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Meyers EE, Brizzi KT. Analgesic Strategies in Patients With Amyotrophic Lateral Sclerosis #477. J Palliat Med 2024; 27:565-566. [PMID: 38574339 DOI: 10.1089/jpm.2024.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
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Rush CL, Lester EG, Berry JD, Brizzi KT, Lindenberger EC, Curtis JR, Vranceanu AM. A roadmap for early psychosocial support in palliative care for people impacted by ALS-reducing suffering, building resiliency, and setting the stage for delivering timely transdiagnostic psychosocial care. Transl Behav Med 2023; 13:722-726. [PMID: 37043596 DOI: 10.1093/tbm/ibad024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
This commentary describes the current state of psychosocial care for people with amyotrophic lateral sclerosis and their caregivers. We provide recommendations for developing a roadmap for future research based on existing literature and our group's clinical and research experience to inform next steps to expand evidence-based psychosocial care for people with amyotrophic lateral sclerosis and their caregivers, with potential implications for a range of advanced illnesses.
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Affiliation(s)
- Christina L Rush
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital (MGH)/Harvard Medical School (HMS), Boston, MA, USA
| | - Ethan G Lester
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital (MGH)/Harvard Medical School (HMS), Boston, MA, USA
| | - James D Berry
- Department of Neurology, Massachusetts General Hospital (MGH)/Harvard Medical School (HMS), Boston, MA, USA
| | - Kate T Brizzi
- Department of Neurology, Massachusetts General Hospital (MGH)/Harvard Medical School (HMS), Boston, MA, USA
| | - Elizabeth C Lindenberger
- Division of Palliative Care & Geriatric Medicine, Massachusetts General Hospital (MGH)/Harvard Medical School (HMS), Boston, MA, USA
| | - Jared Randall Curtis
- Division of Pulmonary, Critical Care and Sleep Medicine and Cambia Palliative Care Center of Excellence, Harborview Medical Center, University of Washington School of Medicine, Seattle, WA, USA
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital (MGH)/Harvard Medical School (HMS), Boston, MA, USA
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Affiliation(s)
- Kate T Brizzi
- Department of Neurology, Massachusetts General Hospital, Boston
- Department of Medicine, Division of Palliative Care, Massachusetts General Hospital, Boston
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Brizzi KT, Bridges JFP, Yersak J, Balas C, Thakur N, Galvin M, Hardiman O, Heatwole C, Ravits J, Simmons Z, Bruijn L, Chan J, Bedlack R, Berry JD. Understanding the needs of people with ALS: a national survey of patients and caregivers. Amyotroph Lateral Scler Frontotemporal Degener 2020; 21:355-363. [DOI: 10.1080/21678421.2020.1760889] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Kate T. Brizzi
- Healey Center for ALS, Massachusetts General Hospital, Boston, MA, USA,
- Department of Medicine, Division of Palliative Care, Massachusetts General Hospital, Boston, MA, USA,
| | | | | | | | | | - Miriam Galvin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland,
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland,
| | - Chad Heatwole
- Medical Center, University of Rochester, Rochester, NY, USA,
| | - John Ravits
- Department of Neurosciences, University of California, San Diego, CA, USA,
| | | | - Lucie Bruijn
- Translational Medicine, EMEA, AVeXis, London, UK,
| | - James Chan
- Center for Biostatistics, Massachusetts General Hospital, Boston, MA, USA,
| | - Richard Bedlack
- Department of Neurology, Duke University Medical Center, Durham, NC, USA
| | - James D. Berry
- Healey Center for ALS, Massachusetts General Hospital, Boston, MA, USA,
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Chua IS, Leiter RE, Brizzi KT, Coey CA, Mazzola E, Tulsky JA, Lindvall C. US National Trends in Opioid-Related Hospitalizations Among Patients With Cancer. JAMA Oncol 2020; 5:734-735. [PMID: 30920595 DOI: 10.1001/jamaoncol.2019.0042] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Isaac S Chua
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Richard E Leiter
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kate T Brizzi
- Division of Palliative Medicine, Department of Medicine, Massachusetts General Hospital, Boston
| | - Charles A Coey
- Osher Center for Integrative Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Emanuele Mazzola
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - James A Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Charlotta Lindvall
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Stephen CD, Brizzi KT, Bouffard MA, Gomery P, Sullivan SL, Mello J, MacLean J, Schmahmann JD. The Comprehensive Management of Cerebellar Ataxia in Adults. Curr Treat Options Neurol 2019; 21:9. [PMID: 30788613 DOI: 10.1007/s11940-019-0549-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW In this review, we present the multidisciplinary approach to the management of the many neurological, medical, social, and emotional issues facing patients with cerebellar ataxia. RECENT FINDINGS Our holistic approach to treatment, developed over the past 25 years in the Massachusetts General Hospital Ataxia Unit, is centered on the compassionate care of the patient and their family, empowering them through engagement, and including the families as partners in the healing process. We present the management of ataxia in adults, beginning with establishing an accurate diagnosis, followed by treatment of the multiple symptoms seen in cerebellar disorders, with a view to maximizing quality of life and effectively living with the consequences of ataxia. We discuss the importance of a multidisciplinary approach to the management of ataxia, including medical and non-medical management and the evidence base that supports these interventions. We address the pharmacological treatment of ataxia, tremor, and other associated movement disorders; ophthalmological symptoms; bowel, bladder, and sexual symptoms; orthostatic hypotension; psychiatric and cognitive symptoms; neuromodulation, including deep brain stimulation; rehabilitation including physical therapy, occupational therapy and speech and language pathology and, as necessary, involving urology, psychiatry, and pain medicine. We discuss the role of palliative care in late-stage disease. The management of adults with ataxia is complex and a team-based approach is essential.
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Affiliation(s)
- Christopher D Stephen
- Ataxia Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
- Movement Disorders Division, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Laboratory for Neuroanatomy and Cerebellar Neurobiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Kate T Brizzi
- Ataxia Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Division of Palliative Care, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Marc A Bouffard
- Ataxia Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Division of Advanced General and Autoimmune Neurology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Pablo Gomery
- Department of Urology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Stacey L Sullivan
- Speech Language Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Julie Mello
- Physical Therapy, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Julie MacLean
- Occupational Therapy, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jeremy D Schmahmann
- Ataxia Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Laboratory for Neuroanatomy and Cerebellar Neurobiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Cognitive Behavioral Neurology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Chua IS, Leiter R, Brizzi KT, Coey CA, Mazzola E, Tulsky JA, Lindvall C. National trends in opioid-related hospitalizations among patients with cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.34_suppl.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
199 Background: Cancer patients are routinely prescribed opioids for cancer-related pain. With recent attention to the opioid epidemic, we sought to identify risk factors and to describe the incidence of opioid-related hospitalizations among cancer patients. Methods: Serial cross-sectional study of adult cancer patients with opioid-related hospitalizations using the National Inpatient Sample (NIS) database from January 2006 to December 2014. We identified cancer patients using the International Classification of Diseases, Ninth Revision (ICD-9) codes. We defined opioid-related hospitalizations as ICD-9 codes for heroin poisoning, opioid poisoning, or opioid dependence or abuse in the primary diagnosis field. A logistic regression model identified predictors for opioid-related hospitalizations. We adjusted temporal trends for opioid-related hospitalizations for all-cause hospitalizations among cancer patients. Results: Among 25,443,362 hospitalizations for cancer patients, there were 14,336 opioid-related hospitalizations. Non-heroin opioid poisoning made up 88% of opioid-related hospitalizations. Predictors for opioid-related hospitalizations for cancer patients included drug abuse (OR 9.40, 95% CI 8.28 - 10.66), younger age [age 18 - 29 (OR 4.00, 95% CI 3.10 - 5.17); age 30 - 49 (OR 3.99, 95% CI 3.43 - 4.65)], depression (OR 2.17, 95% CI 1.97 - 2.39), alcohol abuse (OR 1.21, 95% CI 1.03 - 1.41), and year of hospitalization [2009-2011 (OR 1.19; 95% CI 1.07 - 1.32); 2012 - 2014 (OR 1.19; 95% CI, 1.06 - 1.32)]. On average, opioid-related hospitalizations increased by 0.003% per year (p = 0.002). Conclusions: Opioid-related hospitalizations among cancer patients are rare, appear to be increasing over time, and are largely due to non-heroin opioid poisoning. Standardized opioid risk screening based on validated predictors may identify cancer patients with the greatest risk of an opioid-related hospitalization.
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McKenzie ED, Lim ASP, Leung ECW, Cole AJ, Lam AD, Eloyan A, Nirola DK, Tshering L, Thibert R, Garcia RZ, Bui E, Deki S, Lee L, Clark SJ, Cohen JM, Mantia J, Brizzi KT, Sorets TR, Wahlster S, Borzello M, Stopczynski A, Cash SS, Mateen FJ. Validation of a smartphone-based EEG among people with epilepsy: A prospective study. Sci Rep 2017; 7:45567. [PMID: 28367974 PMCID: PMC5377373 DOI: 10.1038/srep45567] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 02/27/2017] [Indexed: 12/17/2022] Open
Abstract
Our objective was to assess the ability of a smartphone-based electroencephalography (EEG) application, the Smartphone Brain Scanner-2 (SBS2), to detect epileptiform abnormalities compared to standard clinical EEG. The SBS2 system consists of an Android tablet wirelessly connected to a 14-electrode EasyCap headset (cost ~ 300 USD). SBS2 and standard EEG were performed in people with suspected epilepsy in Bhutan (2014-2015), and recordings were interpreted by neurologists. Among 205 participants (54% female, median age 24 years), epileptiform discharges were detected on 14% of SBS2 and 25% of standard EEGs. The SBS2 had 39.2% sensitivity (95% confidence interval (CI) 25.8%, 53.9%) and 94.8% specificity (95% CI 90.0%, 97.7%) for epileptiform discharges with positive and negative predictive values of 0.71 (95% CI 0.51, 0.87) and 0.82 (95% CI 0.76, 0.89) respectively. 31% of focal and 82% of generalized abnormalities were identified on SBS2 recordings. Cohen's kappa (κ) for the SBS2 EEG and standard EEG for the epileptiform versus non-epileptiform outcome was κ = 0.40 (95% CI 0.25, 0.55). No safety or tolerability concerns were reported. Despite limitations in sensitivity, the SBS2 may become a viable supportive test for the capture of epileptiform abnormalities, and extend EEG access to new, especially resource-limited, populations at a reduced cost.
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Affiliation(s)
- Erica D. McKenzie
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew S. P. Lim
- Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Edward C. W. Leung
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Andrew J. Cole
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Alice D. Lam
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Ani Eloyan
- Department of Biostatistics, School of Public Health, Brown University, Providence, RI, USA
| | - Damber K. Nirola
- Department of Psychiatry, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Lhab Tshering
- Department of Psychiatry, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Ronald Thibert
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Esther Bui
- Division of Neurology, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Sonam Deki
- Department of Psychiatry, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Liesly Lee
- Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Sarah J. Clark
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Joseph M. Cohen
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Jo Mantia
- Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Kate T. Brizzi
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Tali R. Sorets
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Sarah Wahlster
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - Mia Borzello
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Arkadiusz Stopczynski
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Sydney S. Cash
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Farrah J. Mateen
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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Ho GPH, Brizzi KT, Meredith DM, Laws ER, Berkowitz AL. Clinical Reasoning: A 58-year-old woman with loss of vision in her left eye. Neurology 2016; 86:e101-7. [PMID: 26952304 DOI: 10.1212/wnl.0000000000002456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Gary P H Ho
- From the Departments of Neurology (G.P.H.H., K.T.B., A.L.B.), Pathology (D.M.M.), and Neurosurgery (E.R.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Kate T Brizzi
- From the Departments of Neurology (G.P.H.H., K.T.B., A.L.B.), Pathology (D.M.M.), and Neurosurgery (E.R.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - David M Meredith
- From the Departments of Neurology (G.P.H.H., K.T.B., A.L.B.), Pathology (D.M.M.), and Neurosurgery (E.R.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Edward R Laws
- From the Departments of Neurology (G.P.H.H., K.T.B., A.L.B.), Pathology (D.M.M.), and Neurosurgery (E.R.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Aaron L Berkowitz
- From the Departments of Neurology (G.P.H.H., K.T.B., A.L.B.), Pathology (D.M.M.), and Neurosurgery (E.R.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Abstract
Infectious causes of peripheral nervous system (PNS) disease are underrecognized but potentially treatable. Heightened awareness educed by advanced understanding of the presentations and management of these infections can aid diagnosis and facilitate treatment. In this review, we discuss the clinical manifestations, diagnosis, and treatment of common bacterial, viral, and parasitic infections that affect the PNS. We additionally detail PNS side effects of some frequently used antimicrobial agents.
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Affiliation(s)
- Kate T. Brizzi
- Massachusetts General Hospital, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA, USA
| | - Jennifer L. Lyons
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
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