OBJECTIVETo describe a patient with a posterior inferior cerebellar artery stroke exhibiting a horizontal direction changing nystagmus with a complex clinical phenotype.MATERIALS AND METHODSA 78-year-old man presented with acute vertigo and gait imbalance. He was dysphagic and ataxic on the left side. He had a fast, small-amplitude right-beating nystagmus in the primary gaze position and in the gaze towards the right. Towards the left, a coarse left-beating nystagmus was seen.RESULTSRadiographic leftwards ocular deviation was evident on admission CT. Intravenous fibrinolysis was administered. 48-hour Holter-EKG, transthoracic ecochardiogram, and transcranial doppler were unremarkable. Brain MRI demonstrated an acute stroke involving the left medulla and cerebellum, mainly within the territory of the ipsilateral posterior inferior cerebellar artery.DISCUSSION AND CONCLUSIONSHorizontal direction changing nystagmus can arise secondary to central lesions as brainstem strokes, it can be spontaneous or gaze-evoked and characteristically remains unchanged after fixation removal. In our case, the vestibular spontaneous and contralesional nystagmus was likely related to lower-brainstem damage; on the other hand, the ipsilesional gaze-evoked nystagmus might be related to lesions of the nucleus prepositus hypoglossi and/or cerebellum, both playing an important role in gaze-holding. Our findings suggest that central lesions with concurrent involvement of the ipsilateral vestibulo-ocular and horizontal gaze-holding pathways can cause direction changing nystagmus with complex phenotypes.

09 Sep 2024·Neuromodulation : journal of the International Neuromodulation Society

Maximal Analgesic Effect Attained by the Use of Objective Neurophysiological Measurements With Closed-Loop Spinal Cord Stimulation.

Article

Author: Costandi, Shrif J ; Thomson, Simon ; Chopra, Harman ; Amirdelfan, Kasra ; Falowski, Steven M ; Gilmore, Christopher A ; Kallewaard, Jan Willem ; AlFarra, Tariq ; Levy, Robert M ; Leitner, Angela ; Bruel, Brian ; Duarte, Rui V ; Kapural, Leonardo ; Guirguis, Maged N ; Rosen, Steven M ; Staats, Peter S ; Calodney, Aaron K ; Mekhail, Nagy A ; Broachwala, Mustafa Y ; Li, Sean ; Sayed, Dawood ; Scowcroft, James ; Hunter, Corey W ; Goree, Johnathan H ; Antony, Ajay ; Pope, Jason E ; Deer, Timothy R ; Buchanan, Patrick ; Hayek, Salim M ; Gilligan, Christopher ; Soliday, Nicole ; Boeding, Ronald B ; Lad, Shivanand P ; Petersen, Erika A

OBJECTIVESSpinal cord stimulation (SCS) has been challenged by the lack of neurophysiologic data to guide therapy optimization. Current SCS programming by trial-and-error results in suboptimal and variable therapeutic effects. A novel system with a physiologic closed-loop feedback mechanism using evoked-compound action potentials enables the optimization of physiologic neural dose by consistently and accurately activating spinal cord fibers. We aimed to identify neurophysiologic dose metrics and their ranges that resulted in clinically meaningful treatment responses.MATERIALS AND METHODSSubjects from 3 clinical studies (n = 180) with baseline back and leg pain ≥60 mm visual analog scale and physical function in the severe to crippled category were included. Maximal analgesic effect (MAE) was operationally defined as the greatest percent reduction in pain intensity or as the greatest cumulative responder score (minimal clinically important differences [MCIDs]) obtained within the first 3 months of SCS implant. The physiologic metrics that produced the MAE were analyzed.RESULTSWe showed that a neural dose regimen with a high neural dose accuracy of 2.8μV and dose ratio of 1.4 resulted in a profound clinical benefit to chronic pain patients (MAE of 79 ± 1% for pain reduction and 12.5 ± 0.4 MCIDs). No differences were observed for MAE or neurophysiological dose metrics between the trial phase and post-implant MAE visit.CONCLUSIONFor the first time, an evidence-based neural dose regimen is available for a neurostimulation intervention as a starting point to enable optimization of clinical benefit, monitoring of adherence, and management of the therapy.

01 Aug 2024·Cephalalgia

Disability in migraine: Multicountry results from the Chronic Migraine Epidemiology and Outcomes – International (CaMEO-I) Study

Article

Author: Lanteri-Minet, Michel ; Carr, Karen ; Fanning, Kristina M ; Adams, Aubrey Manack ; Matharu, Manjit S ; Sakai, Fumihiko ; Buse, Dawn C ; Leroux, Elizabeth ; Katsarava, Zaza ; Lipton, Richard B

Background Few studies of migraine have evaluated migraine disability across multiple countries using the same methodology. Methods This cross-sectional, web-based survey was conducted in 2021–2022 in Canada, France, Germany, Japan, UK and USA. Respondents with migraine were identified based on modified International Classification of Headache Disorders, 3rd edition, criteria. Headache features (Migraine Symptom Severity Score (MSSS, range: 0–21), presence of allodynia (Allodynia Symptom Checklist, ASC-12)) and migraine burden (Patient Health Questionnaire-4 (PHQ-4), Migraine-Specific Quality of Life questionnaire version 2.1 (MSQ v2.1), Work Productivity and Activity Impairment (WPAI) questionnaire) were evaluated. Results Among 14,492 respondents with migraine across countries, the mean ± SD MSSS was 15.4 ± 3.2 and 48.5% (7026/14,492) of respondents had allodynia based on ASC-12. Of all respondents living with migraine, 35.5% (5146/14,492) reported moderate to severe anxiety and/or depression symptoms. Mean ± SD MSQ v2.1 Role Function–Restrictive, Role Function–Preventive and Emotional Function domain scores were 60.7 ± 22.9, 71.5 ± 23.0 and 65.1 ± 27.2, respectively. The WPAI mean ± SD percentages of respondents who missed work or worked impaired as a result of migraine were 6.8 ± 18.1% and 41.0 ± 30.1%, respectively. Conclusions For every country surveyed, migraine was associated with high levels of symptom severity, with allodynia and with substantial burden.

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05 Sep 2024

·www.prnewswire.com

A Small Step towards a Big Mission! World's First! UltraDx Received First Clinical Approval of Single-Molecule Analyzer, in China

SHANGHAI, Sept. 5, 2024 /PRNewswire/ -- UltraDx Bio is proud to announce that its flagship product, the UD-X™ Fully Automated Single-Molecule Array Fluorescence Immunoassay Analyzer, has received its first clinical registration approval in China. This groundbreaking achievement is now officially listed on the National Medical Products Administration (NMPA) website (Registration Certificate No.: JXZZ 20242220334) and marks a significant milestone in the field of medical diagnostics. The UD-X™ Single-Molecule Analyzer is designed for the ultra-sensitive detection and quantification of trace protein biomarkers in body fluids, reaching sensitivity levels at the fg/ml scale. This technology will be utilized alongside soon-to-be-approved companion assay kits, addressing the precision detection needs of clinical diagnostics and community health screenings. Continue Reading Jay Dong, CEO of UltraDx Bio Academician George Fu Gao, the Member of the Chinese Academy of Sciences, the Foreign Member of the U.S. National Academy of Sciences , the foreign member of the Royal Academy Academician Guoliang Xu, the Member of the Chinese Academy of Sciences, a researcher at the Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences Prof. Jintai Yu, of National Clinical Center for Neurological diseases in Shanghai, Deputy Director of Department of Neurology, Huashan Hospital Affiliated to Fudan University, Executive Deputy Director of Institute of Neurology, Fudan University, and Vice Chairman of the Youth Committee of Neurology Branch of Chinese Medical Association

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