Grant Enables Researchers to Continue Studying Stroke Recovery

research

Grant Enables Researchers to Continue Studying Stroke Recovery

Oct. 20, 2014

Dr. Michael Kilgard

Dr. Robert Rennaker

At UT Dallas, researchers are developing new techniques to aid recovery from stroke. Their efforts recently received a boost thanks to a multimillion-dollar grant from the National Institutes of Health.

Drs. Michael Kilgard and Robert Rennaker will receive $2.3 million over the next five years to test the effectiveness of using vagus nerve stimulation (VNS) to enhance recovery from stroke in an older population.

According to the Centers for Disease Control and Prevention, more than 795,000 people in the United States will experience a stroke every year. Survivors are often left with weakness or paralysis of their limbs.

“Things like feeding yourself, brushing your teeth, putting your clothes on by yourself — all of those things are almost impossible if you’ve lost upper limb function on one side,” said Rennaker, head of the bioengineering department and director of the Texas Biomedical Device Center at UT Dallas.

Stroke is the No. 1 cause of disability in the United States, but it is also one of the easiest neurological disorders to study because it has a clearly defined cause, according to Kilgard, the Margaret Fonde Jonsson Professor in the School of Behavioral and Brain Sciences. Other brain disorders are more difficult to study because they result from multiple breaks in the nervous system, or their origins are not fully understood, he said.

Strokes occur when blood flow to the brain is interrupted, due to either a blockage (ischemic stroke) or a ruptured blood vessel (hemorrhagic stroke). Blood normally delivers life-sustaining oxygen to the brain. But without that timely and constant delivery, the affected areas become damaged and can eventually result in disability or death to the individual.

Some recovery can occur naturally after a stroke and restore some of the lost brain function. The ability of the brain to change after a stroke is referred to as neuroplasticity. Kilgard and Rennaker are using VNS to try to enhance that neuroplasticity and increase the recovered motor function.

VNS is an FDA-approved method for treating various illnesses, such as depression and epilepsy. It involves sending a mild electric pulse through the vagus nerve, which is in the neck and relays information about the state of the body to the brain.

“We’re interested in learning what is changing in the brain as a result of the VNS therapy, and how those changes lead to recovery.”

Dr. Michael Kilgard,
the Margaret Fonde Jonsson Professor in the School of Behavioral and Brain Sciences

Recent research at UT Dallas explored the use of VNS to enhance recovery from the two types of stroke. Last year, Dr. Navid Khodaparast published research describing the complete recovery of animals’ upper limb function after an ischemic stroke. In August, Dr. Seth Hays demonstrated an improvement in recovery from a hemorrhagic stroke in rats.

The new research project will employ an animal model to examine how effective VNS therapy is in an older population. According to the American Heart Association, the risk of having a stroke approximately doubles for every decade of life over 55 years.

“We’re interested in learning what is changing in the brain as a result of the VNS therapy, and how those changes lead to recovery,” Kilgard said.

Specifically, the researchers will examine changes in dendrites, the part of nerve cells in the brain that receives signals from other neurons. They’ll focus on the motor cortex region of the brain controlling upper limb function. They predict VNS therapy might increase dendritic growth in areas of the brain involved in recovery.

Researchers also will examine the connections between the neurons across the two sides of the brain. In a healthy animal, the right side of the brain controls the left side of the body and vice versa for the other side. In an animal recovering from brain damage to one side, recovery could be due to the surrounding undamaged areas taking over the work of the damaged areas or the other side of the brain taking over. Tracing the connections will allow the researchers to see which area of the brain is taking control, providing insight into where the recovery is taking place.

“Although we focus a lot on figuring out the basic science behind why VNS therapy works, our overall goal is to eventually improve the lives of patients,” Kilgard said. “Research like this will help us do that.”

Media Contact: Ben Porter, UT Dallas, (972) 883-2193, ben.porter@utdallas.edu
or the Office of Media Relations, UT Dallas, (972) 883-2155, newscenter@utdallas.edu.

http://www.utdallas.edu/news/2014/10/20-31243_Grant-Enables-Researchers-to-Continue-Studying-Str_story-wide.html?WT.mc_id=NewsHomePage

A patient’s experience with rTMS…

To the readers,

As many of you know I have through the years primarily devoted my efforts toward educating and sharing my knowledge and experiences as it relates to one particular therapy option; VNS Therapy for Depression.

While I continue to do so I am also a strong vocal mental health advocate/activist for any therapy option which safely and reasonably offers the potential for wellness with minimum potential for serious side-effects. One such treatment I have been following has been TMS (Transcranial Magnetic Stimulation). I have been allowed to share some recent correspondence I’ve had with a young woman currently utilizing TMS for her depressive illness. The correspondence is self-explanatory and copied and pasted below.

Herb

 

………………………………………………………………………………………………………………………………………

Paulette (Redacted)

Oct 12 (5 days ago)

to me

Hi Herb,

On the one hand, I wish I had responded to you sooner.  On the other hand, had I been able to, I would not so desperately have needed the treatments.  I have finished my first four weeks out of six weeks of daily treatments; then I will taper from three to two  to once per week.

I was happy to have been considered eligible for the treatments, but I think the treatment is so new, they will qualify anybody just to build a data-base of outcomes.

I was told the chances were only 50% that it would work; then I was given the three strikes against me: the very strong and broad family history; my unspeakably brutal childhood; and the decades I went without treatment.  But I can clearly tell it is working.

In Ohio, rTMS is covered by Medicare and, because I am so very poor, I'm on state QMB - Qualified Medicaid Beneficiary - which picked up the co-pay that would have been around $1500.  I forget how soon, but I will be allowed at least one "tune-up."

I hope this info helps.  Feel free to respond should you like more.

Peace,

Paulette

………………………………………………………………………………………………………………………………………..

Herb <vnsdepression@gmail.com>

Oct 12 (5 days ago)

to Paulette

Dear Paulette,

I am so very glad to hear from you and more importantly I am absolutely thrilled to not only read you were able to obtain the rTMS Therapy but most importantly the fact that you're responding to the treatment.  Bravo for you that you were willing to venture forth and try something new and different.  When Joyce enrolled in the trial for VNS Therapy for Depression we had absolutely no idea of the potential efficacy for depression.  Then again, it wouldn't have made any difference to us as we were desperate and at that point anything was worth a try. 

As it turned out it was the best decision we could have made and the results for Joyce have been nothing less than remarkable.

I hope you continue to improve and that your insurance covers all your costs.

Thanks for letting me know as it makes me feel good to know others are finding relief one way or another.

I wonder if you would allow me to share our email discussions on my blog site as a means to encourage others to not give up while I also endorse patient education and encourage hope. I shall redact any reference to your email address and only leave your first name. Please do let me know and from time to time please update me on how you’re doing.

Sincerely,

Herb

Joyce and Herbert Stein

1008 Trailmore Lane

Weston, FL 33326-2816

(954) 349-8733

vnsdepression@gmail.com

http://www.vnstherapy-herb.blogspot.com

http://www.vnstherapy.wordpress.com

……………………………………………………………………………………………………………………………………………

Paulette (Redacted)

6:35 PM (4 hours ago)

to me

Hi Herb,

Thanks for your good wishes.  Yes, you may use my story in your blog.

Peace,

Paulette

Magnetic stimulation gains in depression treatment

Magnetic stimulation gains in depression treatment

Transcranial magnetic stimulation offers new treatment for depression

By John Keilman, Chicago Tribunecontact the reporter

 

Though some question effectiveness of TMS, more health care providers offering the service

Patient says sensation of TMS electromagnetic pulses like "having a woodpecker sitting on your head"

A machine that sends magnetic pulses into a patient's brain has become the new frontier of depression treatment, promising to ease symptoms for those who have found little relief from medication or talk therapy.

The treatment, known as transcranial magnetic stimulation, or TMS, is part of a wave of technologies that attempt to jolt the brain back to health. It caught on quickly after the Food and Drug Administration approved its use six years ago, and more than 25 Chicago-area hospitals and psychiatrists now use TMS devices.

Though some have questioned the technology's effectiveness, more insurance companies are starting to cover it, helping with a price tag that can reach $10,000 for six weeks of treatment.

"What this does is raises (your mood) up to normal," a 55-year-old woman from the western suburbs said after finishing a treatment session at Linden Oaks at Edward in Naperville. "You can operate."

Magnetic pulses that battle depression

by Phil Geib

Stimulative brain therapies have been around for decades, with the best known being electroconvulsive therapy, a technique that uses an electric current to cause a seizure. It was portrayed as a mind-erasing menace in the movie "One Flew Over the Cuckoo's Nest," though psychiatrists say the procedure is safe today.

Other methods use implanted devices to send electrical pulses to the vagus nerve — a transmission line that carries messages to the brain's mood center — or to the brain itself. Some studies have found that these techniques help to elevate the moods of people with severe depression.

Dr. Mark George, a South Carolina psychiatrist who edits the medical journal Brain Stimulation, said TMS produces similar effects without the need for surgery.

 

A patient sits in a chair that resembles something from a dentist's office as a device containing the magnetic coil is placed on his head. When it's activated, George said, magnetic pulses penetrate the skull and stimulate nerve cells — the Linden Oaks patient described the sensation as "having a woodpecker sitting on your head" — provoking a therapeutic response.

George acknowledged that the technology doesn't work for everyone. Early studies, which relied on subjects who had been taken off their medications, found that only about 15 percent saw their depressive symptoms go away.

But later research that allowed subjects to stay on their meds, which George called a more true-to-life test, found that 40 percent had complete relief from their symptoms, while 60 percent got at least somewhat better.

That's not as effective as electroconvulsive therapy, which has full remission rates of around 60 percent, but George said that treatment requires patients to be anesthetized and is known to cause memory and cognitive problems in some.

 

TMS, by contrast, requires no sedation, and its biggest complication appears to be discomfort where the magnets are placed on the head.

"It's a highly effective treatment and has only trivial side effects," said Dr. Jesse Viner, medical director at Evanston's Yellowbrick psychiatric health care center. "There's no persistent adverse effect. You can have a little bit of a headache or facial pain, but that quickly subsides, and in our experience, by the time people have their third or fourth treatment, they're OK."

The effectiveness of TMS came into question in 2007 when the FDA was considering its use as a depression treatment. The Washington-based advocacy group Public Citizen, which often tangles with the agency over what it considers lax standards for medical devices, claimed the study the FDA relied on was unreliable.

The data at first showed that TMS was not significantly superior to a "sham treatment" that didn't subject patients to the magnetic pulses, the group said: Better results from TMS were evident only when some subjects were removed from the trial, and even then the difference was small.

What's more, the group said, patients receiving TMS knew they were getting something because unlike the sham treatment, the pulses produced a painful sensation.

"Given the small differences we were seeing, that could have been explained by the placebo effect," said Dr. Michael Carome, director of Public Citizen's health research group.

Dr. David Brock of Neuronetics, the Pennsylvania-based company that sought FDA approval for its TMS machines, pointed to a rebuttal by the study's authors that defended their methodology and cited the improvement made by patients who received the treatment. Subsequent research, Brock said, has further demonstrated the effectiveness of the technology.

The FDA decided to allow TMS as a depression treatment, and many Medicare contractors have since covered the service. Though private insurance companies remain split, with companies such as Blue Cross and Blue Shield of Illinois paying for TMS and others declining to do so, more than 100 million people now have coverage for the treatment, Brock said

That has encouraged more health care providers to invest in the machines, which doctors said cost $75,000 to $90,000. But Dr. Rad Gharavi, an Oak Park psychiatrist who has offered the service for four years, said insurance problems remain.

Coverage begins only after a patient has failed to get better after trying antidepressants. Gharavi said that can force patients to endure the side effects of medications for months.

"That means we are essentially delaying treatment," he said. "TMS can literally take away all the symptoms in six weeks."

It was more complicated than that for the Linden Oaks patient, who has dealt with depression since she was a teenager. She first received the treatment four years ago but comes for follow-up treatments every three months or so when she "can feel the beast creeping up," she said.

"It's apparently very individualized," she said. "There's been a bit of fine-tuning in terms of knowing when to come back for a booster."

Dr. Philip Janicak, a psychiatrist who has researched and performed TMS and is now helping Linden Oaks set up its program, said a recent study to which he contributed found that, generally speaking, the effects of the treatment last for a year.

With TMS now firmly established as a depression treatment, Janicak said research is turning to other possible uses, from migraines to Parkinson's disease to post-traumatic stress disorder.

"I see us really at the opening of this era," he said. "There's a lot of things we can do with this technology to help people, and we're just starting to touch the surface of it with depression."

jkeilman@tribune.com

Twitter @JohnKeilman

Copyright © 2014, Chicago Tribune

http://www.chicagotribune.com/lifestyles/health/ct-brain-stimulation-met-20141015-story.html

How Medicare Beneficiaries Can Save Money on Prescription Drugs

Senior Health

How Medicare Beneficiaries Can Save Money on Prescription Drugs

• By Kimberly Leonard, U.S. News and World Report

 

Tips on finding the best Medicare drug plan—and getting the most from it.

Medication costs can make up a large part of seniors citizens' budgets, but a few simple steps can easily save hundreds of dollars a year. The biggest single cost-saver? Picking the right Medicare plan. Whether you're preparing to renew your Medicare enrollment or signing up for Medicare for the first time, you'll want to make a careful selection so you don't end up spending more than you need to. Asking your doctors a few key questions – such as, "Is there a generic?" – can save you a bundle.

First, focus on choosing the right drug plan, which depends in part on which drugs you take. The majority of seniors are enrolled under original Medicare, which includes hospital insurance (known as Medicare Part A) and medical insurance (Medicare Part B).

Getting drug coverage requires one of two additional extra steps. Seniors can either get drug benefits via a private plan regulated by the government, under what's called Medicare Part D, or they can get drug coverage bundled with a private Medicare Advantage plan. For a Part D plan, members pay between $15 and $165.40 a month in premiums for 2013, depending on plans and regions, according to the nonprofit Kaiser Family Foundation.

The alternative is a Medicare Advantage plan, also called Medicare Part C, which replaces original Medicare and often provides prescription drug coverage as well. It is essentially a way to get Medicare A, B and D all lumped into one. Medicare beneficiaries can enroll in Medicare Advantage to receive their benefits in a private health plan, like a health maintenance organization. Across all Medicare Advantage plans with drug coverage, the average premium is $49 per month, according to the Kaiser Family Foundation. Consumers should evaluate on an individual basis whether this is the best option. Depending on your prescriptions and other health care needs, Medicare Advantage may or may not be better for you than original Medicare.

Comparing drug plans or Medicare Advantage plans can feel overwhelming. There are several free, simple tools online that can help you wade through the options. One tool, PlanPrescriber.com, could save users an average of $654 a year by helping them find the right health plan, according to a study the company conducted during the 2012 Medicare enrollment period. The study analyzed 12,000 users who entered their then-current drug plan and at least one prescription they were taking. The average savings were calculated by subtracting the customer's total estimated out-of-pocket spending on their then-current plan from their estimated spending on the plan recommended by PlanPrescriber. (Disclosure: U.S. News has a revenue-generating agreement with eHealthInsurance, which owns PlanPrescriber.)

RELATED: 5 Doctor Traits That Could Affect Your Bank Account

Another tool is available through the federal government at Medicare.gov, which, like PlanPrescriber, allows users to compare up to three plans at a time. The main difference: PlanPrescriber CEO Ross Blair says using his site's tool takes seniors an average of three to four minutes versus about 15 minutes on Medicare.gov. Users can also talk to agents over the phone.

ExtendHealth.com is another option, especially for people who may be uncomfortable submitting their information online. Though the tool also allows you to do a Web search and compare up to five plans at a time, the company has 1,200 advisers during enrollment season who can help you over the phone, says Bryce Williams, the company's CEO.

These three websites will also allow you to see drug pricing by pharmacy based on your location. Note that each pharmacy can charge a different amount.

Regardless of which Medicare plan you settle on, keep these other money-saving tips in mind.

Have Drugs Delivered

For medications you take regularly for a chronic condition, opt for the convenience and potential cost-savings of mail-order. In addition to sparing you unnecessary trips to the pharmacy, mail-ordering can sometimes include a 90-day supply at a reduced cost, depending on your insurance company and what kind of medications you need. Once you enroll in an insurance plan you should be able to go to that insurer's website to get your prescriptions delivered, or you can do it over the phone. Be sure to ask your doctor whether he or she needs to sign off on a 90-day supply. And take care to order refills before you need them so there isn't a gap of time when you don't have any pills. Also beware of illegal pharmacies on the Internet, which can pose a serious danger by sending you fake or incorrect prescriptions. Legitimate pharmacies will ask for a faxed prescription from a licensed doctor and a detailed medical history. They will also clearly state their payment, privacy and shipping fees, according to FBI warnings.

Go Generic

Ask your doctor if this is an option. The brand-name version of the drug you take is significantly more expensive than the generic form, if one is available. For example, simvastatin is the generic version of the drug Zocor, which is prescribed to control elevated cholesterol.

Thirty 40 mg tablets of the brand version of the drug will cost between $88.90 and $113.20 a month, according to a search in the Washington, D.C., area on PlanPrescriber, while the generic equivalent can cost as low as $15 a month. The online Medicare tools described above will allow you to compare the generic and brand-name drugs.

Double the Dosage, and Split the Pill

Sometimes pills that are double the dose of your medication cost the same as a single dose, and can easily be cut in half. For instance, if your doctor says you need a 10-mg dose of a particular drug each day, ask him or her whether your medication comes in doses of 20 mg and if they can safely be split in half. Many drugs used to treat high blood pressure and depression can be split, as can all cholesterol-lowering drugs known as statins, according to Consumer Reports. 

Enroll on Time

The open enrollment period for Medicare is from Oct. 15 to Dec. 7, with changes taking effect Jan. 1. You can enroll for the first time when you turn 65, and there are also special enrollment periods when you move or become eligible for Medicaid. 

Though Medicare drug coverage is considered voluntary, you must be getting drug coverage from another source that is at least as good as the offerings through the federal government. If you do not, you can face a penalty fee that grows each month you delay enrollment. Beware: If you are receiving another form of drug coverage, you may actually end up spending more if you sign up with Medicare. This applies to members of the Federal Employee Health Benefits Program, TRICARE (military health benefits) and Veterans Affairs. If you are an active worker on an employer plan, you will want to talk to your human resources department to make sure you understand all your options.

Some Prescription Drug Finding Tools

Medicare.gov

The federal government's site, Medicare.gov, helps users sift through different health plans and compare them three at a time, side by side.

The tool will allow you to do a general search by entering your ZIP code information, or farther down on the page you have the option to do a more specialized search. A questionnaire will ask how you pay for Medicare, then prompt you to enter your prescriptions. You have the option of entering the full name of your drugs, or selecting the first letter to scan a list of drug names.

Once you've entered all your prescriptions, you can indicate the pharmacy you want to use and continue to your plan results.

Phone numbers to call about enrolling in the plans will be provided, though some companies will also give you the option to enroll online.

PlanPrescriber.com

PlanPrescriber mainly differs from Medicare.gov in the amount of time it takes for a user to go through the search process.

This is mainly because the starting questionnaire is shorter, but its drug-finding tool is also simpler. Instead of asking users to enter the full drug name, the system will request only the drug's first three letters. Once the letters are in, the drugs have been narrowed down and a clickable list of options appears directly underneath the letters.

You can select your dosage, and then you will be taken to a comparison screen. A prompt will ask you whether you would like an agent to call you and help you sort through the health plans. If you decide you want to continue browsing options yourself, you will be able to compare plans in a separate tab, three at a time.

ExtendHealth.com

Extend Health, owned by human resources consulting firm Towers Watson, entered the consumer market during the last Medicare enrollment period, but the company has been helping seniors find drug plans for about eight years through its relationships with employers. Extend Health has partnered with Fortune 500 companies, including Chrysler and General Motors, to reach employees. If you belong to a company that works with Extend Health, your employer may mandate that you work only with this broker.

The process is simple, though. Retirees receive a mailer, which asks them to select a date and time that they would like an adviser to call them. They can also go through the process online, and compare up to five plans against one another. The company invests heavily in setting up people with brokers over the phone. The conversations will last an average of 23 minutes, says Williams, adding that seniors generally prefer to complete these enrollments over the phone.

Keep in mind that agents from PlanPrescriber or Extend Health may call you about their product offerings if you enter your personal information in their websites. 

http://www.everydayhealth.com/news/how-medicare-beneficiaries-can-save-money-prescription-drugs/

Last Updated: 10/15/2014