Neurology 2019 Projects

Project Title: Case Review of Myotonic Dystrophy Patients

Faculty Mentor’s Name: Dr. Miguel Chuquilin
Phone: 314-322-6363
Email: miguel.chuquilin@neurology.ufl.edu

Student’s Name: Gabrielle Young
Email: younggaby@ufl.edu

Project Description:

Myotonic dystrophy is the most common muscular dystrophy in adults. Although the name suggests only a muscular involvement, myotonic dystrophy is a systemic disease, affecting different body functions. There are 2 types of myotonic dystrophy: type 1 (most common) and type 2. The goal of this project is to compare different characteristics/variables of patients with myotonic dystrophy type 1 and 2 seen in our institution for the last few years. The student(s) will help on creating a database of patients with myotonic dystrophy type 1 and type 2 that includes different variables, including clinical and history findings, test results, electromyography results, genetic testing, sleep study results, etc. from a list of patients already available. The student then can be involved in the write up of a case series comparing both types of myotonic dystrophy in our institution and also other studies that can be mined from the database.

Project Title: Monocular Viewing, Influence on Global Versus Focal Attention

Faculty Mentor’s Name: Dr. Kenneth Heilman
Email: heilman@neurology.ufl.edu

Student’s Name: David Drucker
Email: david.drucker@ufl.edu

Project Description:

In a recent study Rodriguez et al., (2018) found, that when healthy participants attempt to bisect vertical lines, there is an upward bias. In addition, when lines were eccentrically placed on a paper (e.g., toward the top or bottom), but the middle of the paper was at eye level, healthy young participants were distracted by the page. Their attempted bisections deviated toward the middle of the page and this deviation was greater when the lines were placed toward the top of the page than when placed toward the bottom of the page. Monocular viewing can alter hemispheric activation, but it is unknown if left versus right eye monocular viewing can alter vertical and horizontal global versus focal attention. The operating hypothesis of this study is that right versus left monocular viewing will alter vertical or horizontal distractibility.

The aim of this project is to contribute to the growing body of research with goal of elucidating the neuronal mechanisms that govern visual and spatial processing and the lateralization of such processes. The novelty of this particular project explores these processes under the condition of monocular viewing.

Project Title: Neuro-modulatory medication to manage cortical spreading depolarization in aneurysmal subarachnoid hemorrhage

Faculty Mentor’s Name: Katharina Busl
Phone: 352-294-8453
Email: katharina.busl@neurology.ufl.edu

Student’s Name: Chad Jones
Email: chadhjones@ufl.edu

Project Description:

Aneurysmal subarachnoid hemorrhage is a serious life-threatening condition that can affect multiple body systems and require complex medical decision-making by a multidisciplinary team in the Neurological Intensive Care Unit. Patients with aneurysmal subarachnoid hemorrhages often present acutely with headaches, in addition to other neurological findings. To further complicate matters, a condition called vasospasm is known to develop in this population, which may also cause and exacerbate headaches. In this patient population, a phenomenon called cortical spreading depolarization is hypothesized to result in vasospasm.

The purpose of this study is to examine the following aims:

Aim #1: Identify opiate usage during hospital stay for patients who have aneurysmal subarachnoid hemorrhage

Aim #2: Identify pain score at admission and during hospital stay

Aim #3: Identify whether patients who receive neuro-modulatory and migraine medications have decreased opiate requirement during hospitalization compared to patients that did not receive this class of medications

Medical record numbers of patients with a diagnosis of aneurysmal subarachnoid hemorrhage who presented directly to the UFHealth Comprehensive Stroke Center between January 2012 and January 2019 will be obtained from the database kept by the UFHealth Stroke Program for quality improvement. We will review these patients’ charts in the UFHealth electronic medical record (EPIC) to abstract demographic, clinical, laboratory, and radiographic data from hospital admission note, progress notes, discharge summaries, clinic notes, nursing notes, laboratory data, and radiological studies (both from the official neuroradiology report and direct visualization of these studies in the medical record).

Project Title: Opiate use after aneurysmal subarachnoid hemorrhage in the neuro ICU

Faculty Mentor’s Name: Katharina Busl
Phone: 352-294-8453
Email: katharina.busl@neurology.ufl.edu

Student’s Name: Gabrielle Aiello
Email: gaiello11@ufl.edu

Project Description:

Aneurysmal subarachnoid hemorrhage (SAH) is a potentially life-threatening condition that is often associated with an acute severe headache followed by chronic headache that can persist long after the patient leaves the hospital. In the Neuro-ICU, opioids are often used to control the pain experienced by these patients. Concerns over the side effects of opioids and the potential for addiction have led to studies on potential alternative pain control measures such as gabapentin, but opioids are still the mainstay of pain control (Dhakal et al, 2015). However, patients still often report inadequate pain control, and data on optimal opioid dosing regimens are lacking (Glisic et al, 2016).

In recent years, increasing awareness of the opioid epidemic has created increased scrutiny over the number of opioids prescribed to patients. Considering this, there is increased pressure among healthcare providers to assure that the amount and frequency of opioids prescribed does not far exceed what is deemed medically necessary. Previous studies have shown a significant decrease in opioids prescribed in the United States from 2010 to 2015 (Guy et al, 2017). In SAH patients, it is not well characterized whether prescribing patterns have changed significantly in recent years and how that may contribute to adequacy of pain control.

People with subarachnoid hemorrhage have a tremendous amount of pain. This has been traditionally treated with opioids. However, in light of concerns over the prevalence of opioid addiction and resulting changes in policy, pain regiments have changed in recent years. Between 2012 and 2018 there is a difference in discharge medication patterns of opioids. Departments comply with these new rules and there are guidelines within institutions. In analyzing opioid prescriptions at discharge in 2012 and 2018, we expect to see variation between prescriptions and a decline in prescriptions over time. The specific aims of this project include defining the amount of opioid pain medications prescribed at discharge in patients recovering from subarachnoid hemorrhage. We also wish to show that, with the opioid crisis, prescription patterns have changed.

Project Title: Pain control in patients with subarachnoid hemorrhage in the neuro ICU

Faculty Mentor’s Name: Katharina Busl
Phone: 352-294-8453
Email: katharina.busl@neurology.ufl.edu

Student’s Name: Youlei Li
Email: youlei.li@ufl.edu

Project Description:

Background: Headache management is a major challenge in subarachnoid hemorrhage (SAH) patients. Over 90% of SAH survivors are plagued by severe headaches, frequently beyond the hospital stay. Data on optimal management are lacking. Opioids remain the mainstay of acute therapy; however, sedation, and high potential for tachyphylaxis and addiction are major therapeutic limitations. Our long-term goal is to improve headache management while reducing opioid prescription in SAH.
Hypothesis: Current pain control is reliant on variable but overall high doses of opiates with inadequate pain control.
Methods: retrospective chart review, descriptive analysis: characterize current patterns of pain control during hospital stay for patients with SAH (Hunt and Hess Grade 1-3), its effectiveness, and their discharge regimen for pain control
Role for medical student: chart review, data organization, participation in manuscript preparation

Project Title: Parkinson’s Disease Subtypes: Clinical Outcomes Following Deep Brain Stimulation

Faculty Mentor’s Name: Michael S. Okun
Email: okun@neurology.ufl.edu

Student’s Name: Ziqi Wang
Email: zwang12@ufl.edu

Project Description:

Parkinson’s disease (PD) is a neurodegenerative disorder characterized pathologically by the loss of dopaminergic neurons in the substantia nigra and intracellular aggregates of the protein alpha-synuclein across multiple basal ganglia circuits. PD has long been recognized as a clinically heterogeneous disorder and has been traditionally categorized into two main subtypes based on motor symptoms: 1) tremor-dominant (TD) and 2) postural instability and gait difficulty (PIGD).[1] PD has also been categorized into subtypes based on age of onset: young onset PD (YOPD; aged 20-40 years) and late-onset PD (LOPD; over 60 years of age).[1] Generally, PD patients with the TD subtype tend to exhibit younger age of onset (20-40 years), tremor, and slower disease progression.[1] In contrast, PIGD patients tend to have older age of onset (after 60 years), with rigidity and bradykinesia as well as more accelerated disease progression.[1] The PIGD subtype is commonly associated with a worse overall clinical prognosis than TD, including a higher incidence of dementia as well as psychiatric symptoms such as depression and apathy.[1] In addition, there are also patients who exhibit a mixture of these subtypes and can be classified as having “mixed” or “intermediate” PD.[2]

Deep Brain Stimulation (DBS) is a safe, well-established therapy for treating the motor symptoms of PD patients.[3] It involves the implantation of electrodes and subsequent high-frequency electrical stimulation of targets of the brain thought to be involved in producing the motor symptoms of PD.[4] The most commonly targeted sites in the brain for DBS are the subthalamic nucleus (STN) and the globus pallidus interna (GPi).[5] Candidates for DBS surgery include patients with medically refractory tremor, who are responsive to dopaminergic therapy, and who do not have severe cognitive impairment or psychiatric disorders.[5] Although there is insufficient evidence to suggest that DBS alters the progression of PD, DBS has been shown to provide long-term control of tremor and motor fluctuations.[6]

The specific aims of the proposed project are:

1.) To determine the most accepted set of clinical criteria for differentiating PD subtypes. This will be accomplished through a detailed PubMed literature search.

2.) To establish an algorithm to filter DBS patients in the UF INFORM database based on the most accepted clinical criteria for PD subtypes.

3.) To perform a retrospective analysis of patient DBS clinical outcomes separated by PD subtype and to characterize long-term trends and differences among the groups in terms of medication requirements, motor changes, quality of life, weight, and psychiatric symptoms.

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