Official AANN Journal Introduces iPad App Edition to Aid Practitioners with Fast,
Convenient Access to the Research

Philadelphia PA (March 7, 2013) – The American Association of Neuroscience Nurses (AANN) will celebrate its 45^th Annual Education Conference designed to help neuroscience nurses explore the critical, evidence-based information of its specialty to support a wide range of patient conditions. In recognition of the field’s advances over the past 45 years, AANN’s official research publication, the Journal of Neuroscience Nursing (JNN), will introduce an iPad app edition at the meeting. The AANN Annual Educational Meeting takes place March 9-12 in Charlotte, North Carolina. JNN is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

“Digital access is part of our future and is increasingly how our members and practitioners want to access the Journal,” said V. Susan Carroll, MS, RN-BC, Editor of the JNN.  “We are pleased to launch the Journal app during our annual meeting, reinforcing our focus to make the JNN even more accessible to nurses and practitioners in today’s demanding, quickly-changing field.”

AANN’s 45^th Annual Educational Meeting theme – Listen, Learn, Lead –is designed to explore the critical information of the specialty, which encompasses nursing care for patients suffering a wide range of conditions, including strokes, dementia, brain trauma and injuries, and neurological diseases. This aligns with the JNN’s focus to provide research and information that is directly applicable to neuroscience nursing practice, as evidenced in the March/April issue.  

For example, State of the Science: Use of Biomarkers and Imaging in Diagnosis and Management of Alzheimer Disease by Dierdre Brett Faller explores recent techniques that may soon allow a clinical diagnosis before the disease progresses to the point where symptoms become evident – when the benefits of treatment are limited. While still in the research stages, new methods to determine the disease’s pathology at earlier stages have the potential for an immense impact in clinical diagnosis and management.  For neuroscience nurses, this important research is key to putting the techniques into practice as they become more widely available, and being able to discuss them with patients and their families.         

Neurological and Psychiatric Diseases and Their Unique Cognitive Profiles: Implications for Nursing Practice and Research by David E. Vance, Joan E. Dodson, Jason Watkins, Bridgett H. Kennedy, and Norman L. Keltner, highlights the distinct ‘cognitive profiles’ of neurological and psychiatric diseases – which include bipolar disorder, schizophrenia, post-traumatic stress syndrome, depression, and anxiety disorders.  Knowledge of how these diseases impact a patient’s cognitive function and ability to interact in society helps nurses determine how well the patient may be able to manage important aspects of their care regimen, such as remembering to make appointments or take medications.  Overall, this understanding will help nurses provide the best care, tailored to the individual patient’s needs. 

“Both articles have a strong research and new practice implications focus,” says Carroll. “They directly reflect the quality content in the JNN, and show how the Journal is positioned to help every nurse provide the best patient care.”

JNN for the iPad is Convenient, Accessible

The March/April issue of the JNN is now available as a free download in the iTunes App Store.  Each issue, delivered in a state-of-the art digital format, provides an enhanced print-like reading experience.  Special features include the ability to share articles and content via email, videos, and podcasts.  The iPad app also provides links back to JNNOnline.com, the Journal website, where subscribers can search, access, complete continuing education opportunities, and read the full contents of every issue.

Subsequent issues of the JNN will be available on the iPad on the same bimonthly schedule as the current online and print editions.  Future supplements and special issues will also be posted for download as soon as they are published. During an initial trial period, all readers of the JNN for the iPad will have free full access to the current issue.  After this free introductory period, AANN members and subscribers will continue to enjoy full access via a simple login process.

About  the Journal of Neuroscience Nursing

The Journal of Neuroscience Nursing (JNN), the official journal of the American Association of Neuroscience Nurses, contains original articles on advances in neurosurgical and neurological techniques as they affect nursing care, theory and research, as well as commentary on the roles of the neuroscience nurse in the health care team.  The Journal provides information to nurses and health care professionals working in diverse areas of neuroscience patient care such as multi-specialty and neuroscience intensive care units, general neuroscience units, combination units (neuro/ortho, neuromuscular/rehabilitation, neuropsychiatry, neurogerontology), rehabilitation units, medical-surgical units, pediatric units, emergency and trauma departments, and surgery. The information is applicable to professionals working in clinical, research, administrative, and educational settings.

About the American Association of Neuroscience Nurses (AANN)

Founded in 1968, the American Association of Neuroscience Nurses, an organization of more than 4,000 members worldwide, is committed to working for the highest standard of care for neuroscience patients by advancing the science and practice of neuroscience nursing. AANN accomplishes this through continuing education, information dissemination, standard setting, and advocacy on behalf of neuroscience patients, families, and nurses. AANN develops and supports nurses in providing excellence in care and promotes the neuroscience nursing specialty. As the leading authority in neuroscience nursing, AANN inspires passion in nurses and creates the future for the specialty.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2012 annual revenues of €3.6 billion ($4.6 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Philadelphia, Pa. (December 3, 2012) – A new technology called the Pipeline embolization device (PED) shows encouraging results in patients with certain types of difficult-to-treat brain aneurysms, reports the December issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Data collected since the PED was approved for marketing show generally good results in “real world” clinical practice. However, the report raises concerns about fatal bleeding and other serious complications, especially for aneurysms in one specific location. The lead author of the study was Dr. Peter Kan of University at Buffalo, N.Y.

Pipeline Device Shows Promising Results…

The researchers evaluated “early postmarket” results—that is, after approval by the U.S. Food and Drug Administration (FDA)—using the PED at seven surgical centers. The PED is designed for use in treating certain types of aneurysms that can’t be blocked off by surgery or other treatments, such as “wide-necked” or giant aneurysms.

An aneurysm is a weakened spot in a blood vessel wall. If the aneurysm enlarges or ruptures (breaks), it can cause a stroke or life-threatening bleeding in the brain. The study reflects the increased emphasis on collecting postmarketing data on newly approved medical devices to see if the results in initial clinical experience are comparable to those in research trials. The PED received FDA approval for use in treating specific types of brain aneurysms in 2011.

The study included 62 PED procedures performed to treat aneurysms in 56 patients. The patients’ average age was 59 years. More than 40 percent of the aneurysms were discovered incidentally, before they caused any symptoms or bleeding.

On average, it took two PEDs to treat each aneurysm. Some patients needed additional procedures related to problems deploying the PEDs. In one-fourth of aneurysms, additional “coil” treatments were used in addition to PEDs to help block off the aneurysm.

Three-month follow-up data were available for 19 patients. In 68 percent, the aneurysm was completely blocked off. Two patients had some narrowing within the Pipeline device—this was successfully treated with an additional angioplasty procedure.

…But Also Some Serious Complications

However, the data also showed substantial risks, including an 8.5 percent rate of major complications or death. Six patients had clots leading to strokes or transient ischemic attacks (“mini strokes”) after the PED procedure. Most of these patients had vertebrobasilar aneurysms—located in an area at the base of the brain where three major arteries meet.

In addition, four patients suffered bleeding, which developed up to two months after the PED procedure. Bleeding was fatal in all four cases.

Unlike surgery or other treatments for brain aneurysms, the PED does not achieve immediate occlusion. Rather, the “Pipeline” redirects blood flow away from the aneurysm and through the parent vessel. Over time, new blood vessel tissue grows across the neck of the aneurysm, blocking it off permanently.

This initial “real world” experience with the PED shows results similar to those achieved in clinical trials leading to FDA approval. Although treatment may take months to complete, the aneurysm is eventually completely occluded in most patients. Thus the PED offers an effective new option for patients with aneurysms that would previously have been difficult or impossible to treat.

The postmarketing data also show a significant risk of serious complications, including potentially fatal bleeding. Pending further study, Dr. Kan and colleagues caution against “off-label” use of the PED to treat aneurysms in the vertebrobasilar region. They conclude, “Long-term data are needed to establish long-term efficacy and to understand the delayed complications of this new technology.”

About Neurosurgery

Neurosurgery, the Official Journal of the Congress of Neurological Surgeons, is your most complete window to the contemporary field of neurosurgery. Members of the Congress and non-member subscribers receive 3,000 pages per year packed with the very latest science, technology, and medicine, not to mention full-text online access to the world’s most complete, up-to-the-minute neurosurgery resource. For professionals aware of the rapid pace of developments in the field, Neurosurgery is nothing short of indispensable.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

“Osborn’s Brain” poised to become the new gold standard of neuroradiology

PHILADELPHIA (Nov. 27, 2012) — Lippincott Williams & Wilkins (LWW), part of Wolters Kluwer Health, together with Amirsys Publishing, Inc., today announced publication of Osborn’s Brain:  Imaging, Pathology, and Anatomy, the much-anticipated new text from world-renowned neuroradiologist and author Dr. Anne G. Osborn.  Ever since she published her award-winning 1993 classic, Diagnostic Neuroradiology—the best-selling neuroradiology text of all-time—her admirers around the world have pleaded for a “new Osborn” teaching text.  Osborn’s Brain promises to be the new gold standard of its field.

Written for neurologists, neuroradiologists, and neurosurgeons, Osborn’s Brain is designed to help residents, fellows, and practitioners think logically about the various pathologies that can affect the brain.  The new 1,300-page volume weaves the critical aspects of brain imaging together with spectacular pathology examples and relevant anatomy.  Osborn’s Brain contains more than 3,200 high-resolution radiologic and pathologic images as well as detailed, full-color medical illustrations—all paired with clearly written explanatory text. 

The format of Osborn’s Brain departs significantly from Osborn’s other recent publications.  Rather than using bulleted text, Osborn returns to detailed prose of her earlier texts.  Although she had said she would never write another prose-based text, according to Osborn, the prose format helps readers understand the reasoning behind the conclusions and makes the book an easy-to-read yet comprehensive learning resource.  Furthermore, Osborn’s signature summary boxes are sprinkled throughout the text to highlight the most important points from each section and facilitate quick review.

“Instead of approaching imaging in the conventional manner—starting with congenital anomalies and proceeding through the spectrum of acquired disorders—I structured the book as a learning curriculum,” said Anne G. Osborn, author and University Distinguished Professor of Radiology at the University of Utah School of Medicine.  “I start with the most immediate ‘must know’ topics, beginning with trauma, then move to a discussion of non-traumatic hemorrhage and vascular lesions.  Presenting the most critical topics first gives quick access to what matters most.”

“Anne Osborn has a rare gift for taking a highly complex topic and making it visually appealing and easy to understand,” said Susan Driscoll, President and CEO, Wolters Kluwer Health, Professional & Education division.  “In Osborn’s Brain, she strikes a chord again by presenting the most up-to-date look at brain pathologies in a way that both informs and exhilarates.  This impressive new volume will resonate as well with first-year residents as it will with seasoned neuroradiologists.”

Anne G. Osborn, MD, is an internationally acclaimed teacher and lecturer, and author of several texts that are considered the definitive references in her field.  She was the first recipient of RSNA’s Outstanding Educator Award.  Cited as one of the “20 Most Influential” people in radiology by Diagnostic Imaging magazine, she was the first woman elected president of the American Society of Neuroradiology, the largest subspecialty society in radiology.

Available now, the hardbound Osborn’s Brain:  Imaging, Pathology, and Anatomy comes with a companion eBook, accessible online with fully searchable text.  Priced at $349, Osborn’s Brain can be purchased by visiting www.LWW.com/osbornsbrain.  For more information, visit www.LWW.com.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

About Amirsys Publishing, Inc.

Amirsys Publishing, Inc. is a leading provider of innovative online healthcare solutions in medical education, radiology, pathology, and surgery. Over 99% of North American academic medical centers use Amirsys products daily. Through use of its proprietary technology and image-intensive, expert and evidence-based content, Amirsys provides online problem-solving solutions to thousands of radiologists, pathologists, surgeons, and residents-in-training worldwide.

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Philadelphia, Pa. (November 27, 2012) – A test to detect brain amyloid deposits associated with Alzheimer disease (AD) provides doctors with useful information on treatment and further testing for patients with cognitive impairment, according to a study published online by the journal Alzheimer Disease & Associated Disorders. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Positron emission tomography (PET) scans using a biomarker called florbetapir F18 can show amyloid plaques in the brain—a characteristic feature of AD.  “Amyloid imaging results altered physicians’ diagnostic thinking, intended testing and management of patients undergoing evaluation for cognitive decline,” according to the study by Dr Mark Mintun of Avid Pharmaceuticals, Philadelphia, and colleagues.

Is It Alzheimer Disease?  Florbetapir Scan Provides Evidence

The researchers designed a “real-world” study to determine how florbetapir would affect clinical management of patients with cognitive impairment.  While a florbetapir PET scan showing amyloid plaques doesn’t prove that AD is present, it provides a previously unavailable piece of evidence to support the diagnosis.

The study included 229 patients seen by neurologists or other specialists for evaluation of cognitive decline or impairment of uncertain etiology.  Before the florbetapir PET scan, doctors provided a provisional diagnosis, an estimate of their diagnostic confidence, and their plans for further testing and treatment.  The goal was to assess the value of florbetapir PET in making the final diagnosis and in providing doctors with useful information for clinical decision making.

The florbetapir PET scans showed amyloid deposits in 113 out of 229 patients.  The information provided led doctors to change their diagnosis in 55 percent of cases. 

When the provisional diagnosis was AD, imaging results led to a change in diagnosis in 37 percent of cases.  When the pre-scan diagnosis was either “indeterminate” or another cause of dementia, the diagnosis changed in over 60 percent of cases.   In either direction, the scans increased the physicians’ ratings of diagnostic confidence by about 20 percent.

Impact on Treatment and Testing Decisions

Florbetapir PET also provided useful information for treatment decision-making:  in 87 percent of patients, the results contributed to at least one change in the treatment plan.  The main impact was in deciding whether or not to use medications that are helpful in AD.  The scan results also affected decisions on further testing—in many cases, physicians dropped plans to perform additional brain imaging studies or neuropsychological tests.

Alzheimer disease is the most common cause of dementia, but the diagnosis can be challenging to make.  The only definitive way to diagnose AD is by autopsy examination of the brain after death.  Up to 20 percent of patients diagnosed with AD turn out not to have had AD on autopsy, while up to 40 percent of patients diagnosed with other causes of dementia have evidence of AD at autopsy.

Florbetapir PET is the first FDA-approved imaging that can estimate amyloid deposits in the brain of a living patient.  Previous studies have shown that the scans are accurate in identifying patients later shown to have AD at autopsy.

The new results show that florbetapir PET scans can have a significant effect in “real world” clinical evaluation of patients with cognitive impairment.  By strengthening the case for or against a diagnosis of AD, this test can have a significant impact on patient management—particularly related to the use of AD medications and the need for further testing.  Additional studies will be needed to confirm whether “clinical care that includes amyloid imaging will translate into better outcomes” for patients with cognitive impairment and possible AD.

About Alzheimer Disease & Associated Disorders

Alzheimer Disease & Associated Disorders is a leading international forum for reports of new research findings and new approaches to diagnosis and treatment. Contributions fall within all relevant scientific fields and clinical specialties, including neurobiology, neurochemistry, molecular biology, neurology, neuropathology, neuropsychology, psychiatry, gerontology, and geriatrics.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Philadelphia, Pa. (November 20, 2012) – The time has come to develop a pituitary “centers of excellence” (CoE) designation for hospitals with high-level surgical skills and other capabilities needed to provide state-of-the-art care for patients with pituitary tumors, according to an article in the November issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Recent advances in surgical and medical management—along with the high prevalence and impact of pituitary tumors—warrant development of a voluntary system for designating pituitary centers of excellence, according to the special article by four leading U.S. neurosurgeons including Daniel Kelly and Nancy McLaughlin (John Wayne Cancer Institute & Saint John’s Health Center, Santa Monica, CA), Edward Laws, (Brigham & Women’s Hospital, Boston, MA) and Nelson Oyesiku (Emory University, Atlanta, GA), as well as a leading endocrinologist (Laurence Katznelson, Stanford University, Palo Alto, CA).

Designation Recognizes Surgical Skills and Coordinated Care for Pituitary Tumors

Tumors of the pituitary gland, located directly under the brain in the skull base, pose difficult challenges in both diagnosis and treatment. Known as the body’s “master gland,” the pituitary produces hormones that control a wide range of bodily functions. In recent years, studies have shown that pituitary adenomas and other related tumors are more common than previously thought—affecting perhaps 1 out of 1,000 people. These tumors can lead to conditions of hormonal excess such as acromegaly, Cushing’s disease and prolactinoma, as well as hormonal loss, visual loss and headaches.

The idea of a CoE designation reflects specialized skills and expertise needed to provide top-level care for patients with particular types of problems. Perhaps the best-known example is the designation of level I to IV trauma centers, based on criteria such as the volume of severely injured patients treated, levels of specialist staffing, and the presence of educational and outreach programs.

The authors believe it’s time for a similar approach to identifying hospitals and medical centers with the capacity to provide optimal clinical management for patients with pituitary tumors. Care is best provided in a “multidisciplinary collaborative environment,” including neurosurgeons and endocrinologists with special experience in managing pituitary disorders. The treatment team should also include a wide range of other medical and surgical subspecialists who play important roles in managing these complex cases, such as neuro-ophthalmologists, radiation oncologists and otolaryngologists (ENT).

The call for a CoE designation reflects the rapid evolution of highly specialized surgical techniques for pituitary tumors, known as transsphenoidal surgery, increasingly performed with endoscopy, as well as new medical approaches to treating the hormonal abnormalities these tumors can produce. Advances in radiology and pathology have also raised the standard of skills needed for diagnosis and management.

As with other advanced surgical procedures, studies have shown that centers performing a larger volume of transsphenoidal surgeries achieve better outcomes with lower complication rates. Such high levels of volume and expertise are also essential for training the next generation of pituitary surgeons, who may not be getting the experience they need at some residency programs.

“[O]ptimal care for pituitary patients is best provided by experienced practitioners, working in a collaborative environment using state-of-the-art techniques and therapies,” the authors write. They outline a “preliminary proposal” for a pituitary CoE designation, based on three key missions:

• Providing comprehensive care and support to patients with pituitary disorders.
• Providing residency training, fellowship training, and/or continuing medical education in the management of pituitary and neuroendocrine disease.
• Contributing to research in pituitary disorders.

The authors acknowledge that many questions remain to be answered, such as what organization would oversee the effort and how to ensure that expertise is adequately distributed across regions. As time goes on, it will be important to show that pituitary centers of excellence are truly effective in improving patient outcomes and reducing health care costs. They conclude, “Such an effort would enhance patient care, increase public awareness, promote training and expertise, and advance research in the management of pituitary tumors and related hormonal disorders.”

About Neurosurgery

Neurosurgery, the Official Journal of the Congress of Neurological Surgeons, is your most complete window to the contemporary field of neurosurgery. Members of the Congress and non-member subscribers receive 3,000 pages per year packed with the very latest science, technology, and medicine, not to mention full-text online access to the world’s most complete, up-to-the-minute neurosurgery resource. For professionals aware of the rapid pace of developments in the field, Neurosurgery is nothing short of indispensable.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Philadelphia, Pa. (September 10, 2012) – Women and girls are at increased risk of adverse outcomes after surgical treatment for moyamoya disease, an uncommon but serious disease of the brain blood vessels, reports a study in the September issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Although the postoperative risks are increased, patients of both sexes with moyamoya disease achieve significant improvement after surgery. The study was performed by Dr. Gary K. Steinberg and colleagues of Stanford University.

Higher Rates and Risks of Moyamoya in Women and Girls

The researchers analyzed the characteristics and outcomes of 430 patients undergoing surgical treatment (revascularization) for moyamoya disease between 1991 and 2010. All procedures were performed at Stanford by Dr. Steinberg.

Moyamoya disease is an uncommon condition in which arteries at the base of the brain become blocked. The disease gets its unusual name from Japanese for “puff of smoke,” which describes the common appearance of the vessels on x-rays. The cause is unknown, but genetic factors may be involved.

Moyamoya disease occurs most often in children and young adults. Although it is more common in females, the new study is one of the first to evaluate possible sex-related differences in patient characteristics and outcomes after treatment.

Consistent with previous studies, there were more female patients than males: more than 70 percent of the patients were women and girls. The mean age was 31 years, with children accounting for about one-third of the patients. Treatment required a total of 717 revascularization procedures, as most patients had arterial blockage on both sides of the brain. This type of “bilateral” disease was more common in females.

Females were more than twice as likely to have transient ischemic attacks (TIAs)—sometimes called “mini-strokes”—as a symptom of moyamoya disease before surgery. However, there was no sex-related difference in the rate of more serious strokes.

After surgical revascularization, both male and female patients had significant improvements in health and functioning after surgery, with similar outcomes between the sexes. However, over five years after successful surgery, women and girls were about twice as likely to experience some type of adverse event, including stroke or death: 11.4 versus 5.3 percent.

The new study is the largest series of patients treated for moyamoya disease in North America. “These data suggest that sex may play an underappreciated role in influencing the natural history and posttreatment course in patients with moyamoya disease,” the researchers write. Their findings suggest that moyamoya disease may have a “more aggressive nature” in women.

Nevertheless, Dr. Steinberg and coauthors emphasize that most patients—women as well as men—have excellent results after revascularization for moyamoya disease. Although adverse outcomes are more common in females, the overall risk of further problems is relatively low. The researchers call for further study to understand “the role of sex-specific influences on the pathophysiology of moyamoya disease.”

About Neurosurgery

Neurosurgery, the Official Journal of the Congress of Neurological Surgeons, is your most complete window to the contemporary field of neurosurgery. Members of the Congress and non-member subscribers receive 3,000 pages per year packed with the very latest science, technology, and medicine, not to mention full-text online access to the world’s most complete, up-to-the-minute neurosurgery resource. For professionals aware of the rapid pace of developments in the field, Neurosurgery is nothing short of indispensable.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Philadelphia, Pa. (August 20, 2012) – A technique called high-definition fiber tractography (HDFT) provides a powerful new tool for tracing the course of nerve fiber connections within the brain—with the potential to improve the accuracy of neurosurgical planning and to advance scientific understanding of the brain’s structural and functional networks, reports a paper in the August issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

In the new report, Dr. Juan C. Fernandez-Miranda and colleagues of University of Pittsburgh describe and illustrate the use of the HDFT to track the course of the nerve fibers that make up the white matter of the brain. The researchers write, “Our HDFT approach provides an accurate reconstruction of white matter fiber tracts with unprecedented detail in both the normal and pathological human brain.”

HDFT Shows White Matter Tracts in Living Brain

Dr. Fernandez-Miranda and coauthors report on the development and evaluation of the HDFT technique, including initial findings in healthy people and patients with various brain lesions. The new technique adds advanced digital processing and reconstruction techniques to current methods of tractography—a method used to trace the course of bundles of white matter fibers, or “tracts,” in the brain.

Tractography using a technique called diffusion tensor imaging (DTI) has been available for more than a decade. However, DTI has some important limitations: it can’t show the complex course of white matter fiber tracts as they cross each other, and it can’t accurately show the starting point and ending points of white matter tracts. The researchers call these the “crossing problem” and the “termination problem,” respectively.

Over the past three years, Dr. Fernandez-Miranda and colleagues have been working on refining new fiber mapping techniques—such as high-angular resolution diffusion imaging and diffusion spectrum imaging—to study the structural connections of the brain. They write, “In an attempt to more effectively solve the crossing and termination problems, we have focused on optimizing these methods to obtain what we refer to as HDFT.” Through a combination of imaging processing and reconstruction and tractography methods, HDFT can track white matter fiber tracts from their origin, through complex fiber crossings, to their termination point, with resolution of one millimeter or less.

For brain researchers, HDFT provides an unprecedented level of detail to solve both the crossing and termination problems. Color-coded images show the complex architecture of white matter fibers, as they cross each other in complex patterns. The HDFT images accurately replicate known features of the brain anatomy, including the folds and grooves (gyri and sulci) of the brain and the characteristic shape of brain structures.

To evaluate how the new technique might be used for surgical planning, the researchers analyzed HDFT images obtained in patients with cancers and other brain lesions. In patients with brain cancers, HDFT clearly showed the disruption of brain tissue caused by rapid tumor growth. Importantly, it was able to show the absence of white matter fibers within the tumor itself in two types of brain cancers.

In patients with brain blood vessel malformations, HDFT provided information likely to be useful in planning the safest approach to surgery. The ability to differentiate displacement versus disruption of fibers may become a critical factor in determining whether or not damage caused by brain lesions is reversible.

The researchers emphasize that much more research will be needed to refine the HDFT technique and to evaluate its scientific and clinical uses. “From a clinical perspective, we show that accurate structural connectivity studies in patients facilitate white matter damage assessment, aid in understanding lesional patterns of white matter structural damage, and allow innovative neurosurgical applications,” the researchers write. They also believe that structural connections shown by HDFT will provide a useful complement to efforts to map the functional connections of brain networks, such as the Human Connectome Project.

About Neurosurgery

Neurosurgery, the Official Journal of the Congress of Neurological Surgeons, is your most complete window to the contemporary field of neurosurgery. Members of the Congress and non-member subscribers receive 3,000 pages per year packed with the very latest science, technology, and medicine, not to mention full-text online access to the world’s most complete, up-to-the-minute neurosurgery resource. For professionals aware of the rapid pace of developments in the field, Neurosurgery is nothing short of indispensable.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Philadelphia, Pa. (August 7, 2012) – A new study supports what neurosurgeons have long suspected—that pregnancy is an important risk factor for bleeding from arteriovenous malformations (AVMs) in the brain, reports the August issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The best available data suggest that pregnant women with AVMs face an eight percent risk of rupture and bleeding during pregnancy—far higher than the risk in non-pregnant women. Based on their findings, Bradley A. Gross, MD, and Rose Du, PhD, of Harvard Medical School outline some recommendations for women with AVMs who want to have children or are already pregnant.

Risk of AVM Bleeding Is Eight Times Higher During Pregnancy

Drs. Gross and Du reviewed the records of 54 women with confirmed AVMs between 2002 and 2010. Arteriovenous malformations are tangled complexes of interconnected arteries and veins that are prone to rupture and bleeding, which can lead to death or serious disability.

The researchers calculated the total risk of bleeding AVMs in terms of the total number of “patient-years” at risk. They then assessed the risk of bleeding events during the total time their patients were pregnant. The 54 patients had a total of 62 pregnancies during follow-up. Four of the women had a total of five bleeding events while pregnant.

Based on the data, the researchers calculated an AVM bleeding risk of 8.1 percent per pregnancy, or 10.8 per year. By contrast, the rate of bleeding while the women were not pregnant was 1.1 percent per year.

Thus the risk of bleeding from an AVM was about eight times higher during pregnancy. On analysis of follow-up data to age 40, the risk of bleeding during pregnancy appeared even greater—18 times higher.

Neurosurgeons have long regarded pregnancy as a risk factor for bleeding AVMs. However, because ruptured AVMs are relatively rare, it is difficult to calculate the true risks.

Within the limitations of the data, the study strongly suggests that the risk of bleeding AVMs is substantially higher during pregnancy. In the authors’ four cases, bleeding AVMs caused sudden headache and other symptoms between 22 and 39 weeks of pregnancy. With prompt treatment, all of the women and their infants survived (although one of the mothers was left with permanent disability).

Based on their findings, Drs. Gross and Du recommend treatment for any woman with an AVM who is considering having children—especially if they’ve previously had an episode of bleeding. If an unruptured AVM is discovered during pregnancy, they recommend “comprehensive patient counseling,” discussing the risks of treatment versus “cautious continuation” of pregnancy without treatment.

When it’s time for delivery, they recommend cesarean section. While noting that other doctors and hospitals may follow a different approach, Drs. Gross and Du hope their study and recommendations will “incite thought and invoke added caution in women with known, untreated AVMs planning to bear children.”

About Neurosurgery

Neurosurgery, the Official Journal of the Congress of Neurological Surgeons, is your most complete window to the contemporary field of neurosurgery. Members of the Congress and non-member subscribers receive 3,000 pages per year packed with the very latest science, technology, and medicine, not to mention full-text online access to the world’s most complete, up-to-the-minute neurosurgery resource. For professionals aware of the rapid pace of developments in the field, Neurosurgery is nothing short of indispensable.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Philadelphia, Pa. (July 26, 2012) – The anesthetic agent ketamine has a fast-acting antidepressant effect, but that doesn’t improve the response to electroconvulsive therapy (ECT) for severe depression, according to a study in the September issue of The Journal of ECT, official journal of the International Society for ECT and Neurostimulation.  The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The study did not show the “robust rapid antidepressant response” to ketamine reported in previous studies—perhaps because ketamine was used in combination with a different type of anesthetic.  The research was performed by Dr. Gerard Sancora and colleagues of Yale University School of Medicine.

Ketamine Has Rapid Antidepressant Effect…

Recent studies have suggested that ketamine brings rapid improvement in patients with severe depression.  In contrast to standard antidepressants, which can take weeks to months to have an effect, a single injection of ketamine improves symptoms within a few hours.

Electroconvulsive therapy is a highly effective treatment for severe depression, but repeated treatments are generally needed to bring improvement.  Ketamine might help to bridge the gap before ECT takes effect.  “Interestingly, ketamine has been used in ECT anesthesia for decades,” the researchers note.

The study included 18 patients with episodes of major depression who were scheduled for ECT after not responding to standard antidepressant drugs.  All patients received a drug called thiopental to provide anesthesia for ECT.  One group received a low dose of ketamine in addition to thiopental.  The ketamine dose was “subanesthetic”—lower than needed to produce anesthesia.

…But Doesn’t Enhance Response to ECT for Major Depression

The study was stopped early when preliminary results showed no improvement in the response to ECT with ketamine.  Depression scores improved in both groups; it generally took six ECT treatments over two weeks to show an effect.

Ketamine did not produce the fast antidepressant effect seen in previous studies.  In fact, the response to ECT was somewhat faster in patients who received thiopental alone, without ketamine.

Some studies have suggested that ketamine improves the seizure response to ECT while minimizing side effects.  In the new study, there was some evidence of a longer seizure response with ketamine.

Why didn’t ketamine’s rapid antidepressant appear in the new study?  There are several possible explanations, but the authors believe the most likely is some type of interaction between ketamine and thiopental, which is a barbiturate anesthetic.  “It is conceivable that the thiopental effects interfere with ketamine’s mechanism of antidepressant action,” Dr. Sancora and colleagues write.

The results don’t close the door on the possibility that ketamine could help to improve the response to ECT in patients with severe episodes of major depression.  Future studies should consider the effects of different doses, timing, and routes of ketamine administration, or of using ketamine as the sole anesthetic or combined with other types of anesthetics.

About The Journal of ECT 

The Journal of ECT covers all aspects of contemporary electroconvulsive therapy, reporting on major clinical and research developments worldwide. Leading clinicians and researchers examine the effects of induced seizures on behavior and on organ systems; review important research results on the mode of induction, occurrence, and propagation of seizures; and explore the difficult sociological, ethical, and legal issues concerning the use of ECT.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Philadelphia, Pa. (July 2, 2012) – A research effort called the Human Connectome Project is seeking to explore, define, and map the functional connections of the human brain. An update on progress in and upcoming plans for the Human Connectome Project appears in the July issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Analogous to the Human Genome Project—which mapped the human genetic code—the Human Connectome Project seeks to map “the complete, point-to-point spatial connectivity of neural pathways in the brain,” according to Arthur W. Toga, PhD, and colleagues of David Geffen School of Medicine, University of California Los Angeles. They write, “For neuroscientists and the lay public alike, the ability to assess, measure, and explore this wealth of layered information concerning how the brain is wired is a much sought after prize.”

‘Connectome’ Mapping to Understand Brain Functional Networks

The 100 billion neurons of the human nervous system interconnect to form a relatively small number of “functional neural networks” responsible for behavior and thought. However, even after more than a century of research, there is no comprehensive map of the connections of the human brain.

Historically, studies of the human brain function have employed a “modular” view—for example, “region X is responsible for function Y.” However, a more appropriate approach is to consider which network of two or more “connected or interacting” regions is involved in a given function. Until recently, it was not possible to view networks in the living brain.

But newer magnetic resonance imaging (MRI) methods sensitive to water diffusion have made it possible to create detailed maps of the underlying white matter connections between different areas of the brain. This opens the way to new approaches to mapping the structural connectivity of the brain, and showing it in ways that correspond to the brain anatomy.

Researchers are working out ways to analyze these data using sophisticated modeling approaches to represent the “nodes and connections” that make up the functional networks of the brain. Such efforts are in their infancy, but these network models are capturing not only the connectedness of brain networks, but also their capacity to process information.

Data Will Lend Insights into Alzheimer’s, Autism and Other Diseases

Preliminary studies have yielded tantalizing findings, such as a link between more efficient cortical networks and increased intelligence and differences in connectedness between the right and left hemispheres of the brain. “The HCP has recently generated considerable interest because of its potential to explore connectivity and its relationship with genetics and behavior,” Dr. Toga and coauthors write.

The project has far-reaching implications for a wide range of neurological and psychiatric diseases, such as autism, schizophrenia, and Alzheimer’s disease. “The similarities and differences that mark normal diversity will help us to understand variation among people and set the stage to chart genetic influences on typical brain development and decline in human disease,” according to the authors.

Dr. Toga and colleagues are making their data available for download and analysis by other researchers on the project website, http://www.humanconnectomeproject.org/. In the future, the data will be openly available for exploration by the public. Meanwhile, a gallery of beautiful and fascinating images illustrating the various modeling techniques and preliminary findings on brain connectivity can be viewed at http://www.humanconnectomeproject.org/gallery/.

About Neurosurgery

Neurosurgery, the Official Journal of the Congress of Neurological Surgeons, is your most complete window to the contemporary field of neurosurgery. Members of the Congress and non-member subscribers receive 3,000 pages per year packed with the very latest science, technology, and medicine, not to mention full-text online access to the world’s most complete, up-to-the-minute neurosurgery resource. For professionals aware of the rapid pace of developments in the field, Neurosurgery is nothing short of indispensable.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com