Neurology News – June 2020

Department News

COVID-19

We would like to thank each and every member of the Department of Neurology for adapting so rapidly to the many changes brought about by the COVID-19 pandemic over the past few months. UNC Health’s mission “to improve the health and well-being of North Carolinians and others whom we serve” is now more essential than ever.

Are you in need of child care resources due to Covid-19? Check out these resources to support UNC health care workers.

UNC Neurology Welcomes New Residents, Fellows and Neuroscience ICU APP’s

We are pleased to welcome our incoming adult and child neurology residents as well as our fellows specializing in sleep medicine and neuromuscular disorders. Learn more about each of these new team members >

We are also proud to introduce our new Neuroscience ICU APP’s:

• Courtney Blodgett, MSN, AG-ACNP, CCRN, graduated from Winston-Salem State University with a bachelor’s degree in nursing. She went on to receive a master’s degree in nursing from Georgetown University and is board-certified as an adult/gerontology acute care nurse practitioner.

• Andrea McCulloch, MSN, AG-ACNP, graduated with a bachelor’s and a master’s degree in nursing from Madonna University in Livonia, Michigan. She is board-certified as an adult/gerontology acute care nurse practitioner with a certificate in advanced practice hospice and palliative care.

• Tyler Okelberry, MSN, AG-ACNP, CCRN, graduated from Utah Valley University with a bachelor’s degree in nursing followed by a master’s degree in nursing from the University of Utah. He is certified as an adult/gerontology acute care nurse practitioner after receiving a post-master’s certificate from Duke University School of Nursing.

The Face Behind The Mask

Providing patient care while wearing masks is disorienting and impersonal for everyone involved. Yael Shiloh-Malawsky, MD, and her daughter have a solution: the Unmask UNC badge. These photo badges reveal the smiling face behind the mask, allowing providers to connect more closely with their patients. Resident Katelyn Bricker, MD, models her badge in the photos. Interested?  Email your name, role/position and photo to UnmaskUNC@gmail.com and your badge will be produced and delivered free of charge.

BOOST-3 Community Research Study

The UNC Medical Center will soon become part a nationwide NIH study of the emergency treatment of patients with severe traumatic brain injury (TBI). The study, Brain Oxygen Optimization in Severe Traumatic Brain Injury (BOOST-3), will compare two treatments routinely used for monitoring and treating patients with severe TBI in the Neuroscience Intensive Care Unit. To learn more, visit the Research for Me website. Questions may be sent directly to the study team, Rhonda Cadena, MD, or Luigi Toiani, PA, at boost3@med.unc.edu or (919) 283-9281.

Research

James F. Howard Jr., MD, was the principal investigator of the phase 3 trial for the experimental drug efgartigimod, developed by Argenx. The company plans to seek U.S. approval of the drug by the end of year in response to data showing rapid and robust responses in people with generalized myasthenia gravis. Learn more >

In addition, Dr. Howard, along with other researchers published:

• “Zilucoplan, a subcutaneously self-administered peptide inhibitor of complement component 5, for the treatment of generalized myasthenia gravis.” JAMA Neurology, May 2020

• “Minimal symptom expression in patients with acetylcholine receptor antibody-positive refractory myasthenia gravis treated with eculizumab.” Journal of Neurology, March 2020

• “Guidance for the management of myasthenia gravis (MG) and Lambert-Eaton myasthenic syndrome (LEMS) during the COVID-19 pandemic.” Journal of the Neurological Sciences, May 2020

• “Response to eculizumab in patients with myasthenia gravis recently treated with chronic IVIg: a subgroup analysis of REGAIN and its open-label extension study.” Therapeutic Advances in Neurological Disorders, May 2020

• “Complement inhibitor therapy for myasthenia gravis.” Frontiers in Immunology – Autoimmune and Autoinflammatory Disorders, April 2020

• In addition, the Italian Society of Neurology selected the following research by Dr. Howard as the most interesting article of the month for February 2020: “Clinical effects of the self-administered subcutaneous complement inhibitor zilucoplan in patients with moderate to severe generalized myasthenia gravis Results of a phase 2 randomized, double-blind, placebo-controlled, multicenter clinical trial.” JAMA Neurology, February 2020
  

William Powers, MD, and PGY-4 resident Candice Kam, MD, along with two UNC Gillings researchers published, “Diagnostic accuracy of acute infarcts in multiple cerebral circulations for cardioembolic stroke: Literature review and meta-analysis.” Journal of Stroke Cerebrovascular Diseases, May 2020

Nina Browner, MD, is co-author of an accepted paper, “Targeted rhythmic auditory cueing during treadmill and overground gait for individuals with Parkinson disease: A case series.” Journal of Neurologic Physical Therapy, April 2020

Daniel Kaufer, MD, was part of a public-private collaboration that published “Diagnostic value of plasma phosphorylated tau181 in Alzheimer’s disease and frontotemporal lobar degeneration.” Nature Medicine, March 2020

Chon Lee, MD, along with her former medical student at Wake Forest, Kelsey Poisson, are co-authors of a paper, “Response to cannabidiol in epilepsy of infancy with migrating focal seizures associated with KCNT1 mutations: An open-label, prospective, interventional study,” published in European Journal of Paediatric Neurology, March 2020

Steven P. Trau, MD, published:

• “An unusual case of new tic emergence and exacerbation following treatment with fluticasone propionate.” Pediatric Neurology, April 2020

• “PURA syndrome and myotonia: a case report.” Pediatric Neurology, March 2020 (co-author)

• “Child Neurology: A young child with an undiagnosed case of dystonia responsive to L-dopa.” Neurology, February 2020 (co-author)

Presentations

William Powers, MD, presented “Do’s and Don’ts from the 2019 Update of the Guidelines for the Early Management of Acute Ischemic Stroke” American Stroke Association International Stroke Conference, Los Angeles, CA, February 21, 2020

James F. Howard, Jr, MD, presented:

• “Clinical effects of zilucoplan in patients with generalized myasthenia gravis.” Recorded interview – JAMA Neurology, February 17, 2020.

• “Long-term efficacy of eculizumab in refractory generalized myasthenia gravis: Responder analyses.” Webcast presented at the 2020 Virtual MDA Clinical and Scientific Conference, April 22-25, 2020.

• “Additional analyses of the phase 2 efgartigimod study in myasthenia gravis.” Webcast presented at the Virtual 2020 Annual Meeting of the American Academy of Neurology, April 25-May 1, 2020.

• “No change in risk of infection among NMOSD and refractory gMG patients related with eculizumab: findings from two phase 3 studies and their extensions.” Webcast presented at the Virtual 2020 6^th Congress of the European Academy of Neurology, May 23-26, 2020.

• “Efgartigimod in myasthenia gravis: Phase 3 trial design.” Webcast presented at the Virtual 2020 6th Congress of the European Academy of Neurology, May 24, 2020.

Nina Browner, MD, organized and moderated a virtual poster blitz for grand rounds on April 31. Faculty and residents presented posters that were accepted for the 2020 American Academy of Neurology Annual Meeting (canceled due to COVID-19). Abstracts included:

• “Interim Safety and Effectiveness Outcomes from a Prospective Post-Approval Trial of the RNSA® System.”
  • UNC researcher and presenter: HaeWon Shin, MD

• “Poor Epilepsy Self-Management and Self-Efficacy Skills in EMU Patients.”
  • UNC researchers: Drs. HaeWon Shin (presenter), Angela Wabulya; NP’s Darcy Subramaniam, Linh Ngo, Shabina Sheikh, Erin Carrier; Sana Chopra

• “Are We Following Best Practices for Evaluation of Psychogenic Non-epileptic Seizures (PNES) – We Shouldn’t Need to Reinvent the Wheel”
  • UNC researchers: Drs. Angela Wabulya (presenter), Michael Tennison, William Powers, Manisha Chopra, Bradley Vaughn

• “Additional Analyses of the Phase 2 Efgartigimod Study in Myasthenia Gravis”
  • UNC researcher and presenter: James F. Howard, Jr., MD

• “Miller-Fisher Syndrome (MFS) with Delayed Bilateral Facial Nerve Palsy: Imaging and Electrodiagnostic Findings, Treatment and Outcome.”
  • UNC researchers: Drs. Charles Port, Anahit Mehrabyan, Victor Lin (presenter)

• “Figure Copy and Recall Profiles Help Distinguish Alzheimer’s Disease, Frontotemporal Degeneration, and Dementia with Lewy Bodies”
  • Drs. Amalia Peterson (presenter), Daniel Kaufer; Adrian Boltz, Matthew Harris, Alexander Eisenstein
    

Resident poster presentations at the North Carolina Neurological Society meeting held in Raleigh on February 21-23 included:

• Carolyn Tsai, MD, presenting updates in the treatment of status epilepticus.

• Xiaoyang Li, MD, and Amalia Peterson, MD, presenting, “Acquired hepatocerebral degeneration as a cause of dyskinesia in a patient with liver cirrhosis: a case report,” under the mentorship of Irena Dujmovic Basuroski.

• Steven Palmer, MD and Amalia Peterson, MD, poster presentation of “Two Cases of Sporadic Late-Onset Nemaline Rod Myopathy” under the mentorship of Anahit Mehrabyan, MD. 

• Carolyn Tsai, MD; Zuleyma Toledo-Nieves, MD; Gregory Chamberlin, MD; Thomas Bouldin, MD; poster presentation of “Vasculitic Mononeuritis Multiplex Associated with Hepatitis B and C: Presentation, Diagnosis, and Treatment Options” under the mentorship of Anahit Mehrabyan, MD.
  

Steven Palmer, MD, under the mentorship of Anahit Mehrabyan, MD:

• Presented a poster titled “A case of HNRNPA1 gene mutation with multisystem proteinopathy presenting as inclusion body myopathy” at the 16th International Congress of Neuromuscular Diseases in Valencia, Spain, May 28 – June 1, 2021.

• Was accepted to present “A 46-year-old man with slowly progressive weakness” at the AAN 2020 Annual Meeting, Section: Diagnosis and Management of Unusual Cases in Neuromuscular Disease.

Casey Olm-Shipman, MD, MS, in her role as the director of the Clinician Leadership in Quality and Safety Scholarly Concentration Program, organized the UNC Clinician Leadership in Quality and Safety Symposium on March 5. Twelve students from the School of Nursing and the School of Medicine presented QI projects they conducted with their faculty mentors. Medical student Cindy Pi, mentored by Dr. Olm-Shipman, presented “Reducing routine daily chest x- rays in the neuroscience ICU.”

Outreach

Jessica Shurer, MSW, LCSW, recently joined the board of directors for CurePSP and will serve on their Patient and Care Partner Advocacy Committee. The organization also asked Jessica to co-facilitate a new virtual support group that meets every other week with attendees from across the U.S., Canada and Europe. Jessica’s three local community support groups (Parkinson’s disease; progressive supranuclear palsy & corticobasal degeneration; multiple system atrophy) have also gone virtual with great turnout and engagement, and now include attendees from across the state.

In addition, Jessica presented on the Self-Care panel at the Parkinson’s Foundation’s 2020 Care Partner Summit which was held virtually on May 16 and attended by more than 1,100 individuals from across the country.

PGY2 neurology resident Carolyn Tsai, MD, was one of 216 neurologists who gathered for the 18th annual American Academy of Neurology Neurology on the Hill on February 24-25. The neurologists met with federal lawmakers to educate Congress on the critical role of neurologists in health care, the needs of their patients, and the need for drug pricing reform.

Nina Browner, MD, co-presented a Parkinson’s Foundation webinar, “Answering Your Parkinson’s Disease Questions with AARP” on April 30.

Robert Smith III, PhD, served as a coach and a judge last February in the School of Medicine’s Making the Case program sponsored by the Office of Faculty Affairs and Leadership Development. Program participants included six faculty members who developed and practiced pitching their business ideas in front of a panel of institutional leaders.

Events

The UNC Comprehensive Stroke Center held its second annual Stroke Survivor & Caregiver Event on March 7 at the Carolina Inn. This free educational event offered a morning of helpful resources, inspirational speakers and an opportunity for fellowship among the 75 stroke survivors, caregivers and health care professionals who attended.