Recent publications from the Providence Brain and Spine Institute

Stroke

Morrell K, Hyers M, Stuchiner T, Lucas L, Schwartz K, Mako J, Spinelli KJ, Yanase L. (2017) Telehealth Stroke Dysphagia Evaluation Is Safe and Effective. Cerebrovasc Dis 44(3-4):225-231.
https://www.ncbi.nlm.nih.gov/pubmed/28848110

Up to 70% of patients who suffer a stroke are at risk for swallowing problems (dysphagia) which can leave them unable to eat or drink safely. Once dysphagia has been identified, a patient is seen by a speech language pathologist (SLP), ideally within 24 hours, to help them get on a safe diet. In this study, we validated the safety and efficacy of a teleswallow evaluation conducted by a remote SLP and an in-room nursing assistant, via telemedicine robot. This technology will be particularly impactful for stroke patients in remote and rural hospitals where an SLP may not be available, by allowing them to remain in their communities to receive care.

Jauch E, Barreto A, Broderick K, Char D, Cucchiara B, Haddock A, Hicks W, Hiestand B, Jickling G, June J, Liebeskind D, Lowenkopf T, Miller J, O'Neill J, Schoonover T, Sharp F, Peacock W. (2017) Biomarkers of Acute Stroke Etiology (BASE) Study Methodology. Transl Stroke Res 8: 424.
https://www.ncbi.nlm.nih.gov/pubmed/28477280

Acute ischemic stroke affects over 800,000 US adults annually, with hundreds of thousands more experiencing a transient ischemic attack. Emergent evaluation, prompt acute treatment, and identification of stroke or TIA (transient ischemic attack) etiology for specific secondary prevention are critical for decreasing further morbidity and mortality of cerebrovascular disease. The Biomarkers of Acute Stroke Etiology (BASE) study is a multicenter observational study to identify serum markers defining the etiology of acute ischemic stroke. Observational trial of patients presenting to the hospital within 24 h of stroke onset. Blood samples are collected at arrival, 24, and 48 h later, and RNA gene expression is utilized to identify stroke etiology marker candidates. The BASE study began January 2014. At the time of writing, there are 22 recruiting sites. Enrollment is ongoing, expected to hit 1000 patients by March 2017. The BASE study could potentially aid in focusing the initial diagnostic evaluation to determine stroke etiology, with more rapidly initiated targeted evaluations and secondary prevention strategies.

Dancer S, Brown A, Yanase L. (2017) National Institutes of Health Stroke Scale in plain English is reliable for novice users with minimal training. J Emerg Nurs 43(3):221-227.
https://www.ncbi.nlm.nih.gov/pubmed/28359710

The National Institutes of Health Stroke Scale (NIHSS) is commonly used in Comprehensive Stroke Centers, but it has not been easily implemented in smaller centers. The aim of this study was to assess whether nurse providers who were naive to stroke assessment scales could obtain accurate stroke severity scores using our previously validated NIH Stroke Scale in Plain English (NIHSS-PE) with minimal or no training.

Multiple Sclerosis

Smoot K, Spinelli KJ, Stuchiner T, Lucas L, Chen C, Grote L, Baraban E, Kresa-Reahl K, Cohan S. (2017) Three-year clinical outcomes of relapsing multiple sclerosis patients treated with dimethyl fumarate in a United States community health center. Mult Scler 2017 May 1. Epub ahead of print.
https://www.ncbi.nlm.nih.gov/pubmed/28537110

In this post-approval study of dimethyl fumarate (DMF) for treatment of relapsing MS, we report clinical outcomes from patients in our community hospital DMF registry over the past three years. Compared to the clinical trials, our patients had higher rates of discontinuation and lymphopenia. These results will aid in clinical decision-making for the real-world MS patient.

Cohan S, Kappos L, Giovannoni G, Wiendl H, Selmaj K, Havrdova E, Rose J, Greenberg S, Phillips G, Ma W, Wang P, Lima G, Sabatella G. (2017) Efficacy of daclizumab beta versus intramuscular interferon beta-1a on disability progression across patient demographic and disease activity subgroups in DECIDE. Mult Scler 2017 Oct 1. Epub ahead of print.
https://www.ncbi.nlm.nih.gov/pubmed/28984179

BACKGROUND: Demonstration of clinical benefits on disability progression measures is an important attribute of effective multiple sclerosis (MS) treatments.
OBJECTIVE: Examine efficacy of daclizumab beta versus intramuscular (IM) interferon beta-1a on measures of disability progression in patient subgroups from DECIDE.
METHODS: Twenty-four-week confirmed disability progression (CDP), 24-week sustained worsening on a modified Multiple Sclerosis Functional Composite (MSFCS) where 3-Second Paced Auditory Serial Addition Test was replaced by Symbol Digit Modalities Test, and proportion of patients with clinically meaningful worsening in 29-Item Multiple Sclerosis Impact Scale physical impact subscale (MSIS-29 PHYS) score from baseline to week 96 were examined in the overall population and subgroups defined by baseline demographic/disease characteristics.
RESULTS: Daclizumab beta significantly reduced risk of 24-week CDP (hazard ratio (HR), 0.73; 95% confidence interval (95% CI), 0.55-0.98), risk of 24-week sustained MSFCS progression (HR, 0.80; 95% CI, 0.67-0.95), and odds of clinically meaningful worsening in MSIS-29 PHYS (odds ratio, 0.76; 95% CI, 0.60-0.95) versus IM interferon beta-1a. Point estimates showed trends favoring daclizumab beta over IM interferon beta-1a across several patient subgroups for all three outcome measures.
CONCLUSION: Daclizumab beta showed consistent benefit versus IM interferon beta-1a across measures assessing patient disability/function and across a range of clinical baseline characteristics in patients with relapsing-remitting MS.

Benedict RH, Cohan S, Lynch SG, Riester K, Wang P, Castro-Borrero W, Elkins J, Sabatella G. (2017) Improved cognitive outcomes in patients with relapsing remitting multiple sclerosis treated with daclizumab beta: Results from the DECIDE study. Mult Scler 2017 May 1. Epub ahead of print/
https://www.ncbi.nlm.nih.gov/pubmed/28485186

BACKGROUND: Cognitive impairment is common in multiple sclerosis (MS), with cognitive processing speed being the most frequently affected domain.
OBJECTIVE: Examine the effects of daclizumab beta versus intramuscular (IM) interferon (IFN) beta-1a on cognitive processing speed as assessed by Symbol Digit Modalities Test (SDMT).
METHODS: In DECIDE, patients with relapsing-remitting multiple sclerosis (RRMS) (age: 18-55 years; Expanded Disability Status Scale (EDSS) score 0-5.0) were randomized to daclizumab beta ( n = 919) or IM IFN beta-1a ( n = 922) for 96-144 weeks. SDMT was administered at baseline and at 24-week intervals.
RESULTS: At week 96, significantly greater mean improvement from baseline in SDMT was observed with daclizumab beta versus IM IFN beta-1a ( p = 0.0274). Significantly more patients treated with daclizumab beta showed clinically meaningful improvement in SDMT (increase from baseline of ⩾3 points ( p = 0.0153) or ⩾4 points ( p = 0.0366)), and significantly fewer patients showed clinically meaningful worsening (decrease from baseline of ⩾3 points ( p = 0.0103)). Odds representing risk of worsening versus stability or improvement on SDMT were significantly smaller for daclizumab beta ( p = 0.0088 (3-point threshold); p = 0.0267 (4-point threshold)). In patients completing 144 weeks of treatment, the effects of daclizumab beta were generally sustained.
CONCLUSION: These results provide evidence for a benefit of daclizumab beta versus IM IFN beta-1a on cognitive processing speed in RRMS.
TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT01064401