, students, and neurologists know that sleep is an important priority, just like nutrition and exercise.”
The second annual Student Sleep Health Week, held September 12-18, 2021, coincides with the start of the school year, serving as a reminder about the need to prioritize sleep health in children and teenagers. In light of the COVID-19 pandemic, students, school officials, and parents are all facing an adjustment period outside of the ‘normal’ transition from summer vacation, as they move from virtual learning back to more in-person settings.
Raman Malhotra, MD, associate professor of neurology, Washington University in St. Louis, and president, American Academy of Medicine (AASM), which organized the event, sat down with NeurologyLive to highlight the key takeaways from this year’s event. According to Malhotra, middle and high school students may look like adults, but they still require more sleep than their adult counterparts, with the AASM recommending 8 to 10 hours.1
WATCH TIME: 3 minutes
"The research needs to focus on a number of different things, including whether or not we are inviting people to the research in the same way. Lots of studies have shown that White people come to the research because they’re recruited through the clinic while non-White people get recruited because we’re supposed to recruit non-White people. It’s a very different way to sample people in terms of their concerns and risks."
Although it has been previously documented that the frequency of Alzheimer disease (AD) dementia is higher in women, sex differences in the incidence of AD dementia are less than clear. To better understand the effects of gender and sex in AD, the National Institutes of Health (NIH) awarded a 4-year, $1.8-million grant to Jessica Caldwell, PhD, director, Women’s Alzheimer’s Movement Prevention Center, Cleveland Clinic. The grant marked the 1-year anniversary of the center’s opening, which was the first prevention center designed specifically for women.
Caldwell will use the grant to study how gender-linked stress exposure and estrogen may interact to impact memory, inflammation in the body, and brain activation and connectivity in women at risk for AD. She hopes that the findings will help to inform development of interventions targeting stress and inflammation to reduce AD risk.
WATCH TIME: 3 minutes
“It’s almost as if the more we looked, the more we saw that the AAN could do, but we also think that this is an effort that individual neurologists should play a role in, even outside of those organizational efforts, because some boots on the ground are really necessary.”
The shortage of neurologists is an ongoing issue, recently addressed in a report from the American Academy of Neurology (AAN) 2019 Transforming Leaders Program. Entitled “A Shortage of Neurologists – We Must Act Now,” the paper was authored by 10 experts led by Jennifer Majersik, MD, MS, chief, division of vascular neurology and professor of neurology, the University of Utah.
Majersik spoke with NeurologyLive on the shortage and the resultant report, commenting on the AAN’s role in increasing awareness, as the main professional organization in the United States for neurologists. Advocacy efforts are primarily conducted through BrainPAC, AAN’s federal political action committee, located in Washington, DC, but additional advocacy arms also assisting in efforts to address salary discrepancies and increase telemedicine within the field, Majersik said.
WATCH TIME: 4 minutes
“Unfortunately, if patients get a referral for therapy and they’re not directed to specialized care, they might just say, ‘Oh, the corner therapist is more convenient to me.’ And maybe they’re getting good care there, but maybe it’s an ortho-based philosophy of care, which is not the most effective or efficient or the standard of practice for MS care.”
For patients with multiple sclerosis (MS), like many neurologic and neurodegenerative diseases, the need for physical therapy and rehabilitative medicine as a part of the care paradigm is imperative to ensure good outcomes. Although many patients seek care at larger institutions with multidisciplinary care teams, there remains a gap in access to good rehabilitative professionals for a number of the 2 million individuals in the US with MS.
Patricia Bobryk, MHS, PT, MSCS, ATP, explained to NeurologyLive that the reasons for this stem from a number of places, including the supply-and-demand issue related to the number of available physical therapists with specialized training. Patients with MS often require a specific approach that not all rehabilitative professionals can provide without proper education. This can lead to individuals utilizing benefits to see providers who may not be able to offer them the precise type of care they require.
WATCH TIME: 3 minutes
“The good news for MS patients is that for the most part, they don't appear to be more susceptible to getting COVID, or having more severe infections if they do get COVID…But we don't really have a lot of experience with the breakthrough cases, so I'm sort of waiting with bated breath to find out if my patients who have been vaccinated, but who didn't have a good response to the first vaccine, are going to show signs that they're more susceptible to breakthrough infections.”
A phase 2 clinical trial has been initiated by the National Institutes of Health (NIH) to evaluate antibody response to a COVID-19 booster vaccine in immunocompromised patients who have not had a response to the original vaccine dosing regimen.2 Joshua Katz, MD, codirector, Elliot Lewis Center for Multiple Sclerosis Care, assistant professor, neurology, Tufts University School of Medicine, and chairman, Clinical Advisory Committee, New England Chapter, National MS Society, while not associated with the trial itself, offered commentary on what he hopes to learn from the trial as well as the importance of an effective booster for patients with multiple sclerosis (MS).
The desired outcome from the trial is twofold in that experts hope to reduce infectivity and provide better levels of protection, as breakthrough cases and the Delta variant of COVID-19 continue to raise questions and concerns. The trial is sponsored and funded by a subsect of NIH, the National Institute of Allergy and Infectious Disease, and will evaluate patients with MS, pemphigus, rheumatoid arthritis, systemic lupus erythematosus, or systemic sclerosis. Katz addressed the patient population with MS specifically, noting that data does not show an increased risk of infection or more intense illness, despite a lack of understanding as to susceptibility to breakthrough infections.
To hear more insight from experts in the clinical care of patients and leading researchers in neurology, check out more of NeurologyLive's videos.