Nevin Manimala

Lung Cancer. 2025 Feb 12;201:108421. doi: 10.1016/j.lungcan.2025.108421. Online ahead of print.

ABSTRACT

BACKGROUND: KRAS G12D and G12C mutations have distinct biological traits influencing treatment response. This study examines real-world demographics, clinical characteristics, and first-line treatment outcomes in metastatic non-small-cell lung cancer (NSCLC) patients with these mutations.

METHODS: This retrospective, multi-institution observational study used data from the AURORA database. Patients aged 18 years or older, diagnosed with metastatic KRAS G12D or G12C NSCLC between January 1, 2010, and April 30, 2024, were included. Descriptive statistics compared patient characteristics, and time-to-event outcomes were assessed using Cox proportional hazards regression.

RESULTS: A total of 298 (216 KRAS G12C and 82 KRAS G12D) patients were included. The KRAS G12D group had a higher proportion of never smokers (15 % vs. 1 %, p < 0.01) and PD-L1 < 1 % (36 % vs. 21 %, p = 0.06). No significant differences were observed in overall survival (OS) (HR 1.09, 95 % CI 0.80-1.48, p = 0.60) or real-world progression-free survival (rwPFS) (HR 1.21, 95 % CI 0.92-1.59, p = 0.18) between mutation groups. In KRAS G12C, monotherapy immunotherapy (HR 0.61, 95 % CI 0.39-0.97, p = 0.04) and chemo-immunotherapy (HR 0.59, 95 % CI 0.37-0.94, p = 0.03) improved OS compared to chemotherapy. For KRAS G12D, neither immunotherapy (HR 0.74, 95 % CI 0.29-1.89, p = 0.53) nor chemo-immunotherapy (HR 0.73, 95 % CI 0.34-1.57, p = 0.42) improved OS compared to chemotherapy alone.

CONCLUSION: KRAS G12C and G12D mutations demonstrate distinct clinical characteristics and treatment responses, with poorer immunotherapy outcomes in KRAS G12D patients. Prospective studies are needed to validate these findings.

PMID:39977966 | DOI:10.1016/j.lungcan.2025.108421

Neurology. 2024 Apr 9;102(7_supplement_1):6874. doi: 10.1212/WNL.0000000000208147. Epub 2024 Apr 9.

ABSTRACT

OBJECTIVE: To characterize early adopters of subcutaneous (SC) neonatal receptor (FcRn) blockers efgartigimod alfa and hyaluronidase (SC efgartigimod) and rozanolixizumab, approved for generalized myasthenia gravis (gMG).

BACKGROUND: Monthly survey fielded by an independent market intelligence agency specializing in tracking neurological therapeutic markets, including benchmarking new product launch metrics.

DESIGN/METHODS: Online survey fielded in October 2023, approximately two months after SC efgartigimod and rozanolixumab availability, among 65 US neurologists and neuromuscular specialists.

RESULTS: 42% of surveyed neurologists reported prescribing either SC efgartigimod, rozanolixizumab, or both products within the first two months of commercial availability (“early adopters”). Early adopters reported significantly higher patient shares for originator FcRn blocker IV efgartigimod than non-adopters (11.3% vs 3.6%). Early adopters were more likely than non-adopters to rate themselves as highly familiar with SC efgartigimod (8.1 for adopters, 6.8 for non-adopters on 10-point scale) and to rate both SC FcRn blockers as a significant advance over other agents to treat gMG (7.6 vs 6.4 [SC efgartigimod], 7.1 vs 5.9 [rozanolixizumab]). They were more likely than non-adopters to view more of their patients as candidates for SC efgartigimod (23.4% vs 14.7%). Early adopters rated market access as significantly better for both SC products than non-adopters (6.8 vs. 4.4; 6.0 vs 4.0). They also were more likely to have a positive perception of launch execution for both SC products (7.7 vs 6.3; 6.7 vs 5.1). gMG patient load and past month sales representative contact did not significantly differ between early adopters and non-prescribers.

CONCLUSIONS: Prior use of IV efgartigmod may have increased comfort with SC FcRn products, leading to faster uptake and more positive perceptions of both brands across degree of advance, market access, and launch execution. Disclosure: Georgiana Kuhlmann has received personal compensation for serving as an employee of Amgen. Georgiana Kuhlmann has stock in Amgen. Dr. Cloud has nothing to disclose.

PMID:39977948 | DOI:10.1212/WNL.0000000000208147

Neurology. 2024 Apr 9;102(7_supplement_1):3348. doi: 10.1212/WNL.0000000000205078. Epub 2024 Apr 9.

ABSTRACT

OBJECTIVE: To analyze within-group effect sizes of cipaglucosidase alfa plus miglustat (cipa+mig) and alglucosidase alfa (alg) for efficacy, quality of life (QoL), and biomarker variables in ERT-experienced patients.

BACKGROUND: The randomized, double-blind PROPEL study (ATB200-03; NCT03729362) compared the efficacy and safety of the investigational two-component enzyme replacement therapy (ERT) cipa+mig with alg plus placebo in adults with late-onset Pompe disease (LOPD); 77% of patients had received ERT with alg before study entry (median ERT duration 7.4 years).

DESIGN/METHODS: We analyzed within-group effect sizes of cipa+mig and alg for outcome variables including motor function, lung function and muscle strength tests; patient-reported outcomes/QoL; and biomarkers in ERT-experienced patients. Standardized within-group effect sizes (Cohen’s d for correlated measurements from baseline to week 52) were calculated by dividing the mean change from baseline by the standard deviation of the difference scores.

RESULTS: ERT-experienced patients remaining on alg (n=30) generally showed worsening (d<-0.2) or stability (-0.2≤d≥+0.2) across most outcomes, while those switching to cipa+mig (n=65) mostly showed improvement (d>0.2) or stability. Patients remaining on alg demonstrated statistically significant within-group worsening for sitting and supine forced vital capacity; slow vital capacity; maximal expiratory pressure; and creatine kinase (CK) and hexose tetrasaccharide (Hex4) levels, and no significant improvements for any outcomes. Patients switching to cipa+mig did not demonstrate significant within-group worsening for any outcomes and showed significant improvements for 6-minute walk distance (absolute and % predicted); upper, lower and overall manual muscle test; Patient-Reported Outcomes Measurement Information System (PROMIS)-Fatigue; Physician and Subject Global Impression of Change (five of eight subdomains); and CK and Hex4 levels.

CONCLUSIONS: This analysis shows that ERT-experienced patients with LOPD who switched from alg to cipa+mig treatment achieved improvements in a number of outcomes, highlighting the potential of cipa+mig to become an important treatment option for these patients. Sponsored by Amicus Therapeutics Inc. Disclosure: Dr. Kushlaf has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion AstraZeneca Rare Disease. Dr. Kushlaf has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi Genzyme. Dr. Kushlaf has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Immunovant. Dr. Kushlaf has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. Dr. Kushlaf has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Sanofi Genzyme. Drago Bratkovic has nothing to disclose. Barry Byrne has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for AavantiBio. Barry Byrne has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Pfizer. Barry Byrne has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Vertex. Barry Byrne has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sarepta. Barry Byrne has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Muscular Dystrophy Association. Barry Byrne has received intellectual property interests from a discovery or technology relating to health care. Dr. Claeys has nothing to disclose. Jordi Diaz-Manera has nothing to disclose. Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EcoR1 Capital, LLC. Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cello Health BioConsulting, previously Defined Health. Dr. Dimachkie has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Sanofi. Dr. Dimachkie has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for CSL Behring. Dr. Dimachkie has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Octapharma. Dr. Dimachkie has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for ArgenX. Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Spark Therapeutics. Dr. Dimachkie has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for RAF-5. Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Houston NeuroCare. Dr. Dimachkie has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Shire. Dr. Dimachkie has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Catalyst. Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Kezar. Dr. Dimachkie has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for RaPharma/UCB. Dr. Dimachkie has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for ArgenX. Dr. Dimachkie has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Sanofi. An immediate family member of Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Kezar. Dr. Dimachkie has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Catalyst. Dr. Dimachkie has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Takeda. Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for SCHOLAR Rock. Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Jenssen. Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amazentis / Vandria. Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Spark Therapeutics. Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roivant. Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for SANEM. Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medlink. Dr. Dimachkie has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for CSL Behring. Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Third Rock. Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Orphazyme . Dr. Dimachkie has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Astellas. Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen. Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roivant . Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Dianthus. Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TACT / Treat NMD. Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cabaletta Bio. Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Clinical Neurological Society of America, Inc . Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ig Society, Inc. Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abcuro. Dr. Dimachkie has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Covance / Labcorp. The institution of Dr. Dimachkie has received research support from CSL Behring. The institution of Dr. Dimachkie has received research support from Orphazyme. The institution of Dr. Dimachkie has received research support from FDA-OOPD. The institution of Dr. Dimachkie has received research support from NIH. Dr. Dimachkie has received intellectual property interests from a discovery or technology relating to health care. Dr. Dimachkie has received publishing royalties from a publication relating to health care. Priya Kishnani, MD has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Sanofi/Genzyme. Priya Kishnani, MD has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Amicus Therapeutics. Priya Kishnani, MD has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Maze Therapeutics. Priya Kishnani, MD has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for JCR Pharmaceutical. Priya Kishnani, MD has received personal compensation in the range of $500,000-$999,999 for serving as a Consultant for Asklepios Biopharmaceutical Inc. (AskBio). Priya Kishnani, MD has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi/Genzyme. Priya Kishnani, MD has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Amicus Therapeutics. Priya Kishnani, MD has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Baebies, Inc.. The institution of Priya Kishnani, MD has received research support from Sanofi/Genzyme. Priya Kishnani, MD has received research support from Amicus Therapeutics. Priya Kishnani, MD has received intellectual property interests from a discovery or technology relating to health care. Priya Kishnani, MD has received intellectual property interests from a discovery or technology relating to health care. Mark Roberts has nothing to disclose. Dr. Toscano has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi Genzyme. Dr. Castelli has received personal compensation for serving as an employee of Amicus Therpeutics. Frederick Holdbrook has received personal compensation for serving as an employee of Amicus Therapeutics Inc.. Frederick Holdbrook has stock in Amicus Therapeutics Inc.. Dr. Das has received personal compensation for serving as an employee of Amicus Therapeutics. Dr. Wasfi has received personal compensation for serving as an employee of Amicus Therapeutics. Dr. Wasfi has stock in Amicus Therapeutics. Benedikt Schoser has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi Genzyme. Benedikt Schoser has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Amicus. Benedikt Schoser has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bayer. Benedikt Schoser has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Taysha. Benedikt Schoser has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Argenx. Benedikt Schoser has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Benedikt Schoser has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Taysha. Benedikt Schoser has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Kedrion. Dr. Mozaffar has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Alexion Pharmaceuticals. Dr. Mozaffar has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Argenx. Dr. Mozaffar has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Sanofi-Genzyme. Dr. Mozaffar has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amicus. Dr. Mozaffar has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Modis Therapeutics. Dr. Mozaffar has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB/ Ra Pharmaceuticals. Dr. Mozaffar has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Maze Therapeutics. Dr. Mozaffar has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Spark Therapeutics. Dr. Mozaffar has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sarepta. Dr. Mozaffar has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for National Institutes of Health. Dr. Mozaffar has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Argenx. Dr. Mozaffar has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for Neuromuscular Disease Foundation. The institution of Dr. Mozaffar has received research support from NIH. The institution of Dr. Mozaffar has received research support from Muscular Dystrophy Association. The institution of Dr. Mozaffar has received research support from Sanofi-Genzyme. The institution of Dr. Mozaffar has received research support from Argenx. The institution of Dr. Mozaffar has received research support from Amicus Therapeutics. The institution of Dr. Mozaffar has received research support from Spark Therapeutics. The institution of Dr. Mozaffar has received research support from Audentes Therapeutics. The institution of Dr. Mozaffar has received research support from Cartesian. Dr. Mozaffar has received personal compensation in the range of $500-$4,999 for serving as a Study Section Member with NIH.

PMID:39977945 | DOI:10.1212/WNL.0000000000205078

Neurology. 2024 Apr 9;102(7_supplement_1):6868. doi: 10.1212/WNL.0000000000208142. Epub 2024 Apr 9.

ABSTRACT

OBJECTIVE: Reversible Cerebral Vasoconstriction Syndrome (RCVS) is characterized by the presence of segmental, multifocal and reversible vasoconstriction of intracranial arteries, with clinical presentation being recurrent thunderclap headaches. In patients with RCVS, angiographic studies may initially appear normal, posing a differential diagnosis challenge with clinically similar conditions.

BACKGROUND: Our objective was to analyse the clinical characteristics of patients with suspected RCVS, with and without evidence of vasospasm in initial angiographic studies, and to identify clinical differences between both groups.

DESIGN/METHODS: We included hospitalized patients with suspected RCVS. Patients were divided into one group (1) with evidence of cerebral vasospasm and another group (2) without evidence of vasospasm. We analyzed and compared demographic, clinical, and post-hospitalization outcomes through a retrospective analysis of medical records and subsequent in-person and/or telephone follow-up. The Fisher exact test was used for categorical variables, and the Wilcoxon test for continuous variables. Differences were considered statistically significant at a p-value of 0.05.

RESULTS: We included 102 patients. 56 patients completed follow-up after their hospitalization. A trigger for the episodes was identified in 40 patients, with sexual activity being the most common. We found a significant association (p=0.042) between female gender and the presence of angiographic vasospasm. In the subgroup of patients with an identified trigger other than sexual intercourse or orgasm, we found a significant association (p=0.031) with the presence of vasospasm. We also found a significant association (p=0.043) with the presence of post-hospitalization headaches in the group without evidence of vasospasm.

CONCLUSIONS: In this study, female gender and a trigger history unrelated to sexual activity were associated with a higher risk of vasoconstriction in angiographic studies. The absence of vasospasm in non-invasive studies during the initial evaluation of patients with recurrent thunderclap headaches would require, in addition to repeating studies or performing digital angiography, close follow-up aimed at identifying a primary headache. Disclosure: Ms. Perez Arana has nothing to disclose. Dr. Portuondo has nothing to disclose. Mr. Garat has nothing to disclose. Dr. Pujol Lereis has nothing to disclose.

PMID:39977942 | DOI:10.1212/WNL.0000000000208142

Neurology. 2024 Apr 9;102(7_supplement_1):6870. doi: 10.1212/WNL.0000000000208144. Epub 2024 Apr 9.

ABSTRACT

OBJECTIVE: This analysis uses current national-population-based data to elucidate trends in racial minority access to and utilization of palliative care services (PCS).

BACKGROUND: Intracerebral hemorrhage (ICH) is the second-highest cause of stroke-related mortality, and its long-term effects can be difficult for survivors to cope with. Palliative care has emerged as a compassionate, effective strategy to manage critically ill patients by focusing on improving quality of life for patients and their loved ones.

DESIGN/METHODS: This analysis utilized pooled data from the 2016-2019 United States Government Agency for Healthcare Research and Quality National Inpatient Sample (NIS), which contains >7 million unweighted hospital stays for each year. When weighted, it estimates >35 million hospitalizations yearly (95% of annual American hospitalizations). NIS’ International Classification of Diseases (ICD-10) codes were used for data extraction. After weighting, 84,840 adult patients admitted with intracerebral hemorrhage were included. Patients with a hospital stay less than 24 hours were excluded, as patients likely passed away before being able to receive PCS counseling. T- and chi-square-tests compared groups.

RESULTS: 16,940 (20%) of ICH patients received PCS. Patients who received PCS were significantly older (mean age 75 years, SD 13 vs. 68 years, SD 15, p<0.001) and were more likely to be female (57.2%, p<0.001) than patients who did not receive PCS. Caucasian ICH patients were significantly more likely to receive palliative care services (p<0.001). 23% of Caucasian ICH patients (n=11,940 of 52,125) received PCS. In comparison, only 12% of African American (n=1,740 of 13,835), 15% of Hispanic (n=1,285 of 8,690), and 19% of Asian/Pacific Islander (n=829 of 4,394) ICH patients received PCS.

CONCLUSIONS: Intracerebral hemorrhage patients of racial minority status were disproportionately less likely to receive palliative care services. These findings emphasize the need for improvement in provider- and patient-education or modification of PCS resources to fit patients’ differing cultural needs to improve care accessibility. Disclosure: The institution of Ms. Trivedi has received research support from American Academy of Neurology. Mr. Venishetty has nothing to disclose. Dr. Chaudhry has nothing to disclose. The institution of Dr. Cruz-Flores has received research support from University of Texas System.

PMID:39977938 | DOI:10.1212/WNL.0000000000208144

Neurology. 2024 Apr 9;102(7_supplement_1):3343. doi: 10.1212/WNL.0000000000205074. Epub 2024 Apr 9.

ABSTRACT

OBJECTIVE: This study examined associations of concomitant hypertension and elevated body mass index (BMI) with persistence of concussion symptoms.

BACKGROUND: Most patients with concussion experience symptom resolution within weeks after injury. However, approximately one-third of patients’ symptoms last for months or longer. Identifying risk factors for prolonged concussion symptoms is clinically meaningful for evaluating at-risk patients and for developing treatments.

DESIGN/METHODS: This study included a retrospective review of medical records from the NYU Langone Health Concussion Center between 2013-2022. Patients included had no prior history of concussion and received care within one year of injury. Captured variables included blood pressure and BMI at initial visit, existing hypertension diagnosis, number of visits, number of days between injury and final visit, and diagnosis of post-concussion syndrome (PCS).

RESULTS: Of 422 patients, the mean age was 41 (SD=16.7), 65% were female, 60% reported white race, and 65% reported non-Hispanic or Latino ethnicity. Patients with hypertension had a greater mean duration from injury to last appointment compared with non-hypertensive patients (465 vs. 240 days, p<0.0001, Wilcoxon Rank-Sum Test). The same pattern was observed for patients with elevated BMI compared to those without (388 vs. 259 days, p=0.002). Hypertension and elevated BMI were associated with greater numbers of visits (4.5 vs. 2.5 visits for hypertensive vs. non-hypertensive, p<0.0001; 3.8 vs. 2.7 visits for patients with vs. without elevated BMI, p=0.003). The probability of receiving a PCS diagnosis was increased for hypertensive patients (35% vs. 17%, p<0.001) and patients with elevated BMI (29% vs. 19%, p=0.021). When accounting simultaneously for injury mechanism, race, ethnicity, age, and sex, all reported associations for hypertension remained statistically significant.

CONCLUSIONS: Hypertension may be a risk factor for greater symptom duration and continued referrals following concussion. Further investigation is needed to determine whether treatment of hypertension prior to or following injury could improve concussion-related outcomes. Disclosure: Mr. De Souza has nothing to disclose. Ms. Hyman has nothing to disclose. Dr. Grossman has nothing to disclose. An immediate family member of Dr. Balcer has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Children’s Hospital of Philadelphia. Dr. Balcer has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for North American Neuro-Ophthalmology Society.

PMID:39977937 | DOI:10.1212/WNL.0000000000205074

Neurology. 2024 Apr 9;102(7_supplement_1):6883. doi: 10.1212/WNL.0000000000208153. Epub 2024 Apr 9.

ABSTRACT

OBJECTIVE: To create a dedicated, multi-stakeholder feedback survey focused on residency didactic education and utilize corresponding results to prioritize educational initiatives.

BACKGROUND: The didactic curriculum constitutes a significant component of trainee education, but existing program performance measures provide very little focused feedback on this element of learning.

DESIGN/METHODS: We designed three overlapping online surveys targeting residents, teaching faculty, and alumni of the adult neurology residency program at the our institution following best practice survey development recommendations. Surveys were sent out over email in the spring of 2023. Descriptive statistics were used to summarize responses.

RESULTS: Survey response rate for the current residents was 78% (39/50), 29% (28/98) for teaching faculty, and 7% for alumni (27/386). Residents and faculty differed on their views of the ideal overall goal of the didactic curriculum with 62% of residents selecting “review of foundational knowledge” and 54% of faculty selecting “application of concepts to practice.” However, residents and faculty aligned on their most desired and most used interactive teaching strategies respectively, with both groups selecting case-based learning, questioning, and discussions as their top three strategies. Alumni reported the three most important areas to cover in didactics were cerebrovascular diseases, neurological exam skills, and epilepsy. Residents reported the three strongest areas of our current curriculum were cerebrovascular diseases, neuroimmunology and neuromuscular medicine. Faculty and residents agreed the weakest areas of resident performance were in EMG and neuro-ophthalmology. Faculty additionally reported weakness in the business of medicine, while residents reported additional weakness in neuroanatomy.

CONCLUSIONS: The unique perspectives of residents, faculty, and alumni may allow us to bridge gaps between teachers and learners and ensure our residents are well-equipped for practice in a variety of settings and locations. Periodic surveying of the stakeholders can provide a pulse measurement of didactic curriculum as it pertains to both groups. Disclosure: Dr. Uysal has nothing to disclose. An immediate family member of Dr. Swetlik has received personal compensation for serving as an employee of Pfizer. Dr. Mays has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for CoolTech Medical. Dr. Mays has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Abbvie. The institution of Dr. Mays has received research support from Amgen. Dr. Soni has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Abbvie. Dr. Marquardt has nothing to disclose. Dr. Buletko has nothing to disclose. The institution of Dr. Ross has received research support from National MS Society.

PMID:39977924 | DOI:10.1212/WNL.0000000000208153

Neurology. 2024 Apr 9;102(7_supplement_1):3364. doi: 10.1212/WNL.0000000000205087. Epub 2024 Apr 9.

ABSTRACT

OBJECTIVE: To provide an artistic environment that strengthens connections between patients and healthcare providers in the setting of difficult clinical experiences.

BACKGROUND: The Synapses Art and Literary Magazine is a Back to Bedside Initiative project that provides a meaningful outlet for patients and providers to reflect on their experiences.

DESIGN/METHODS: This is a prospective observational study evaluating patients and providers before and after the creation of an artistic piece. Interested patients and providers are given art supplies during hospital admission along with a pre/post-survey. The art pieces are published in an institutionally approved Art Magazine. Patient surveys include the Patient Health Questionnaire-9 and Generalized Anxiety Disorder Questionnaire-7, while provider surveys include the Professional Fulfillment Index. A total of 45 art projects were completed by 43 medical providers and 2 patients. A total of 23 pre-surveys and 18 post-surveys were completed, and 16 projects were included when adjusted for missing data. The patients surveys were excluded due to inability to draw any statistical conclusions. Paired t-tests and linear regression were used for statistical analysis. Thematic analysis was used for evaluating free-response questions.

RESULTS: Statistical analysis showed an 8% significant increase in the mean value from the pre-survey to the post-survey in workplace happiness (9.18 vs 6.71, p=0.02), 11% increase in Self-Esteem (6.35 vs 7.18, p=0.001) and 9% increase in Connection with Patient (6.94 vs 7.65), p=0.01). Linear regression analysis revealed a positive association (R2=0.2606) between the increase in the self esteem of providers and positive connection with patients. Thematic analysis used for the qualitative portion of the data shows recurrent themes of increased connection and positive perception of illness.

CONCLUSIONS: This study shows that artistic expression as a reflective tool for providers is associated with an increase in self-esteem and interpersonal connection with patients. Larger focused studies are needed to further evaluate the proposed associations. Disclosure: Dr. Wilson has nothing to disclose. Miss Sblendorio has nothing to disclose. Dr. Pawar has nothing to disclose. Dr. Seachrist has stock in Medtronic. Dr. Seachrist has stock in Pfizer. The institution of Dr. Seachrist has received research support from Bristol Myers Squibb. Dr. Seachrist has a non-compensated relationship as a Topic Group, QOD Committee, and Wellness Program Committee with American Academy of Neurology that is relevant to AAN interests or activities. Dr. Peshwe has nothing to disclose. The institution of Dr. Frey has received research support from Tourette Association of America.

PMID:39977923 | DOI:10.1212/WNL.0000000000205087

Neurology. 2024 Apr 9;102(7_supplement_1):6885. doi: 10.1212/WNL.0000000000208155. Epub 2024 Apr 9.

ABSTRACT

OBJECTIVE: To analyze whether cerebrospinal fluid (CSF) biomarkers, such as total tau (t-Tau), phosphorylated tau (p-Tau), and amyloid-β42 (Aβ42), increase with sleep deprivation (SD).

BACKGROUND: Several studies have assessed CSF biomarkers associated with Alzheimer’s disease (AD) that could increase with SD; however, the results remain conflicting.

DESIGN/METHODS: We conducted a prognostic systematic review and meta-analysis of randomized and non-randomized studies evaluating SD of any type versus regular sleep patterns in patients without AD. This study was registered with PROSPERO (CRD42023453244). There were no restrictions on follow-up or age. We calculated the mean differences (MD) with 95% confidence intervals (CI) to compare continuous endpoints between the intervention and control arms. Cochran’s Q test and I² statistics were used to evaluate heterogeneity. We defined low heterogeneity as p > 0.10 and I² < 25%, moderate heterogeneity as I² between 25%-75%, and high heterogeneity as I² > 75%. The DerSimonian Laird random effects model was used to calculate the pooled effect estimates. Statistical significance was set at p ≤ 0.05. We conducted the statistical analyses using Review Manager 5.4 (Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark).

RESULTS: We searched PubMed, Embase, and Cochrane Library and found 27 studies. After screening and selection, following the Cochrane and PRISMA recommendations, 5 studies with 177 patients were included. Our analysis showed that SD increased p-Tau levels (MD 1.01, 95% CI 0.29 to 1.74, p=0.06, I² = 0%). However, SD was not associated with changes in Aβ42 (MD -9.57, 95% CI -89.92 to 70.78, p=0.815, I² = 61%) or t-Tau levels (MD 16.29, 95% CI -9.20 to 41.78, p=0.210, I² = 35%).

CONCLUSIONS: Sleep deprivation increased p-Tau, but not t-Tau nor Aβ42 in patients without AD. Disclosure: Mr. Berton has nothing to disclose. Mr. Moreira has nothing to disclose. Ms. Rodrigues has nothing to disclose. Miss Batista Donadon has nothing to disclose. Mrs. Dreon Calza has nothing to disclose. Mrs. Menegat has nothing to disclose. Mrs. Brkanitch has nothing to disclose. Miss Mattei has nothing to disclose. Mr. Dias has nothing to disclose. Mr. Guerra has nothing to disclose. Dr. Tonial has nothing to disclose.

PMID:39977921 | DOI:10.1212/WNL.0000000000208155

Neurology. 2024 Apr 9;102(7_supplement_1):6886. doi: 10.1212/WNL.0000000000208156. Epub 2024 Apr 9.

ABSTRACT

OBJECTIVE: Migraine affects about 14.4% of the population causing substantial burden. Our objective was to describe the populations of individuals diagnosed with migraine headache with regards to diagnosis and review healthcare service utilization across various categories.

DESIGN/METHODS: We reviewed recent (8/2018 – 7/2021) medical and pharmacy data from Health Verity for N=187,780. The final sample included 76,684 migraine cases matched to (matching criteria included demographic, geographic, comorbidity, and time-based variables) 76,684 non-migraine controls.

RESULTS: Within the migraine group, 68.4% were female (44.7 yrs, SD=13.9) vs. 69.7% female in the control group (45.6 yrs, SD=14.6). At baseline, migraine cases had higher rates of all-cause healthcare service utilization in each utilization subgroup: Migraine group was more likely to be hospitalized (10.4% vs. 4.5%*), have an Emergency Department (ED) visit (30.3% vs. 11.9%*), have a primary care physician visit (88.1% vs. 54.4%*), have a neurology visit (20.3% vs. 2.0%*), have higher overall use of other medical services, and have higher prescription fill rates (21.3 fills vs 9.53*) (*= p < 0.05). Similar differences were noted during the follow-up period, with migraine cases having higher rates of all-cause healthcare service utilization in each utilization subgroup. Notably, Neurology visits were 12.2 times more likely among the migraine case group compared to the control group, followed by other outpatient visits (OR: 9.5*), prescription fills (OR: 8.8*), PCP visits (OR: 6.9*), inpatient hospitalizations (OR: 3.4*), and ED visits (OR: 2.9*).

CONCLUSIONS: Migraine groups experienced significantly higher rates of healthcare service utilization across various categories, including hospitalization, ED and PCP visits, neurology consultations, and prescription fill rates underscoring continuous need to enhance the management of this condition. Disclosure: Dr. Petrova has nothing to disclose. Miss Besedina has received personal compensation for serving as an employee of Click Therapeutics Inc.. Mr. Hare has received personal compensation for serving as an employee of Click Therapeutics. Dr. Gupta has received personal compensation for serving as an employee of Click Therapeutics. Dr. Lakhan has received personal compensation for serving as an employee of Zogenix, Fern Health, Thriveworks, The Learning Corp, Click Therapeutics. Dr. Lakhan has received personal compensation in the range of $1,000,000+ for serving as a Consultant for Shaheen Lakhan, MD, PhD, LLC. Dr. Lakhan has received personal compensation in the range of $100,000-$499,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Neurocrine, Fern Health, Lin Health. Dr. Lakhan has received personal compensation in the range of $500,000-$999,999 for serving as an officer or member of the Board of Directors for Click Therapeutics, SpineThera. Dr. Lakhan has stock in Zogenix, NeuroSport, Click Therapeutics, SpineThera.

PMID:39977919 | DOI:10.1212/WNL.0000000000208156