We are happy to report that Monmouth’s stoke program was well represented at the 2014 New Jersey Stroke Conference earlier this month.
Two department of medicine residents, Drs Amor and Chan, presented our TIA center data in the poster session:
Dr Holland gave a talk on the role of telemedicine in stroke rehabilitation.
Our first tremor patient treated with gamma knife radiosurgery recently came back, one year later, to have the other side treated.
He has essential tremor, which was affecting both arms.
He had undergone treatment to the left brain for right sided tremor last year.
He was so pleased with his results, he recently came to have the right brain treated to address the left sided tremor.
Here is his most recent video.
Note the action and postural tremor on the left (untreated) side, and the fact that he has almost not residual tremor on the right (treated) side.
The device, which is similar to an electric toothbrush, consists of a detachable spoon, a motion-generating platform, a controller/sensor, and a rechargeable battery. It detects the frequency of the patient’s tremor, and then counteracts that motion, to keep the spoon stable.
Patients in the study still had tremor, but they were less likely to spill their food when eating with the spoon.
The device is now commercially available, and costs around $295.
We are trying to do a better job educating our patients about the warning signs of stroke, and that if they think they might be having a stroke they should act FAST and call 911 to get to the ER as soon as possible.
However, despite these efforts only 5% of US stroke patients get to the ER in time to receive clot busting therapy to treat their stroke. Furthermore, the quicker the drug is given, the better the outcome, TIME IS BRAIN!
We would like to see patients getting treated within one hour of the onset of their stroke, but because of the time it takes to get to the hospital and get evaluated in the ER this is rarely possible.
A pilot study in Texas is looking at getting stroke therapy administered faster by bringing the ER to the stroke patient.
The project brings a mobile CT scanner and a stroke neurologist (via telemedicine) to the patient in a specially equipped ambulance. The investigators hope to see stroke patients getting treated faster and improved outcomes.
How it this possible?
Well, the genetic code which is translated to from proteins “talks” in words made of three letters (base pairs).
A gene mutation that deletes only one or two base pairs, or worse still signals the end of the word (known a “premature stop codon”) will result it a very abnormal dysfunctional gene product, leading to complete deficiency of functioning dystrophin, and the more severe Duchenne Muscular Dystrophy.
However a gene mutation (deletion) that removes base pairs in a multiples of three is called an in-frame mutation, and causes a (sometimes only minor) qualitative change in the dystrophin protein, leading to the milder Becker’s muscular dystrophy.
Ataluren (also known as PTC124) is a small molecule designed to overcome premature stop codons.
Put simply, the idea is that it might convert some Duchenne boys in to a milder form (more like Becker’s) of muscular dystrophy by allowing them to produce some more normal dystrophin.
The drug can only help boys affected with premature stop codons confirmed by DNA testing.