Neurology Service

Miami, FL, United States

Neurology Service

Miami, FL, United States
Time filter
Source Type

Wallace D.M.,University of Miami | Ramos A.R.,Neurology Service | Rundek T.,University of Miami
International Journal of Stroke | Year: 2012

The purpose of this review is to highlight existing literature on the epidemiology, pathophysiology, and treatments of stroke sleep disorders. Stroke sleep disorders are associated with many intermediary vascular risk factors leading to stroke, but they may also influence these risk factors through direct or indirect mechanisms. Sleep disturbances may be further exacerbated by stroke or caused by stroke. Unrecognized and untreated sleep disorders may influence rehabilitation efforts and poor functional outcomes following stroke and increase risk for stroke recurrence. Increasing awareness and improving screening for sleep disorders is paramount in the primary and secondary prevention of stroke and in improving stroke outcomes. Many vital questions about the relationship of sleep disorders and stroke are still unanswered and await future well-designed studies. © 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.

Deal is first stemming from Northwell partnership with Enterprise Ireland signed Dec. 2 NEW YORK, NY--(Marketwired - December 07, 2016) - After signing an agreement on Friday that allows clients of Enterprise Ireland to supply it with innovative goods and services, Northwell Health today announced that the new partnership has already produced its first deal. New York's largest health care provider has signed an agreement with Kerry-based Salaso Health Solutions Limited to offer online care management services to patients. Northwell Health's Department of Neurology will utilize Salaso's innovative patient engagement solutions to offer online physical therapy services to victims of stroke, movement disorders and other neurological conditions. Other clinical service lines within Northwell are also in discussions with the company. "We are excited about our partnership with Salaso and believe their online physical therapy solution will enhance the quality and experience of care for our patients," said Souhel Najjar, MD, senior vice president and executive director of Northwell's Neurology Service Line, and chair and professor of neurology at the Hofstra Northwell School of Medicine. Based on evidence-based protocols, the Salaso platform uses individualized exercise videos that are prescribed by physicians, therapists, exercise physiologists, nurse practitioners and other clinicians to benefit their patients' recovery from a range of diseases and conditions. Patients report their compliance and progress through a mobile app, including their pain and effort levels, and other measures that help evaluate whether they are improving. Health care professionals are able to review patients' feedback remotely to help determine if patients are complying with the therapy and progressing in their recovery. "Having the opportunity to partner with Northwell Health, a leading U.S hospital system, has been instrumental in the international expansion of Salaso," said Aoife NiMhuiri, chief executive officer of Salaso Health Solutions. "The innovative and patient centric approach to care at Northwell Health is key to optimizing the patient engagement solutions developed by Salaso. We very much look forward to developing our relationship with Northwell Health further in 2017 and beyond." Salaso has partnered globally with panels of academic and clinical experts across many facets of health care to support research interventions in exercise prescription for multiple disease areas. The company has developed a content library of evidence-based exercises and physical activity protocols for use across multiple clinical disciplines. Salaso is the first Enterprise Ireland client to contract with Northwell Health following a ceremony on Friday at the Irish Consulate in Manhattan, where the two organizations signed a partnership agreement in the presence of Ireland Taoiseach Enda Kenny, who visited the US last week. Northwell Health is New York State's largest health care provider and private employer, with 21 hospitals and over 500 outpatient practices. We care for more than 1.8 million people annually in the metro New York area and beyond, thanks to philanthropic support from our communities. Our 61,000 employees -- including 15,000+ nurses and nearly 4,000 + doctors within Northwell Health Physician Partners -- are working to change health care for the better. We're making breakthroughs in medicine at the Feinstein Institute. We're training the next generation of medical professionals at the visionary Hofstra Northwell School of Medicine and the School of Graduate Nursing and Physician Assistant Studies. And we offer health insurance through CareConnect. For information on our more than 100 medical specialties, visit Salaso Health Solutions Limited ( is a connected heath technology company providing innovative patient engagement solutions which incorporate a multimedia based clinical care management platform. Salaso's online care management platform and mobile apps support patients in building prescribed exercise routines into daily habits. Underpinned by eLearning and behavioral change principles, Salaso improves patient education and empowers patients in self-care and self-management, resulting in longer-term adherence to exercise programs and better outcomes, improving efficiency of the healthcare service being delivered. Enterprise Ireland is the Irish State agency that works with Irish enterprises to help them start, grow, innovate and win export sales in global markets. Enterprise Ireland partners with entrepreneurs, Irish businesses, and the research and investment communities to develop Ireland's international trade, innovation, leadership and competitiveness. In this way, we support sustainable economic growth and regional development, and help create and sustain employment in Ireland.

Elder G.A.,Neurology Service | Elder G.A.,Mount Sinai School of Medicine | Stone J.R.,University of Virginia | Ahlers S.T.,Naval Medical Research Center
Frontiers in Neurology | Year: 2014

High-pressure blast waves can cause extensive CNS injury in human beings. However, in combat settings, such as Iraq and Afghanistan, lower level exposures associated with mild traumatic brain injury (mTBI) or subclinical exposure have been much more common. Yet controversy exists concerning what traits can be attributed to low-level blast, in large part due to the difficulty of distinguishing blast-related mTBI from post-traumatic stress disorder (PTSD). We describe how TBI is defined in human beings and the problems posed in using current definitions to recognize blast-related mTBI. We next consider the problem of applying definitions of human mTBI to animal models, in particular that TBI severity in human beings is defined in relation to alteration of consciousness at the time of injury, which typically cannot be assessed in animals. However, based on outcome assessments, a condition of "low-level" blast exposure can be defined in animals that likely approximates human mTBI or subclinical exposure. We review blast injury modeling in animals noting that inconsistencies in experimental approach have contributed to uncertainty over the effects of low-level blast. Yet, animal studies show that low-level blast pressure waves are transmitted to the brain. In brain, low-level blast exposures cause behavioral, biochemical, pathological, and physiological effects on the nervous system including the induction of PTSD-related behavioral traits in the absence of a psychological stressor. We review the relationship of blast exposure to chronic neurodegenerative diseases noting the paradoxical lowering of Abeta by blast, which along with other observations suggest that blast-related TBI is pathophysiologically distinct from non-blast TBI. Human neuroimaging studies show that blast-related mTBI is associated with a variety of chronic effects that are unlikely to be explained by co-morbid PTSD. We conclude that abundant evidence supports low-level blast as having long-term effects on the nervous system. © 2014 Elder, Stone and Ahlers.

Elder G.A.,Neurology Service | Elder G.A.,Mount Sinai School of Medicine | Dorr N.P.,Mount Sinai School of Medicine | De Gasperi R.,Mount Sinai School of Medicine | And 6 more authors.
Journal of Neurotrauma | Year: 2012

Blast related traumatic brain injury (TBI) has been a major cause of injury in the wars in Iraq and Afghanistan. A striking feature of the mild TBI (mTBI) cases has been the prominent association with post-traumatic stress disorder (PTSD). However, because of the overlapping symptoms, distinction between the two disorders has been difficult. We studied a rat model of mTBI in which adult male rats were exposed to repetitive blast injury while under anesthesia. Blast exposure induced a variety of PTSD-related behavioral traits that were present many months after the blast exposure, including increased anxiety, enhanced contextual fear conditioning, and an altered response in a predator scent assay. We also found elevation in the amygdala of the protein stathmin 1, which is known to influence the generation of fear responses. Because the blast overpressure injuries occurred while animals were under general anesthesia, our results suggest that a blast-related mTBI exposure can, in the absence of any psychological stressor, induce PTSD-related traits that are chronic and persistent. These studies have implications for understanding the relationship of PTSD to mTBI in the population of veterans returning from the wars in Iraq and Afghanistan. © Copyright 2012, Mary Ann Liebert, Inc. 2012.

Elder G.A.,Neurology Service | Elder G.A.,Mount Sinai School of Medicine | Mitsis E.M.,Mount Sinai School of Medicine | Mitsis E.M.,James ters Veterans Affairs Medical Center | And 3 more authors.
Psychiatric Clinics of North America | Year: 2010

Traumatic brain injury (TBI) has been a major cause of mortality and morbidity in the wars in Iraq and Afghanistan. Blast exposure has been the most common cause of TBI, occurring through multiple mechanisms. What is less clear is whether the primary blast wave causes brain damage through mechanisms that are distinct from those common in civilian TBI and whether multiple exposures to low-level blast can lead to long-term sequelae. Complicating TBI in soldiers is the high prevalence of posttraumatic stress disorder. At present, the relationship is unclear. Resolution of these issues will affect both treatment strategies and strategies for the protection of troops in the field. © 2010.

Wallace D.M.,Neurology Service | Wallace D.M.,University of Miami | Wohlgemuth W.K.,University of Miami
Journal of Clinical Sleep Medicine | Year: 2014

Background: Little is known about the association of race-ethnicity and the relationship of continuous positive airway pressure (CPAP) adherence with functional outcomes of sleep in American samples with obstructive sleep apnea syndrome (OSAS). This retrospective study examines whether race-ethnicity moderates the relationship between CPAP adherence and functional outcomes of sleep in OSAS. Methods: Over 4 months, consecutive OSAS patients had CPAP data downloads and completed questionnaires (demographics, Functional Outcomes of Sleep Questionnaire [FOSQ], Epworth Sleepiness Scale [ESS], Insomnia Severity Index [ISI]) at the Miami VA sleep center. Medical diagnoses and polysomnography data were obtained from medical record. CPAP adherence was measured as mean daily hours of use. Hierarchical regression modeling was used to explore the differential impact of race-ethnicity and CPAP adherence on functional outcomes of sleep. Results: Two hundred twenty-seven veterans (93% male, age 59 ± 11 years) were included; 142 (63%) participants self-reported as white or Hispanic, and 85 participants (37%) as black. Hierarchical regression analyses failed to show main effects for race-ethnicity or CPAP use and FOSQ scores; however, the interaction of race-ethnicity with CPAP adherence was significantly associated with the total FOSQ (p = 0.04), Social (p = 0.02), and Intimacy (p = 0.01) subscale scores. For blacks, in adjusted analyses, CPAP adherence was positively associated with Social and Intimacy FOSQ subscales; however, no significant relationship was noted between CPAP use and FOSQ scores in whites/Hispanics. Conclusions: Race-ethnicity may moderate the relationship between CPAP adherence and some functional outcomes of sleep; however, further studies are needed.

Elder G.A.,Neurology Service | Elder G.A.,Mount Sinai School of Medicine
Current Neurology and Neuroscience Reports | Year: 2015

Traumatic brain injury (TBI) is a common cause of morbidity and mortality in military life. Interest in military TBI has increased recently due to the conflicts in Iraq and Afghanistan. Certain types of TBI are relatively unique to the military, the most prominent being blast-related TBI. Blast-related mild TBI has been of particular concern in veterans from the most recent conflicts although controversy remains concerning its separation from post-traumatic stress disorder. TBI is also a risk factor for the later development of neurodegenerative diseases in which cognitive impairment is prominent putting veterans at risk for disorders including Alzheimer’s disease and chronic traumatic encephalopathy. Recent evidence associating TBI with chronic cognitive impairment is reviewed in the context of its relevance to military veterans. © 2015, Springer Science+Business Media New York (outside the USA).

Wallace D.M.,University of Miami | Shafazand S.,University of Miami | Aloia M.S.,National Jewish Health | Wohlgemuth W.K.,Neurology Service
Journal of Clinical Sleep Medicine | Year: 2013

Study Objectives: Studies of continuous positive airway pressure (CPAP) adherence in multi-ethnic samples are lacking. This study explores previously described factors associated with therapeutic CPAP use in South Florida veterans with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods: We performed a retrospective, cross-sectional analysis of CPAP adherence comparing white, black, and Hispanic veterans returning to the Miami VA sleep clinic over a 4-month period. Participants had CPAP use download and completed questionnaires on demographics, sleepiness, insomnia, and social cognitive measures related to adherence. Linear regression modeling was used to explore the impact of measured variables and potential interactions with race-ethnicity on mean daily CPAP use. Results: Participants (N = 248) were 94% male with mean age of 59 ± 11 years and included 95 blacks (38%), 91 whites (37%), and 62 Hispanic (25%) veterans. Blacks had less mean daily CPAP use than whites (-1.6 h, p < 0.001) and Hispanics (-1.3 h, p < 0.01). Blacks reported worse sleep onset insomnia symptoms compared to whites. In the final multivariable regression model, black race-ethnicity (p < 0.01), insomnia symptoms (p < 0.001), and self-efficacy (p < 0.001) were significantly associated with mean daily CPAP use. In addition, the black race by age interaction term showed a trend towards significance (p = 0.10). Conclusions: In agreement with recent studies, we found that mean daily CPAP use in blacks was 1 hour less than whites after adjusting for covariates. No CPAP adherence differences were noted between whites and Hispanics. Further investigations exploring sociocultural barriers to regular CPAP use in minority individuals with OSAHS are needed.

Charan R.A.,Neurology Service | Charan R.A.,University of Pittsburgh | Hanson R.,University of Pittsburgh | Clemens P.R.,Neurology Service | Clemens P.R.,University of Pittsburgh
FASEB Journal | Year: 2012

Duchenne muscular dystrophy (DMD) is caused by the lack of a functional dystrophin protein that results in muscle fiber membrane disruption and, ultimately, degeneration. Regeneration of muscle fibers fails progressively, and muscle tissue is replaced with connective tissue. As a result, DMD causes progressive limb muscle weakness and cardiac and respiratory failure. The absence of dystrophin from muscle fibers triggers the chronic activation of the nuclear factor of kappa B (NF-κB). Chronic activation of NF-κB in muscle leads to infiltration of macrophages, up-regulation of the ubiquitin-proteosome system, and downregulation of the helix-loop-helix muscle regulatory factor, MyoD. These processes, triggered by NF-κB activation, promote muscle degeneration and failure of muscle regeneration. A20 (TNFAIP3) is a critical negative regulator of NF-κB. In this study, we characterize the role of A20 in regulating NF-κB activation in skeletal muscle, identifying a novel role in muscle regeneration. A20 is highly expressed in regenerating muscle fibers, and knockdown of A20 impairs muscle differentiation in vitro, which suggests that A20 expression is critically important for regeneration of dystrophic muscle tissue. Furthermore, down-regulation of the classic pathway of NF-κB activation is associated with up-regulation of the alternate pathway in regenerating muscle fibers, suggesting a mechanism by which A20 promotes muscle regeneration. These results demonstrate the important role of A20 in muscle fiber repair and suggest the potential of A20 as a therapeutic target to ameliorate the pathology and clinical symptoms of DMD. © FASEB.

Rey V.,Neurology Service | Faouzi M.,University of Lausanne | Huchmand-Zadeh M.,Neurology Service | Michel P.,Neurology Service
European Journal of Neurology | Year: 2011

Background: Socioeconomic status is thought to have a significant influence on stroke incidence, risk factors and outcome. Its influence on acute stroke severity, stroke mechanisms, and acute recanalisation treatment is less known. Methods: Over a 4-year period, all ischaemic stroke patients admitted within 24h were entered prospectively in a stroke registry. Data included insurance status, demographics, risk factors, time to hospital arrival, initial stroke severity (NIHSS), etiology, use of acute treatments, short-term outcome (modified Rankin Scale, mRS). Private insured patients (PI) were compared with basic insured patients (BI). Results: Of 1062 consecutive acute ischaemic stroke patients, 203 had PI and 859 had BI. They were 585 men and 477 women. Both populations were similar in age, cardiovascular risk factors and preventive medications. The onset to admission time, thrombolysis rate, and stroke etiology according to TOAST classification were not different between PI and BI. Mean NIHSS at admission was significantly higher for BI. Good outcome (mRS≤2) at 7days and 3months was more frequent in PI than in BI. Conclusion: We found better outcome and lesser stroke severity on admission in patients with higher socioeconomic status in an acute stroke population. The reason for milder strokes in patients with better socioeconomic status in a universal health care system needs to be explained. © 2010 The Author(s). European Journal of Neurology © 2010 EFNS.

Loading Neurology Service collaborators
Loading Neurology Service collaborators