ROCHESTER, Minn. — Mayo Clinic experts are available to offer comments throughout the Olympics on everything from the effects of the COVID-19 pandemic on training and competition to injuries that athletes may be dealing with.

Here is a sampling:

• Chad Asplund, M.D.
  Dr. Asplund is a primary care sports medicine physician. He can discuss endurance sports, rhabdomyolysis, heat injury, sleep and athletic performance.

• Elijah Behr, M.D.
  Dr. Behr is a cardiologist at Mayo Clinic Healthcare in London who can discuss athletes and heart issues, including heart rhythm disorders, genetic heart disease, cardiomyopathy and sudden cardiac arrest.

• David Dodick, M.D.
  Dr. Dodick is a neurologist and sports medicine specialist with Mayo Clinic in Arizona. Dr. Dodick can discuss neurological conditions, including cluster headache and migraine, and head injuries, such as concussion.

• Michael Joyner, M.D.
  Dr. Joyner is an anesthesiologist and specialist in exercise physiology. Dr. Joyner is an expert on the limits of human performance and the physiology of world records. He can discuss the history of human performance, aging athletes, the relationship of environment to training, performance-enhancing drugs and gender in competition.

• Gregory Poland, M.D.
  Dr. Poland is an expert in vaccines and infectious diseases. He can discuss public outbreaks of illnesses, including COVID-19, influenza, rubella, smallpox and measles.

• Raul Rosario Concepcion, M.D.
  Dr. Rosario Concepcion is a sports medicine and physical medicine and rehabilitation specialist at Mayo Clinic in Florida. He can discuss management of tendinopathies, acute sports injuries and rehabilitation, and ultrasound-guided procedures. He is fluent in Spanish.

• Michael Stuart, M.D.
  Dr. Stuart is an orthopedic surgeon and sports medicine specialist and has served as team physician for the United States Men's Olympic hockey team. He can discuss complex knee problems, diagnostic procedures, surgical techniques of sports injuries and sports safety.

Journalists: To interview these or other Mayo experts on Olympics-related topics, contact Rhoda Madson, Mayo Clinic Public Affairs, at newsbureau@mayo.edu.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news. For information on COVID-19, including Mayo Clinic’s Coronavirus Map tracking tool, which has 14-day forecasting on COVID-19 trends, visit the Mayo Clinic COVID-19 Resource Center.

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On the Mayo Clinic Radio program, Dr. Brandon Verdoorn, a Mayo Clinic geriatrician, discusses pain management for older adults. Also on the program, Dr. David Dodick, a Mayo Clinic neurologist, explains when it is safe to return to play after a concussion. Then, Dr. Miriam (Priya) Alexander, a Mayo Clinic pathologist, and statistician Dr. Byron Smith explain how Mayo Clinic researchers created a deep learning program to read kidney biopsies faster. And Dr. Anna Bartoo and Dr. Heidi Finnes, Mayo Clinic pharmacists, discuss the work done by research pharmacists to prepare medications for clinical trials.

The post Mayo Clinic Radio: Pain control for older adults / returning to play after concussion / AI to read kidney biopsies / research pharmacy appeared first on Mayo Clinic News Network.

Listen: Mayo Clinic Radio 1/11/20

On the Mayo Clinic Radio podcast, Dr. Brandon Verdoorn, a Mayo Clinic geriatrician, discusses pain management for older adults. Also on the podcast, Dr. David Dodick, a Mayo Clinic neurologist, explains when it is safe to return to play after a concussion. Then, Dr. Miriam (Priya) Alexander, a Mayo Clinic pathologist, and statistician Dr. Byron Smith explain how Mayo Clinic researchers created a deep learning program to read kidney biopsies faster. And Dr. Anna Bartoo and Dr. Heidi Finnes, Mayo Clinic pharmacists, discuss the work done by research pharmacists to prepare medications for clinical trials.

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Here's your Mayo Clinic Radio podcast.

The post Pain management for older adults: Mayo Clinic Radio appeared first on Mayo Clinic News Network.

As we age, we expect a few aches and pains. But chronic pain in later life is a common condition, particularly among adults over the age of 65. Chronic pain can affect every aspect of life, making daily tasks difficult and often affecting the ability to get good sleep. In addition to physical discomfort, pain can affect mental and emotional health — increasing stress and frustration, sapping motivation and activity levels, and contributing to fatigue. Pain management strategies are important to help older adults maintain quality of life.

On the next Mayo Clinic Radio program, Dr. Brandon Verdoorn, a Mayo Clinic geriatrician, will discuss pain management for older adults. Also on the program, Dr. David Dodick, a Mayo Clinic neurologist, will explain when it is safe to return to play after a concussion. Then, Dr. Miriam (Priya) Alexander, a Mayo Clinic pathologist, and statistician Dr. Byron Smith will explain how Mayo Clinic researchers created a deep learning program to read kidney biopsies faster. And Dr. Anna Bartoo and Dr. Heidi Finnes, Mayo Clinic pharmacists, will discuss the work done by research pharmacists to prepare medications for clinical trials.

To hear the program, find an affiliate in your area.

Use the hashtag #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows or subscribe to the podcast.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

The post Pain management for older adults appeared first on Mayo Clinic News Network.

On the next Mayo Clinic Radio program, Dr. Brandon Verdoorn, a Mayo Clinic geriatrician, will discuss pain management for older adults. Also on the program, Dr. David Dodick, a Mayo Clinic neurologist, will explain when it is safe to return to play after a concussion. Then, Dr. Miriam (Priya) Alexander, a Mayo Clinic pathologist, and statistician Dr. Byron Smith will explain how Mayo Clinic researchers created a deep learning program to read kidney biopsies faster. And Dr. Anna Bartoo and Dr. Heidi Finnes, Mayo Clinic pharmacists, will discuss the work done by research pharmacists to prepare medications for clinical trials.

To hear the program, find an affiliate in your area.

Miss the show? Here's your Mayo Clinic Radio podcast.

Use the hashtag #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows or subscribe to the podcast.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

The post Mayo Clinic Radio: Pain control for older adults / returning to play after concussion / AI to read kidney biopsies / research pharmacy appeared first on Mayo Clinic News Network.

“Spin the wheel, see what drug you land on, and just try it. That’s the trial-and-error approach that we have had to use in migraine,” says David Dodick, M.D., a neurologist at Mayo Clinic's Arizona campus.

The World Health Organization ranks migraine as the third most prevalent medical condition in the world. In the U.S., migraine affects 38 million people at an annual estimated cost of more than $20 billion. The impact of migraines is amplified by the fact that people generally start experiencing attacks at a young age.

“Migraine affects people during the prime of their lives — while they’re trying to get an education, build a career and raise a family. And those effects extend throughout people’s lives,” Dr. Dodick says.

But new understanding of the biology underlying migraine, and the development of therapies developed specifically to treat and prevent the disorder, are changing migraine care.

“It’s a brand-new era. We’re about to see a plethora of mechanism-based, disease-specific therapies become available over the next few years,” Dr. Dodick says. “With this range of options in our therapeutic arsenal, I’ve never been more optimistic for patients.”

Mayo Clinic is at the leading edge of these efforts, participating in the design and data analysis of clinical trials for the news classes of migraine medication, such as research in Neurology, JAMA Neurology, JAMA and Cephalalgia in 2018. In the laboratory, Mayo Clinic is using advanced brain imaging to develop biomarkers for classifying migraine, a notoriously subjective disorder. Mayo Clinic neurologists also led the trial that resulted in approval of a noninvasive neurostimulation device to prevent migraine attacks.

The cornerstone of this new approach is precision medicine — tailoring diagnosis and treatment to the individual to optimize care.

“We are in a huge paradigm shift. For patients, that will mean more effective treatment options and less burdensome side effects,” says Amaal Starling, M.D., a Mayo Clinic neurologist. “It’s exciting to be involved as a clinician and a scientist, and it’s also an exciting time for patients.”

Engineering targeted solutions

Perhaps the biggest challenge of migraine treatment has been the dearth of disease-specific therapies. For years, migraine treatment relied on medications developed to treat other diseases, including epilepsy, hypertension and depression. “Although these medications were approved for migraine treatment, they weren’t based on any brain mechanism related to migraine,” Dr. Dodick says.

The triptan class of medications, which was developed in the 1990s specifically for migraine, was engineered to constrict blood vessels around the brain. At the time, migraine was thought to be caused by abnormal dilation of those blood vessels. But subsequent studies have shown that’s not the case.

“It turns out the mechanism for which these drugs were engineered is neither relevant nor necessary,” Dr. Dodick says. In addition, because triptans constrict blood vessels, they can’t be prescribed for people with significant risk factors for cardiovascular disease.

The new classes of migraine therapy target certain neuropeptides, known as "CGRP" and "PACAP."

“As our understanding of the underlying biology of migraine has come into much sharper focus, we’ve identified these neuropeptides that appear to play a pivotal role,” Dr. Dodick says.

To learn more about individual migraine triggers and treatment responses, Mayo Clinic has launched a multicenter registry of migraine patients in the U.S. The first registry of its kind, it includes multiple patient data points, as well as blood samples and an imaging bank where MRI and CT scans are uploaded. A second, international registry, started in Australia and the U.K., is set to expand to other countries.

“Over the next three to five years, we expect there to be a number of new, mechanism-based therapies that have different targets for individual patients,” Dr. Dodick says. “We don’t have to waste time with trial and error, and expose people to medications that aren’t going to be effective. That’s precision medicine.” 

MRI that captures pain

Pain is real but subjective. Unlike a broken limb, you can’t take a picture of it. Nevertheless, at Mayo Clinic, imaging studies are revealing objective clues for diagnosing, treating and predict outcomes for people with migraine.

“Imaging is one way that we might identify additional subtypes of migraine beyond those commonly recognized,” says Todd Schwedt, M.D., director of Mayo’s Neuroimaging of Headache Disorders Laboratory on Mayo Clinic's Arizona campus. “Our current, subjective classification of migraine doesn’t identify all the subtle differences that exist among individuals with migraine.”

The Neuroimaging of Headache Disorders Laboratory is using functional and structural MRI to develop objective biomarkers for the classification of headache disorders. Currently used only for research, the MRI studies eventually may move into the clinical domain.

Functional MRI measures brain activity by detecting changes associated with blood flow. The headache researchers use this tool to assess how people process pain. With functional MRI data and machine learning techniques, the researchers have developed biomarkers that distinguish between people with migraine and healthy controls.

“We can look at the functional MRI and tell you with greater than 80 percent accuracy whether that MRI belongs to somebody who has chronic versus episodic migraine or chronic migraine versus a healthy control,” Dr. Schwedt says.

Structural MRI measures factors such as brain shape, and the volume and thickness of various brain regions. In a study based on structural MRI data, the headache researchers were able to cluster participants with migraine into two groups. During migraine attacks, people in the first group had more severe sensitivity to pain from events that normally wouldn't evoke pain, such as being lightly touched — than people in the second group. That condition is called "allodynia."

“The presence or severity of allodynia could be considered when defining migraine subgroups,” Dr. Schwedt says. “It’s been suggested that allodynia might affect migraine treatment response and disease prognosis, and our study suggests that it affects brain structure. The goal of all of these studies is to identify additional subgroups who have different prognoses or different likelihoods of responding to migraine treatments.” 

Noninvasive prevention

People who live with migraine face a terrible dilemma: Take daily medication to prevent attacks and put up with side effects, such as nausea and fatigue, or stop taking the medication and dread the next attack. Less than 20 percent of people with chronic migraine are able to adhere to preventive medication for more than a year.

A neurostimulation device approved by the Food and Drug Administration offers another option. Using the principles of electromagnetic induction, the device transmits an electrical signal across the scalp and skull, and into superficial layers of the brain to alter the electrical environment.

“The brain of a person with migraine is hyperexcitable. In preclinical studies, we demonstrated that single-pulse transcranial magnetic stimulation reduces brain hyperexcitability,” Dr. Starling says.

The device, previously approved for treating migraine attacks, can be used at home to prevent migraine with aura or migraine without aura. In the Mayo-led trial of the device for preventive treatment, people with chronic migraine administered four pulses twice a day for three months. Nearly half of the study participants had a reduction in their number of headache days of greater than 50 percent. There were also significant reductions in disability and in the number of days of acute medication use. Side effects were rare and mild: lightheadedness, tingling and ear-ringing. Full results can be found in Cephalalgia, published in May, 2018.

“This has been a life-changing experience for some of my patients, who have been able to stop taking some of their oral medications,” Dr. Starling says. “Usually, we prescribe separate medications for headache prevention and for acute treatment. That can be cumbersome and even confusing. Having one treatment option for both, with minimal side effects, is really attractive.”

Migraine affects more women than men. Mayo Clinic also is studying the use of the neurostimulation device in pregnant women with migraines.

One reason Dr. Starling chose to subspecialize in headache disorders is that she experiences migraines, as do several family members, including her husband and son. “There is definitely a stigma associated with migraine and a myth that somehow migraine isn’t real. That myth needs to be broken,” Dr. Starling says. “People with migraine aren’t weak. They have a real neurologic disease, which we are starting to objectively measure and which we can treat.”

-- Barbara Toman

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ROCHESTER, Minn. — With the fall sports season underway, attention turns to concussion awareness. The Centers for Disease Control and Prevention estimates that as many as 3.9 million sports- and recreation-related concussions occur in the U.S. each year. And that number may be higher because many more concussions are not diagnosed correctly.

There continues to be a lot of discussion about concussions. How much do people really know about how to spot a concussion? What should be done about a concussion? And how are they treated? Many people don’t know how a concussion is caused.

A concussion is a mild form of a traumatic brain injury that alters the way your brain functions. Effects are usually temporary but can include headaches and problems with concentration, memory, balance and coordination. Concussions can happen to anyone, but children and athletes are at a particularly high risk. Although concussions usually are caused by a blow to the head, they also can occur when the head and upper body are violently shaken. These injuries can cause a loss of consciousness; however, most concussions do not. Because of this, some people have concussions and don't realize it. Concussions are common, particularly if you play a contact sport.

Mayo Clinic has these experts available for media interviews:

Arizona:

• Charles Adler, M.D., Ph.D., neurologist, movement disorders specialist, brain bank research
• David Dodick, M.D., neurologist and medical director of the Headache and Sports Neurology and Concussion programs
• Amaal Starling, M.D., neurologist, headache and concussion expert
• Jennifer Wethe, Ph.D., neuropsychologist, and concussion and rehabilitation expert

To schedule an interview with any of these physicians at Mayo Clinic’s Arizona campus, contact Jim McVeigh, Mayo Clinic Public Affairs, 480-301-4222 or mcveigh.jim@mayo.edu.

Florida:

• Kevin Bieniek, Ph.D., neuroscientist
• Kristina DeMatas, D.O., family medicine consultant
• Dennis Dickson, M.D., neuropathologist and Robert E. Jacoby Professor of Alzheimer's Research
• Jennifer Maynard, M.D., family and sports medicine consultant

To schedule an interview with any of these physicians at Mayo Clinic’s Florida campus, contact Kevin Punsky, Mayo Clinic Public Affairs, 904-953-0746 or punsky.kevin@mayo.edu.

Rochester:

• David Soma, M.D., pediatric sports medicine physician
• Michael Stuart, M.D., orthopedic surgeon and co-director, Mayo Clinic Sports Medicine

Hockey concussion summit
Mayo Clinic Sports Medicine will host its third hockey concussion summit Sept. 28–29, 2017, at Mayo Clinic’s Rochester campus. Scientists, trainers, coaches, officials, retired professional players and equipment makers from the U.S. and Canada will discuss the science of concussion, the prevention, diagnosis and treatment of concussion injuries, and directions of future research. The summit focuses on ice hockey, but concussion-related topics apply to all sports.

To schedule an interview with either of these physicians at Mayo Clinic’s Rochester campus or for information about the hockey concussion summit, contact Rhoda Madson, Mayo Clinic Public Affairs, 507-284-5005 or newsbureau@mayo.edu.

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About Mayo Clinic 
Mayo Clinic is a nonprofit organization committed to clinical practice, education and research, providing expert, comprehensive care to everyone who needs healing. For more information, visit mayoclinic.org/about-mayo-clinic or newsnetwork.mayoclinic.org.

MEDIA CONTACTS
Rhoda Madson, Mayo Clinic Public Affairs
507-284-5005, newsbureau@mayo.edu

Jim McVeigh, Mayo Clinic Public Affairs
480-301-4222, mcveigh.jim@mayo.edu

Kevin Punsky, Mayo Clinic Public Affairs
904-953-0746, punsky.kevin@mayo.edu

The post Expert Alert: Mayo Clinic specialists address concussion injuries appeared first on Mayo Clinic News Network.

PHOENIX — A Mayo Clinic research team, led by neurologists Todd Schwedt, M.D. and David Dodick, M.D., has been approved for $7 million in funding from the Patient-Centered Outcomes Research Institute (PCORI) to study migraine treatment strategies.

The five-year study, “Determining the Optimal Treatment Strategy for Patients Who Have Chronic Migraine With Medication Overuse,” will compare two current strategies for treating patients who have chronic migraine.

“For the first time, we will be able to directly compare two commonly used treatment strategies for those with chronic migraine and medication overuse. The results will help determine the optimal treatment strategy for patients with this common and disabling condition,” says Dr. Schwedt, adding that the trial is expected to begin later in 2016 and is expected to involve 1,280 enrolled patients.

Approximately 36 million people in the U.S. suffer from migraines and three percent of people (or roughly 10 million) suffer from chronic migraine, according to the American Migraine Foundation. Chronic migraine is defined as having at least 15 days of headache per month, including at least eight days per month of migraine.

About half of chronic migraine sufferers take medication to stop an attack too frequently, which could lead to medication overuse. Medication overuse can lead to more frequent migraines and migraines that are less responsive to other types of treatments. Mayo Clinic’s study will research the effects of immediate discontinuation of the overused medication plus treatment with migraine prophylactic therapy versus migraine prophylactic therapy without immediate discontinuation of the overused medication.

MEDIA CONTACT: Julie Janovsky-Mason, Mayo Clinic Public Affairs, 480-301-6173, newsbureau@mayo.edu

Dr. Schwedt’s study was selected for funding through PCORI’s Pragmatic Clinical Studies Initiative, an effort to produce results that are broadly applicable to a diverse range of patients and care situations, and can be more quickly taken up in clinical practice.

“This project was selected for PCORI funding not only for its scientific merit and commitment to engaging patients and other health care stakeholders in a major study conducted in real-world settings, but also for its potential to answer an important question about migraines and fill a crucial evidence gap,” says Joe Selby, M.D., MPH, executive director, PCORI. “We look forward to following the study’s progress and working with Mayo Clinic to share its results.”

Mayo Clinic’s award has been approved pending completion of a business and programmatic review by PCORI staff and issuance of a formal award contract.
https://youtu.be/j9nrlXrAxZg

About PCORI
PCORI is an independent, nonprofit organization authorized by Congress in 2010. Its mission is to fund research that will provide patients, their caregivers and clinicians with the evidence-based information needed to make better-informed health care decisions. For more information about PCORI’s funding, visit www.pcori.org.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to clinical practice, education and research, providing expert, whole-person care to everyone who needs healing. For more information, visit http://www.mayoclinic.org/about-mayo-clinic or https://newsnetwork.mayoclinic.org/.

The post $7 Million Research Funding Award for Migraine Research appeared first on Mayo Clinic News Network.

The Centers for Disease Control and Prevention estimates that between 1.6 and 3.8 million students have concussions every year. In an effort to bring awareness and increase concussion screening, Mayo Clinic has agreed to a licensing agreement with King-Devick Test Inc., which has developed a proven indicator of ocular motor, visual and cognitive function for concussion detection and evaluation on the sidelines of sporting events to help with the decision to sideline athletes to prevent injury.

Under the terms of the agreement, King-Devick and Mayo Clinic will form a scientific governance committee and Mayo will have membership on the company’s board of directors. Packaging for the test will indicate it is offered in association with Mayo Clinic. Revenue Mayo receives will be used to support its nonprofit mission in patient care, education and research. The King-Devick Test is a quick, accurate and objective concussion screening tool that can be administered on the sidelines by parents, coaches, athletic trainers, school nurses and medical professionals, and a Mayo Clinic study indicated it detects concussions and possible 'silent' concussions.

Click here to listen to audio from today's news conference.

Click here for a transcript of today's news conference.

MEDIA CONTACT: Jim McVeigh, Mayo Clinic Public Affairs, 507-284-5005, newsbureau@mayo.edu

“Youth athletes are at a higher risk for concussion and a longer recovery time than adults,” says David Dodick, M.D., Mayo Clinic neurologist and director of Mayo Clinic’s concussion program who studied its use in high school hockey players. “Our studies show this test detects potential brain injuries in athletes who have not reported symptoms of concussion. We are committed to making sports safer through our comprehensive concussion program and Sports Medicine Center. While concussion testing doesn’t eliminate concussions, it can guide return-to-play decisions and minimize complications and more serious neurological injuries that may occur with a repeat concussion.”

“It’s a privilege to be associated with the premier health care brand in the world,” says Steve Devick, Founder and CEO of King-Devick Test. “This agreement will help us accomplish our goal of having a tool on the sidelines to help determine ‘remove from play’ for athletes to prevent further injury and be referred to qualified professionals for follow up care.”

The test requires an athlete to read single-digit numbers displayed on cards or tablet computer. After suspected head trauma, the athlete is given the test, which takes about two minutes, and the results are compared to a baseline test administered previously. If the time needed to complete the test takes longer than the baseline test time, or if the subject shows any other symptoms of a concussion, the athlete should be removed from play until evaluated by a medical professional. A new baseline is required annually.

Peer reviewed published research has shown that The King-Devick Test requires eye movements, speech, language, and concentration, all of which can be impaired as a result of concussion. Recently more than 20 studies showing the effectiveness of the test as a quick, objective and accurate “remove from play” sideline test have been presented or published in elite scientific journals.  Numerous other recent studies have been published regarding King-Devick Test as it relates to MS, Parkinson’s disease, ALS, hypoxia, extreme sleep deprivation and reading fluency. Under the agreement, Mayo Clinic will provide ongoing medical consultation in future development of the test.

The King-Devick Test has also been proven to detect un-witnessed, un-reported and “silent” concussions in athletes.

“Although concussion awareness has been a trending hot media topic at the professional and collegiate sport levels, more information must be disseminated to the high school and youth levels, Dr. Dodick added. “Concussion guidelines are rapidly changing.   Just a few years ago, athletes were expected to ‘shake it off’ and continue to play after suffering a concussion or a ‘ding.’ Today, we now know that it is unsafe for any athlete to return-to-play the same day they have suffered a concussion, and it is recommended that every athlete not return-to-play until they have been cleared by an appropriate professional.”

Recently Neurology Review listed a King-Devick article as one of their Top News Articles for 2014.

About King-Devick Test, LLC
The King-Devick (K-D) Test was developed more than 30 years ago and has been used worldwide as a proven indicator of saccadic eye movements as they relate to reading, using Rapid Number Naming. Elite neurological journals have called the King-Devick Test an "accurate and reliable method for identifying athletes with head trauma." Other studies have proven King-Devick Test to help determine neurological functionality in: Parkinson's disease, Multiple Sclerosis, ALS, extreme sleep deprivation, and hypoxia. For more information, visit: www.kingdevicktest.com

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to medical research and education, and providing expert, whole-person care to everyone who needs healing. For more information, visit http://mayocl.in/1ohJTMS, or https://newsnetwork.mayoclinic.org/. Mayo Clinic has a financial interest in the technology described in this press release.

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