New COVID-19 Neurology Link
Wednesday, March 25, 2020
We have added a new link to the Neurology Intranet Page under the General Links to the left. Clicking on the COVID-19 Neurology link will take you to a BOX folder with access to files containing current COVID-19 information related to Neurology. If you are not logged into BOX, you will be prompted to log in. If you do not have a BOX account, please contact NeuroIT at NeurologyIT@urmc.rochester.edu or call 5-0431 and they will create an account for you.
New Book Details Roadmap to Prevent and Treat Parkinson’s
Wednesday, March 11, 2020
A new book titled “Ending Parkinson’s Disease: A Prescription for Action” and authored by University of Rochester Medical Center neurologist Ray Dorsey, M.D. and his colleagues, lays out a new vision to prevent, advocate for, care for, and treat this major and growing global health threat.
“Parkinson’s disease is a looming pandemic and we are woefully unprepared to meet this challenge – many people remain undiagnosed and untreated, research funding for the disease has stagnated, and the most effective treatment is now a half century old,” said Dorsey, the David M. Levy Professor of Neurology and director of the Center for Health + Technology (CHeT). “At least some cases of Parkinson’s are man-made and, therefore, preventable.”
Parkinson's disease is the fastest growing neurological disorder in the world, outpacing Alzheimer’s.Over the past 25 years, the number of people with the condition has jumped from three million to more than six million, and by 2040, it is projected to double again.
First described in early 18th century London at the height of the Industrial Revolution, Parkinson’s and its rise have been fueled by environmental exposures to harmful chemicals. The two biggest culprits currently still in use are paraquat, a herbicide widely used in the U.S. despite being banned in 32 countries, and trichloroethylene (TCE), a solvent used in a wide range of industrial and consumer products. Not only are agricultural and industrial workers at risk of exposure, but these chemicals also enter the food chain, water supply, reside in the soil in brownfield sites, and impact indoor air quality.
The authors also advocate removing barriers to care. For example, over 40 percent of individuals with the disease do not see a neurologist soon after diagnosis, primarily because of where they live. Technologies like telemedicine have been shown to deliver effective specialized care to patients and improves their lives. However, Medicare policies often do not pay for these services.
Confronting the Parkinson’s pandemic will require marshalling the same focus and resources employed with success to address other public health challenges, such as polio, HIV, and breast cancer. The authors label their course of action PACT: prevent the disease, advocate for policies and resources, care for all affected, and treat the condition with new and more effective therapies.
URMC has a long been a leader in the field of Parkinson’s research and care. Medical Center researchers were instrumental in conducting pivotal clinical trials that led to at least four FDA-approved drugs currently treat the disease. CHeT is a leading center for the application of new technologies to study and assess Parkinson’s. The themes detailed in the book will form the basis of a new initiative launched by URMC in the coming months that will focus on the research, grassroots advocacy, and public policy steps necessary to prevent the disease and expand access to care.
Additional co-authors of the book include Todd Sherer, Ph.D., CEO of the Michael J. Fox Foundation, Mike Okun, M.D., with the University of Florida, and Bastiaan R. Bloem, M.D., Ph.D., with Radboud University in the Netherlands. Proceeds from sales of the book will support Parkinson’s research at URMC and other institutions.Read More: New Book Details Roadmap to Prevent and Treat Parkinson’s
Kluger to Lead New Palliative Care Research Initiative
Wednesday, March 4, 2020
Benzi Kluger, M.D., has been tapped to lead palliative care research across URMC. Kluger comes to URMC from the University of Colorado School of Medicine and started at the Medical Center on January 1.
Kluger, who has been appointed a professor of Neurology and Medicine, is the director of URMC’s new Palliative Care Research Center within the Department of Medicine. In this role, he will develop resources and core infrastructure to enable researchers and clinicians from across the University to undertake palliative care research projects.
“Dr. Kluger has established himself as a leading researcher and scholar in both neurological disorders and palliative care,” said Bob Holloway, M.D., M.P.H., chair of the Department of Neurology. “We are fortunate to have recruited him to Rochester and look forward to helping him have a major impact on the field of palliative care.”
“In his young and blossoming career Benzi has already gained international recognition as a productive, creative scholar in the realm of innovative palliative care delivery models,” said Robert Horowitz, MD, chief of the Palliative Care Division at URMC. “He is an ambitious, generative, and prolific scholar, clinician, teacher and human being, with an explicit commitment to building ties across UR schools, departments, and divisions.”
Kluger’s specific interest is in innovative models of palliative care delivery, in which an interdisciplinary team addresses the many needs of seriously ill patients and their families, as they grapple with the physical, emotional, social, and spiritual symptoms of their disease. Kluger is working with faculty in the Wilmot Cancer Center, Divisions of Palliative Care and Nephrology, the School of Nursing, and other Medical Center departments and divisions to develop and evaluate integrated models of outpatient palliative care. Kluger will also oversee the creation of a new Neuropalliative Care Division within the Department of Neurology.
With support from a PCORI grant, Kluger led a multisite randomized controlled trial in Colorado that compared the effectiveness of multidisciplinary outpatient palliative care integrated with standard care versus standard care alone for Parkinson’s patients. The results of the study, which were published earlier this month in JAMA Neurology, showed that outpatient palliative care improves quality of life and other outcomes, including reductions in caregiver burden and improvement in motor symptoms.
"Palliative care provides a framework to address the multiple needs of patient populations from the time of diagnosis and is particularly beneficial when people reach more into more advanced stages of illness where our traditional care models have less to offer," said Kluger. “This effort is part of a wider movement to make palliative care a standard and expected part of care for persons living with serious diseases.”
Kluger conducted his Medical and Neurology Residency training at the University of Colorado. He completed fellowship training in Behavioral Neurology and Movement Disorders at the University of Florida. He recently established the International Society of Neuropalliative Care (ISPN), which has members from US, Canada, Europe, Asia and Australia, and will be the organization’s first president. Kluger and Holloway are co-editors of the book “Neuropalliative Care: A Guide to Improving the Lives of Patients and Families Affected by Neurological Disease.”
The ANA Q&A: Neurology Research in Sub-Saharan Africa
Tuesday, March 3, 2020
"One hears a lot about malaria deaths, but the sad reality is that a third of survivors sustain a brain injury with associated neurological sequelae. More than 200,000 African children each year end up with neurodisabilities from malaria. This is low-hanging fruit for decreasing the global burden of neurological disease and increasing the human capacity in this region of the world."
~Gretchen Birbeck, M.D., M.P.H., Professor of Neurology, ANA International Outreach Committee Chair
To celebrate International Women’s Day (March 8), we’re highlighting ANA members who are doing impressive work both domestically and abroad. Keep reading for our interview with Gretchen Birbeck, M.D., M.P.H. Dr. Birbeck is a neurologist who divides her time between the U.S. and Africa. Her U.S. academic home is the University of Rochester, where she is the Rykenboer Professor of Neurology. She also serves as chair of the ANA’s International Outreach Committee.
We spoke with her to learn more about her research, her work with the International Outreach Committee, and what the theme of this year’s International Women’s Day, “Each for Equal,” means to her.
Can you give an overview of the initiatives you've been working on in Zambia?
My work in Zambia really mirrors what an academic neurologist does anywhere—I teach, provide clinical care and conduct research. And for me the split is about 70/30 with the largest proportion of my time being spent on research activities.
On the research front, I am the Principal Investigator for three NIH-funded R01s. The ChASE study is a Cohort Study of HIV-Associated Seizures and Epilepsy. One of the clinical challenges in providing neurological care in sub-Saharan Africa is knowing what to do for someone who is HIV infected presenting with new onset seizure. Epidemiological data that otherwise informs if and when to start a chronic antiseizure medication may not apply to persons with HIV especially if an HIV-associated drug reaction or opportunistic infection has precipitated the seizure. And unfortunately, the choice of seizure medications may be limited to enzyme-inducing agents that interact with antiretroviral medications. ChASE is providing some insights on what causes seizures in this population, who is at risk of long-term seizure disorders and what happens when the seizure medications available in HIV endemic regions are combined with the HIV medications used locally. This is an especially dynamic study as it involves adults and children in rural and urban populations. I spent the first two decades of my time in Zambia based in a rural area and I still have excellent research teams and colleagues there so it is wonderful to remain working and engaged with them even though I am now based primarily in Lusaka.
I am also working on the Malaria Fever study which is a randomized controlled trial (RCT) of aggressive antipyretic therapy using maximal dose ibuprofen and acetaminophen for fever control in pediatric malaria. My K23 project was a prospective cohort study of neurological outcomes in pediatric cerebral malaria survivors. Since completing my K23, I’ve been working down the list of potentially modifiable risk factors for brain injury in this population hoping to eventually conduct a multi-country RCT of a neuroprotective “package” of care to improve outcomes in child survivors of cerebral malaria. One hears a lot about malaria deaths, but the sad reality is that a third of survivors sustain a brain injury with associated neurological sequelae. More than 200,000 African children each year end up with neurodisabilities from malaria. This is low-hanging fruit for decreasing the global burden of neurological disease and increasing the human capacity in this region of the world. I also think what we learn about epileptogenesis from the cerebral malaria model may help us understand the process in general and this has implications for advances in neurological care everywhere.
Finally, the MRI Ancillary Grant is an imaging study of children enrolled in the Malaria Fever study. This is evaluating structural evidence of brain injury to potentially identify neuroprotective effects and/or side effects from the antipyretics that won’t necessarily be mediated by fever control. This is really an important additional outcome for the RCT since it is quite possible that the anti-inflammatory benefits of the antipyretics might be neuroprotective yet not significantly reduce fever. But the addition of imaging may also help us better identify adverse effects from the antipyretics. One of the neurological phenomena that occurs in pediatric cerebral malaria is the development of brain microhemorrhages. These feature prominently among autopsy findings and, more recently, our research team identified microhemorrhages in children who survived cerebral malaria. So, one major concern is that children who receive ibuprofen (which is not standard of care for malaria fevers) may have an increased risk of microhemorrhages or frank bleeding. The MRI Ancillary Grant will allow us to see if this is occurring.
Clinically, I have an epilepsy clinic in rural Zambia that I staff weekly, I pinch hit for attending on child neurology consults when needed on the inpatient service and I read EEGs Zambia at the University Teaching Hospitals (UTH) Children’s Hospital and Malawi for Queen Elizabeth Central Hospital’s Pediatric service.
On the teaching front, there is a new postgraduate training program in neurology now at UTH and it is doing an amazing job of transforming care and education here. I can’t take any credit for the program, which is led by Dr. Deanna Saylor (Johns Hopkins) and was co-founded by Dr. Omar Siddiqi (Beth Israel at Harvard), but I will proclaim myself to be the program’s biggest cheerleader. And in this vibrant environment, I’m able to spend my medical education endeavors primarily as a mentor for young researchers, both American and African. My mentees study stigma, nutritional neuropathies, cognition in adolescents with HIV, TB meningitis, the impact of health system structure on neurological care delivery, CNS IRIS, and comorbid HIV and NCDs.
So, things are busy and chaotic, but never boring!Read More: The ANA Q&A: Neurology Research in Sub-Saharan Africa
Parkinson's Foundation Charity Hockey Game
Friday, January 17, 2020
The Parkinson’s foundation is putting on a charity hockey game Saturday February 8th from 4-6pm. I will be participating in the event showing washed up NHL players how it’s done along with raising money by selling tickets for a good foundation and cause so anyone that can make the game and support it would be amazing! They are asking players to sell tickets (in the “purchasing from a player” box (Here's the link)) and I thought who better to ask than the people that work hands on with Parkinson’s disease. Thanks, everyone!
Justin Alves,Read More: Parkinson's Foundation Charity Hockey Game
Human Subject Research Coordinator
Welcome Resident Applicants
Tuesday, January 7, 2020
The Department of Neurology would like to welcome residency applicants, interviewing on Monday, January 13th. A wine and cheese reception for the applicants will be held from 4:00 - 4:30 PM in the Garvey Room. All Faculty & Residents are invited to attend.
Adult Neurology Applicants
Blake Beehler – Rush Medical College
Christopher Brewer – University of Tennessee Health Science Center
Kim Griffin – Medical College of Wisconsin
Lauren Herrera – University of Cincinnati
Zachary Roesch – Creighton University
Deborah Rose – Loyola University
Carlos Sollero – University of Rio de Janeiro, Brazil