Publications by authors named "Matthew Robbins"

153 Publications

The development of a diversity, equity, and inclusion committee in a neurology department and residency program.

J Neurol Sci 2021 Jul 8;428:117572. Epub 2021 Jul 8.

Department of Neurology, Weill Cornell Medicine, New York, NY, USA. Electronic address:

Background: Diversity, Equity, and Inclusion (DEI) initiatives have been described in different academic and graduate medical education settings, but not specifically in neurology.

Objective: To describe the development of a DEI committee within a neurology department and training program.

Methods: The need to prioritize DEI as a critical focus within our neurology department led to the appointment of an initial task force who identified strategic priorities and stakeholders to establish a committee. DEI committee members included faculty, trainees, and staff, and this phase of the initiative took place from May 2019 through January 2021.

Results: The DEI committee was established and has met monthly for over one year. Initial meetings formulated goals of the initiative. Specific objectives were developed in the domains of recruitment, education, engagement, training, conflict resolution, and recognition. Early outcomes included augmented resident recruitment efforts of UiM students, curriculum changes including frequent representation of DEI topics in Grand Rounds, and measures to reduce unconscious bias.

Conclusions: The creation of a DEI Committee within a specialty department such as neurology is feasible and can result in immediate and long-term actions related to recruitment and education in particular. Our blueprint that heavily involves graduate medical education stakeholders may be generalizable to other specialty departments in academic medicine.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jns.2021.117572DOI Listing
July 2021

The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice.

Headache 2021 Jun 23. Epub 2021 Jun 23.

American Headache Society, Mt Royal, NJ, USA.

Objective: To incorporate recent research findings, expert consensus, and patient perspectives into updated guidance on the use of new acute and preventive treatments for migraine in adults.

Background: The American Headache Society previously published a Consensus Statement on the use of newly introduced treatments for adults with migraine. This update, which is based on the expanded evidence base and emerging expert consensus concerning postapproval usage, provides practical recommendations in the absence of a formal guideline.

Methods: This update involved four steps: (1) review of data about the efficacy, safety, and clinical use of migraine treatments introduced since the previous Statement was published; (2) incorporation of these data into a proposed update; (3) review and commentary by the Board of Directors of the American Headache Society and patients and advocates associated with the American Migraine Foundation; (4) consideration of these collective insights and integration into an updated Consensus Statement.

Results: Since the last Consensus Statement, no evidence has emerged to alter the established principles of either acute or preventive treatment. Newly introduced acute treatments include two small-molecule calcitonin gene-related peptide (CGRP) receptor antagonists (ubrogepant, rimegepant); a serotonin (5-HT ) agonist (lasmiditan); a nonsteroidal anti-inflammatory drug (celecoxib oral solution); and a neuromodulatory device (remote electrical neuromodulation). New preventive treatments include an intravenous anti-CGRP ligand monoclonal antibody (eptinezumab). Several modalities, including neuromodulation (electrical trigeminal nerve stimulation, noninvasive vagus nerve stimulation, single-pulse transcranial magnetic stimulation) and biobehavioral therapy (cognitive behavioral therapy, biofeedback, relaxation therapies, mindfulness-based therapies, acceptance and commitment therapy) may be appropriate for either acute and/or preventive treatment; a neuromodulation device may be appropriate for acute migraine treatment only (remote electrical neuromodulation).

Conclusions: The integration of new treatments into clinical practice should be informed by the potential for benefit relative to established therapies, as well as by the characteristics and preferences of individual patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/head.14153DOI Listing
June 2021

Buprenorphine use and disparities in access among emergency department patients with opioid use disorder: A cross-sectional study.

J Subst Abuse Treat 2021 Apr 20;130:108405. Epub 2021 Apr 20.

Cooper Medical School of Rowan University, 401 Broadway, Camden, NJ 08103, United States of America; Cooper University Hospital, Department of Emergency Medicine, Keleman 152, 1 Cooper Plaza, Camden, NJ 08103, United States of America. Electronic address:

Background: Buprenorphine, a partial mu-opioid agonist and kappa-opioid antagonist, is an approved treatment for opioid use disorder (OUD). Studies demonstrate that buprenorphine decreases cravings for other opioids, effectively ameliorates withdrawal symptoms, and decreases opioid overdose and mortality. However, buprenorphine remains under-utilized. Despite its low potential for misuse, research has reported wide use of non-prescribed buprenorphine, seemingly for its effectiveness in treating withdrawal and helping to maintain sobriety. We designed our study to describe patient experiences with both prescribed and non-prescribed buprenorphine usage and to identify potential disparities in buprenorphine access within a high-risk population of patients with OUD.

Methods: This was a cross-sectional study conducted in the emergency department (ED) of a large inner-city university hospital from January 15, 2015, through April 30, 2018. Patients were eligible to participate in the study if they presented with opioid intoxication or after an opioid overdose and were 18 years of age or older. Research assistants administered surveys after the ED team deemed an eligible patient to be clinically sober.

Results: The study enrolled 423 patients. Most patients in this study were white (59.8%) and male (77.5%), with a mean age of 37.5 years. A majority of patients (58.4%) had Medicaid insurance. Of those, 15.8% had previously been on medication for opioid use disorder (MOUD) with methadone, and 16.3% received outpatient buprenorphine. Most (72.8%, 95% CI 68.6-77.0%) respondents reported having used buprenorphine at one point. Of the participants reporting prior buprenorphine use, 15.5% had either traded, shared, or sold their buprenorphine in the past. Patients who obtained non-prescribed buprenorphine generally purchased it from a dealer, took only 8 mg at a time, and paid $10 per dose. Of those patients with a history of using buprenorphine, only 3.2% reported taking buprenorphine for euphoric effects, though 45.5% of participants declined to provide a specific reason for using the drug. Patients younger than 40 were more likely than those older than 40 to have taken buprenorphine in the past (81% vs 60%, p < 0.001). Further, white patients were more likely than nonwhite patients to have both used (42% vs 31%) and been prescribed buprenorphine (46% vs 25%, p < 0.001).

Discussion: Familiarity with buprenorphine is high among patients with OUD, and our data show that there is a strong demand among these patients for access to legal buprenorphine-based treatment programs. However, a variety of issues hamper access to this medication. Most patients in our study reported having been to an in-patient detox or rehabilitation program, yet only 16% of patients participated in a buprenorphine-based program. Furthermore, less than half of patients surveyed (37%) received a prescription for buprenorphine, and few participants reported taking buprenorphine for euphoric effects. Our findings suggest that a major barrier exists in legally obtaining buprenorphine for treatment of OUD, and that there appear to be racial and other disparities in buprenorphine prescribing, further limiting access to patients. Buprenorphine access needs to be expanded to satisfy the unmet need for appropriate treatment of those struggling with OUD, with particular attention to older and nonwhite patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jsat.2021.108405DOI Listing
April 2021

Clinic-based Procedures for Headache.

Continuum (Minneap Minn) 2021 06;27(3):732-745

Purpose Of Review: Headache disorders are common and disabling, and many therapies that are effective and safe are procedural.

Recent Findings: After pivotal clinical trials, onabotulinumtoxinA has become an established preventive therapy for chronic migraine; it is better tolerated than many other treatments and may be useful for other headache disorders. Peripheral nerve blocks, especially greater occipital nerve blocks, have amassed evidence from randomized trials in the acute and short-term preventive treatment of migraine and cluster headache. Trigger point injections and sphenopalatine ganglion blocks have recent trials suggesting efficacy and safety in properly selected patients. Medical education initiatives are needed to train neurologists in these procedures to help manage the large population of patients with headache disorders who need them.

Summary: Evidence exists for the efficacy and safety of procedural therapies to be incorporated into neurology practice for the management of patients with migraine, cluster headache, and other headache disorders.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1212/CON.0000000000000959DOI Listing
June 2021

Diagnosis and Management of Headache: A Review.

JAMA 2021 May;325(18):1874-1885

Department of Neurology, Weill Cornell Medical College, New York, New York.

Importance: Approximately 90% of people in the US experience headache during their lifetime. Migraine is the second leading cause of years lived with disability worldwide.

Observations: Primary headache disorders are defined as headaches that are unrelated to an underlying medical condition and are categorized into 4 groups: migraine, tension-type headache, trigeminal autonomic cephalalgias, and other primary headache disorders. Studies evaluating prevalence in more than 100 000 people reported that tension-type headache affected 38% of the population, while migraine affected 12% and was the most disabling. Secondary headache disorders are defined as headaches due to an underlying medical condition and are classified according to whether they are due to vascular, neoplastic, infectious, or intracranial pressure/volume causes. Patients presenting with headache should be evaluated to determine whether their headache is most likely a primary or a secondary headache disorder. They should be evaluated for symptoms or signs that suggest an urgent medical problem such as an abrupt onset, neurologic signs, age 50 years and older, presence of cancer or immunosuppression, and provocation by physical activities or postural changes. Acute migraine treatment includes acetaminophen, nonsteroidal anti-inflammatory drugs, and combination products that include caffeine. Patients not responsive to these treatments may require migraine-specific treatments including triptans (5-HT1B/D agonists), which eliminate pain in 20% to 30% of patients by 2 hours, but are accompanied by adverse effects such as transient flushing, tightness, or tingling in the upper body in 25% of patients. Patients with or at high risk for cardiovascular disease should avoid triptans because of vasoconstrictive properties. Acute treatments with gepants, antagonists to receptors for the inflammatory neuropeptide calcitonin gene-related peptide, such as rimegepant or ubrogepant, can eliminate headache symptoms for 2 hours in 20% of patients but have adverse effects of nausea and dry mouth in 1% to 4% of patients. A 5-HT1F agonist, lasmiditan, is also available for acute migraine treatment and appears safe in patients with cardiovascular risk factors. Preventive treatments include antihypertensives, antiepileptics, antidepressants, calcitonin gene-related peptide monoclonal antibodies, and onabotulinumtoxinA, which reduce migraine by 1 to 3 days per month relative to placebo.

Conclusions And Relevance: Headache disorders affect approximately 90% of people during their lifetime. Among primary headache disorders, migraine is most debilitating and can be treated acutely with analgesics, nonsteroidal anti-inflammatory drugs, triptans, gepants, and lasmiditan.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jama.2021.1640DOI Listing
May 2021

Are Two Head(ache)s Better Than One: Consequences of Diagnosing Migraine and Occipital Neuralgia.

Neurol Clin Pract 2021 Feb;11(1):1-2

Department of Neurology (HBS), University of Rochester Medical Center, NY; and Department of Neurology (MSR), Weill Cornell Medical College, New York, NY.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1212/CPJ.0000000000000801DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8101313PMC
February 2021

Bruxism in Acute Neurologic Illness.

Curr Pain Headache Rep 2021 Apr 10;25(6):41. Epub 2021 Apr 10.

Division of Neurocritical Care, Weill Cornell Medicine, New York Presbyterian, 525 East 68th St, RM F610, New York, NY, 10065, USA.

Purpose Of Review: While traditionally encountered in ambulatory settings, bruxism occurs in patients with a variety of acute neurologic illnesses including encephalitis, intracerebral hemorrhage, traumatic brain injury, hypoxic-ischemic encephalopathy, and acute ischemic stroke. Untreated bruxism in acute neurologic illness can lead to tooth loss, difficulty in mouth care resulting in recurrent aspiration pneumonia, endotracheal tube dislodgement, and even tongue laceration or amputation. Inpatient clinicians should be aware of the etiologies and management strategies for bruxism secondary to acute neurologic illness.

Recent Findings: Management strategies for bruxism are varied and include pharmacologic and non-pharmacologic therapies in addition to onabotulinumtoxinA (BoNT-A). Bruxism impacts patients with a variety of acute neurologic illnesses, and emerging evidence suggests successful and safe treatment strategies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11916-021-00953-4DOI Listing
April 2021

Neurological Causes of Chest Pain.

Curr Pain Headache Rep 2021 Mar 24;25(5):32. Epub 2021 Mar 24.

Department of Neurology, Weill Cornell Medicine, 520 East 70th Street, Starr Pavilion 607, New York, NY, 10021, USA.

Purpose Of Review: Chest pain is a very common presenting complaint among patients in the hospital, a large proportion of whom have non-cardiac chest pain (NCCP). Neurological causes of NCCP have not been previously reviewed although several causes have been identified.

Recent Findings: Chest pain has been reported as a symptom of multiple neurological conditions such as migraine, epilepsy, and multiple sclerosis, with varying clinical presentations. The affected patients are often not formally diagnosed for long periods of time due to difficulties in recognizing the symptoms as part of neurological disease processes. This paper will briefly summarize well-known etiologies of chest pain and, then, review neurological causes of NCCP, providing an overview of current literature and possible pathophysiologic mechanisms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11916-021-00944-5DOI Listing
March 2021

Posterior Reversible Encephalopathy Syndrome.

Curr Pain Headache Rep 2021 Feb 25;25(3):19. Epub 2021 Feb 25.

Department of Neurology, New York-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA.

Purpose Of Review: This review provides an updated discussion on the clinical presentation, diagnosis and radiographic features, mechanisms, associations and epidemiology, treatment, and prognosis of posterior reversible encephalopathy syndrome (PRES). Headache is common in PRES, though headache associated with PRES was not identified as a separate entity in the 2018 International Classification of Headache Disorders. Here, we review the relevant literature and suggest criteria for consideration of its inclusion.

Recent Findings: COVID-19 has been identified as a potential risk factor for PRES, with a prevalence of 1-4% in patients with SARS-CoV-2 infection undergoing neuroimaging, thus making a discussion of its identification and treatment particularly timely given the ongoing global pandemic at the time of this writing. PRES is a neuro-clinical syndrome with specific imaging findings. The clinical manifestations of PRES include headache, seizures, encephalopathy, visual disturbances, and focal neurologic deficits. Associations with PRES include renal failure, preeclampsia and eclampsia, autoimmune conditions, and immunosuppression. PRES is theorized to be a syndrome of disordered autoregulation and endothelial dysfunction resulting in preferential hyperperfusion of the posterior circulation. Treatment typically focuses on treating the underlying cause and removal of the offending agents.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11916-020-00932-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7905767PMC
February 2021

The status of neurology fellowships in the United States: clinical needs, educational barriers, and future outlooks.

BMC Med Educ 2021 Feb 17;21(1):108. Epub 2021 Feb 17.

A.B. Baker Section on Neurological Education, American Academy of Neurology, Minneapolis, USA.

The need for subspecialty-trained neurologists is growing in parallel with increasing disease burden. However, despite the immense burden of neurological diseases, like headache and neurodegenerative disorders, recruitment into these subspecialties remains insufficient in the United States. In this manuscript, a group of educators from the American Academy of Neurology's A.B. Baker Section on Neurological Education sought to review and discuss the current landscape of neurology fellowships in the United States, the factors driving fellowship recruitment and the educational barriers. Moreover, suggestions to potentially improve recruitment for under-selected fellowships, which can contribute towards an alignment between neurological education and neurological needs, and future educational scenarios are discussed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12909-021-02536-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7891131PMC
February 2021

Virtual Issue: COVID-19 and headache.

Headache 2021 03 16;61(3):412-413. Epub 2021 Feb 16.

Department of Neurology, Weill Cornell Medicine, New York Presbyterian, New York, NY, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/head.14085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8013424PMC
March 2021

Sphenopalatine ganglion block in primary headaches: An American Headache Society member survey.

Neurol Clin Pract 2020 Dec;10(6):503-509

Department of Neurology (JGB), Allegheny Health Network, Pittsburgh, PA; Department of Neurology (MSR), Weill Cornell Medical College, Bronx, New York; Department of Neurology (CER), Mayo Clinic, Rochester, MN; Medstar Health Research Institute (MM), Georgetown University Washington DC; Dent Neurologic Institute (NPS), Amherst, NY; Department of Neurology (RBHS), Mayo Clinic, Phoenix, AZ; and Medstar Health Research Institute (JA), Georgetown University Washington, DC.

Background: The sphenopalatine ganglion (SPG), in the pterygopalatine fossa, is a known current and historical target for therapeutic intervention in headache disorders because of its role in cranial autonomics and vasodilation. There remains an overall lack of well-established SPG treatment protocols, particularly with the advent of newer commercial devices.

Methods: A 22 multiple-choice question survey was created to evaluate clinical practice patterns with SPG block and sent to members of the American Headache Society (AHS). Questions focused on determining indications, preferred applicators, medications applied, perceived efficacy, tolerability, and reimbursement.

Results: One hundred seventy-two of 1,346 (12.8%) AHS members participated. Ninety-three respondents (56.3%) had performed SPG blocks on 50 or fewer patients. The SphenoCath (42.4%) and the Tx360 (41.8%) were the most common methods of application. Ease of use was the top reason for provider preference in applicator type. SPG blocks were mostly used as an as-needed one-time procedure. When a scheduled protocol was used, twice weekly for 6 weeks was most common. Chronic migraine was the most commonly treated headache disorder and rated the most likely to respond to SPG block. Experienced clinicians found SPG more helpful as a stand-alone treatment and tended to report that acute relief was not predictive of enduring response.

Conclusions: The variety of responses strongly suggests that clinicians would benefit from formalized protocols for SPG blocks. More experienced clinicians may have developed individualized protocols that they feel are more effective. The lack of evidence-based protocols contribute to clinicians not performing SPG blocks more frequently.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1212/CPJ.0000000000000773DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7837428PMC
December 2020

CSF-Venous Fistula.

Curr Pain Headache Rep 2021 Jan 21;25(1). Epub 2021 Jan 21.

Department of Radiology, Weill Cornell Medicine, New York, NY, 10065, USA.

Purpose Of Review: To provide an update on recent developments in the understanding, diagnosis, and treatment of CSF-venous fistula (CVF).

Recent Finding: CVF is a recently recognized cause of spontaneous intracranial hypotension (SIH), an important secondary headache, in which an aberrant connection is formed between the spinal subarachnoid space and an adjacent spinal epidural vein permitting unregulated loss of CSF into the circulatory system. CVFs often occur without a concurrent epidural fluid collection; therefore, CVF should be considered as a potential etiology for patients with SIH symptomatology but without an identifiable CSF leak. Imaging plays a critical role in the detection and localization of CVFs, with a number of imaging techniques and provocative maneuvers described in the literature to facilitate their localization for targeted and definitive treatment. Increasing awareness and improving the localization of CVFs can allow for improved outcomes in the SIH patient population. Future prospective studies are needed to determine the diagnostic performance of currently available imaging techniques as well as their ability to inform workup and guide treatment decisions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11916-020-00921-4DOI Listing
January 2021

Migraine Treatment in Pregnancy: An American Headache Society Survey.

Headache 2020 11 29;60(10):2594-2596. Epub 2020 Sep 29.

Department of Neurology, Weill Cornell, New York, NY, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/head.13974DOI Listing
November 2020

A Randomized, Double-Dummy, Emergency Department-Based Study of Greater Occipital Nerve Block With Bupivacaine vs Intravenous Metoclopramide for Treatment of Migraine.

Headache 2020 Nov 27;60(10):2380-2388. Epub 2020 Sep 27.

Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore, Bronx, NY, USA.

Background: Greater occipital nerve blocks (GONB) are used increasingly to treat acute migraine.

Objective: We conducted a randomized controlled trial to determine whether GONB was as effective as intravenous metoclopramide for migraine.

Methods: This was a double-dummy, double-blind, parallel-arm, non-inferiority study conducted in 2 emergency departments (EDs). Patients with migraine of moderate or severe intensity were randomized to receive bilateral GONB with each side administered 3 mL of bupivacaine 0.5% or metoclopramide 10 mg IV, the putative standard of care. The primary outcome was improvement in pain on a 0-10 scale between time 0 and 1 hour later. To reject the null hypothesis that metoclopramide would be more efficacious in relieving pain, we required that the lower limit of the 95% CI for the difference in pain improvement between those randomized to GONB vs those randomized to metoclopramide be >-1.3, a validated minimum clinically important difference. Secondary outcomes included sustained headache relief, defined as achieving and maintaining for 48 hours a headache level of mild or none without the use of additional analgesic medication, and the use of rescue medication in the ED.

Results: Over a 2.5-year study period, 1358 patients were screened for participation and 99 were randomized, 51 to GONB and 48 to metoclopramide. All of these patients were included in the primary analysis. Patients who received the GONB reported mean improvement of 5.0 (95% CI: 4.1, 5.8) while those who received metoclopramide reported a larger mean improvement of 6.1 (95% CI: 5.2, 6.9). The 95% CI for the between group difference of -1.1 was -2.3, 0.1. Sustained headache relief was reported by 11/51 (22%) GONB and 18/47 (38%) metoclopramide patients (95% CI for rounded difference of 17%: -1, 35%). Of the 51 GONB patients, 17 (33%) required rescue medication in the ED vs 8/48 (17%) metoclopramide patients (95% CI for rounded difference of 17%: 0, 33%). An adverse event was reported by 16/51 (31%) GONB patients and 18/48 (38%) metoclopramide patients (95% CI for (rounded) difference of 6%: -13, 25%).

Conclusion: GONB with bupivacaine was not as efficacious as IV metoclopramide for the first-line treatment of migraine in the ED.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/head.13961DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7704709PMC
November 2020

Efficacy and Feasibility of Behavioral Treatments for Migraine, Headache, and Pain in the Acute Care Setting.

Curr Pain Headache Rep 2020 Sep 26;24(10):66. Epub 2020 Sep 26.

Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA.

Purpose Of Review: This narrative review examines the use of behavioral interventions for acute treatment of headache and pain in the emergency department (ED)/urgent care (UC) and inpatient settings.

Recent Findings: Behavioral interventions demonstrate reductions of pain and associated disability in headache, migraine, and other conditions in the outpatient setting. Behavioral treatments may be a useful addition for patients presenting with acute pain to hospitals and emergency departments. We review challenges and limitations and offer suggestions for implementation of behavioral interventions in the acute setting. Some evidence exists for relaxation-based treatments, mindfulness-based treatments, hypnosis/self-hypnosis, and immersive virtual reality for acute pain, migraine, and headache. There are few high-quality studies on behavioral treatments in the inpatient and emergency department settings. Further research is warranted to determine the efficacy and cost-effectiveness of these interventions. Given the general safety and cost-effectiveness of behavioral interventions, healthcare professionals may want to include these therapies in treatment plans.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11916-020-00899-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7754250PMC
September 2020

Quality improvement in neurology: Headache Quality Measurement Set.

Neurology 2020 11 23;95(19):866-873. Epub 2020 Sep 23.

From the Department of Neurology (M.S.R.), Weill Cornell Medicine, New York, NY; NeuroDevelopmental Science Center (M.C.V.), Akron Children's Hospital, OH; University of Alabama at Birmingham (M.B.), Indian Springs, AL; Emory University (C.C.), School of Nursing, Healthcare, Atlanta, GA; Mayo Clinic (I.V.), Rochester, MN; University of Virginia Health System (J.S.H.), Charlottesville, VA; Baylor Scott & White (D.R.), Temple, TX; Department of Anesthesiology (N.M.S.), University of California San Diego Center for Pain Medicine, La Jolla, CA; Sutter Imaging (D.S.), Sacramento, CA; Albert Einstein College of Medicine and Yeshiva University (E.S.), Bronx, NY; Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania (C.S.), Philadelphia, PA; American Academy of Neurology (E.R.), Minneapolis, MN; and University of Rochester (R.V.), NY.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1212/WNL.0000000000010634DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7713732PMC
November 2020

COVID-19 and Headache: A Primer for Trainees.

Headache 2020 09 19;60(8):1806-1811. Epub 2020 Jun 19.

Department of Neurology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA.

Objective: To summarize for the trainee audience the possible mechanisms of headache in patients with COVID-19 as well as to outline the impact of the pandemic on patients with headache disorders and headache medicine in clinical practice.

Background: COVID-19 is a global pandemic caused by the novel coronavirus severe acute respiratory syndrome coronavirus 2, of which a large subset of patients features neurological symptoms, commonly headache. The virus is highly contagious and is, therefore, changing clinical practice by forcing limitations on in-person visits and procedural treatments, more quickly shifting toward the widespread adaptation of telemedicine services.

Design/results: We review what is currently known about the pathophysiology of COVID-19 and how it relates to possible mechanisms of headache, including indirect, potential direct, and secondary causes. Alternative options for the treatment of patients with headache disorders and the use of telemedicine are also explored.

Conclusions: Limited information exists regarding the mechanisms and timing of headache in patients with COVID-19, though causes relate to plausible direct viral invasion of the nervous system as well as the cytokine release syndrome. Though headache care in the COVID-19 era requires alterations, the improved preventive treatment options now available and evidence for feasibility and safety of telemedicine well positions clinicians to take care of such patients, especially in the COVID-19 epicenter of New York City.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/head.13884DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7300928PMC
September 2020

DNA sequence-based mapping and comparative genomics of the genome of (Pursh) Á. Löve versus wheat ( L.) and barley ( L.).

Genome 2020 Sep 8;63(9):445-457. Epub 2020 May 8.

Department of Animal, Dairy and Veterinary Sciences, Utah State University, Logan, UT 84322-4815, USA.

Bluebunch wheatgrass (referred to as BBWG) [ (Pursh) Á. Löve] is an important rangeland Triticeae grass used for forage, conservation, and restoration. This diploid has the basic genome that occurs also in many polyploid Triticeae species, which serve as a gene reservoir for wheat improvement. Until now, the genome in diploid species of has not been mapped. Using a double-cross mapping populations, we mapped 230 expressed sequence tag derived simple sequence repeat (EST-SSR) and 3468 genotyping-by-sequencing (GBS) markers to 14 linkage groups (LGs), two each for the seven homologous groups of the genome. The 227 GBS markers of BBWG that matched those in a previous study helped identify the unclassified seven LGs of the sub-genome among 21 LGs of (Host) Barkworth & D.R. Dewey. Comparisons of GBS sequences in BBWG to whole-genome sequences in bread wheat ( L.) and barley ( L.) revealed that the genome shared a homology of 35% and 24%, a synteny of 86% and 84%, and a collinearity of 0.85 and 0.86, with and , respectively. This first-draft molecular map of the genome will be useful in breeding cereal and forage crops.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1139/gen-2019-0152DOI Listing
September 2020

Visual snow: Are we beginning to see the light?

Neurology 2020 02 16;94(6):241-242. Epub 2020 Jan 16.

From the Departments of Clinical Neurosciences and Surgery (F.E.C.), University of Calgary, Alberta, Canada; Department of Neurology (A.R.B.), Centre Hospitalier Emile Mayrisch, Esch-sur-Alzette, Luxembourg; and Department of Neurology (M.S.R.), Weill Cornell Medical College, New York, NY.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1212/WNL.0000000000008913DOI Listing
February 2020

OnabotulinumtoxinA Wear-off Phenomenon in the Treatment of Chronic Migraine.

Headache 2019 11 16;59(10):1753-1761. Epub 2019 Sep 16.

Department of Neurology, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA.

Objective: To evaluate the frequency and features of onabotulinumtoxinA (onabotA) wear-off in chronic migraine (CM).

Background: Clinical experience suggests that patients with CM frequently perceive onabotA treatment duration <12 weeks, but this phenomenon has not been well explored.

Methods: This study was a retrospective chart review of patients (n = 143) with CM initiated on onabotA over a 2-year period. Wear-off was considered present with the phrase documented, a quantitative headache day increase, or increased use of abortive medications, bridging therapies or emergency department visits in the 6 weeks preceding the subsequent administration.

Results: Wear-off was present in 90/143 patients (62.9%). Age, sex, medication overuse, psychiatric comorbidity, injector training level, and mean days between injections did not differ between the wear-off and no wear-off groups. Mean units injected per session in the wear-off group until first documented wear-off were significantly less vs no wear-off group (166.0 ± 13.1 vs 173.4 ± 10.3, P = .0005). Wear-off most commonly occurred 2-4 weeks before the next injection (43.3%) and after the very first injection (40.0%). Intramuscular ketorolac injections (33.3%) and peripheral nerve blocks (25.6%) were the most common bridge therapies used in the wear-off period.

Conclusions: Most patients with CM receiving onabotA experience wear-off. Clinicians may consider increasing the units used from the treatment onset to reduce the frequent need for bridging therapies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/head.13638DOI Listing
November 2019

Headache, Visual Loss, and Encephalopathy Associated With Intravenous Ozone Administration.

Headache 2019 10 16;59(9):1643-1644. Epub 2019 Jul 16.

Department of Neurology, Weill Cornell Medical College, New York, NY, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/head.13597DOI Listing
October 2019

Neuromodulation for the Acute and Preventive Therapy of Migraine and Cluster Headache.

Headache 2019 07;59 Suppl 2:33-49

Department of Neurology, Weill Cornell Medicine, New York, NY, USA.

Headache disorders are among the most common and disabling medical conditions worldwide. Pharmacologic acute and preventive treatments are often insufficient and poorly tolerated, and the majority of patients are unable to adhere to their migraine treatments due to these issues. With improvements in our understanding of migraine and cluster headache pathophysiology, neuromodulation devices have been developed as safe and effective acute and preventive treatment options. In this review, we focus on neuromodulation devices that have been studied for migraine and cluster headache, with special attention to those that have gained food and drug administration (FDA) clearance. We will also explore how these devices can be used in patients who might have limited pharmacologic options, including the elderly, children, and pregnant women.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/head.13586DOI Listing
July 2019

Comment: Time for neurologists to see visual snow.

Neurology 2019 07 18;93(4):153. Epub 2019 Jun 18.

From the Department of Neurology, Weill Cornell Medicine, New York, NY.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1212/WNL.0000000000007824DOI Listing
July 2019

Genome mapping of quantitative trait loci (QTL) controlling domestication traits of intermediate wheatgrass (Thinopyrum intermedium).

Theor Appl Genet 2019 Aug 6;132(8):2325-2351. Epub 2019 Jun 6.

United States Department of Agriculture, Agriculture Research Service, Forage and Range Research, Utah State University, Logan, UT, 84322, USA.

Allohexaploid (2n = 6x = 42) intermediate wheatgrass (Thinopyrum intermedium), abbreviated IWG, is an outcrossing perennial grass belonging to the tertiary gene pool of wheat. Perenniality would be valuable option for grain production, but attempts to introgress this complex trait from wheat-Thinopyrum hybrids have not been commercially successful. Efforts to breed IWG itself as a dual-purpose forage and grain crop have demonstrated useful progress and applications, but grain yields are significantly less than wheat. Therefore, genetic and physical maps have been developed to accelerate domestication of IWG. Herein, these maps were used to identify quantitative trait loci (QTLs) and candidate genes associated with IWG grain production traits in a family of 266 full-sib progenies derived from two heterozygous parents, M26 and M35. Transgressive segregation was observed for 17 traits related to seed size, shattering, threshing, inflorescence capacity, fertility, stem size, and flowering time. A total of 111 QTLs were detected in 36 different regions using 3826 genotype-by-sequence markers in 21 linkage groups. The most prominent QTL had a LOD score of 15 with synergistic effects of 29% and 22% over the family means for seed retention and percentage of naked seeds, respectively. Many QTLs aligned with one or more IWG gene models corresponding to 42 possible domestication orthogenes including the wheat Q and RHT genes. A cluster of seed-size and fertility QTLs showed possible alignment to a putative Z self-incompatibility gene, which could have detrimental grain-yield effects when genetic variability is low. These findings elucidate pathways and possible hurdles in the domestication of IWG.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00122-019-03357-6DOI Listing
August 2019

@HeadacheJournal Tweets On.

Headache 2019 06;59(6):828-833

Headache Editorial Office, Ottawa, ON, Canada.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/head.13539DOI Listing
June 2019
-->