In recent years, there have been many exciting innovations in the field of neurology. From new migraine-busting drug therapies to software that can help quickly determine treatment for stroke patients, neurologists at Edward-Elmhurst Health are delivering high-quality patient care through these exciting, innovative treatment options.

Migraine medications

A new group of migraine management medications treats the root cause of the migraine, rather than merely masking the symptoms. “I always joke that if you have to have a migraine, this is probably the best time to have it,” says neurologist Yonghua Michael Zhang, M.D.

When released in the brain, calcitonin gene-related peptide (CGRP) causes the inflammation and pain that occurs during a migraine. A new class of drug called CGRP inhibitors prevents this by blocking CGRP in the brain from binding to CGRP receptors.

Some CGRP inhibitors are prescribed to prevent migraines. The prescription drugs Aimovig, Vyepti, Ajovy and Emgality are administered monthly or quarterly via injection or IV, while the drugs Qulipta, Nurtec and Ubrelvy can be taken orally.

To treat a migraine while it’s happening, people can orally take Nurtec or Ubrelvy. They can even use a nasal spray called Zavzpret. While not a CGRP inhibitor, Reyvow is a newer serotonin-based drug for migraine attacks.

Another lesser-known treatment option for migraine attacks is electrostimulation devices called neuromodulators. One is remote electrical neuromodulation (REN), which stimulates the peripheral nerves in the upper arm and the other is an external concurrent occipital and trigeminal neurostimulation (eCOT-NS) device, a headset that stimulates nerves in the head.

“The new migraine medications are the first designed specifically to target migraines rather than mediating pain and inflammation,” says neurologist Arkadiy Konyukhov, M.D.

Venous stenting for pulsatile tinnitus

Pulsatile tinnitus is a condition where the patient hears a whooshing or heartbeat sound in one or both ears. The sound is typically a symptom of issues related to the brain's blood vessels.

“Most people with pulsatile tinnitus don't have a dangerous cause,” says neurosurgeon Daniel Heiferman, M.D., “If that is the case and the sound doesn’t bother them, they can go about living their life.”

However, some people who don't have a dangerous cause can still experience debilitating sound that negatively affects their everyday life.

A common non-dangerous cause of pulsatile tinnitus is something called venous sinus stenosis, a narrowing of a large vein in the brain that sends a sound to the inner ear. This condition can be treated via venous stenting, a procedure that inserts a tiny mesh tube through a vein in the groin to the brain’s blood vessel, propping it open and eliminating the sound. The procedure is minimally invasive with little pain and a quick recovery.

“Some of the happiest patients in my neurosurgical practice are those with venous stents for truly debilitating sound,” says Dr. Heiferman. “It’s one of the most rewarding procedures we get to do.”

Mobile cardiac telemetry (MCT)

Roughly one-third of stroke patients have no detectable cause of stroke, a phenomenon called cryptogenic strokes. 

While these patients don’t present with any brain vessel blockages or abnormalities on their echocardiograms, they could be experiencing atrial fibrillation (AFib), an irregular heartbeat or arrhythmia that increases the risk of stroke by five times.

But when AFib is not detected while the patient is being monitored at the hospital, doctors use mobile cardiac telemetry (MCT), a small portable device that can remotely monitor a patient’s cardiac activity for 14 to 30 days.

“MCT is a relatively new technology that provides continuous, real-time outpatient monitoring for an extended period of time,” says Hurmina Muqtadar, M.D.

The monitor wirelessly transmits the electrocardiogram to the monitoring company to be reviewed by trained technicians around the clock. The company alerts the patient’s physician of important electrocardiographic events.

“The purpose of MCT is to find AFib, treat the patient and prevent them from having a stroke,” says Dr. Muqtadar. “It's an important tool in preventing future strokes.”

Transient Ischemic Attack (TIA) Clinic at Elmhurst Hospital

Transient ischemic attack (TIA) is a temporary period of time when a person experiences symptoms similar to those of a stroke. While TIA typically only lasts for a few minutes to a few hours without causing permanent damage, it is a warning sign for stroke. On average, about one in three people who have a TIA will have a stroke sometime in the future.

“Though the majority of the time it occurs within one year, it can also occur in a couple of days or weeks.” says Dr. Muqtadar “That's why people who have a TIA need urgent evaluations and treatment.” Studies have shown an 80% reduction in the risk of stroke with early treatment after a TIA, for secondary prevention.

Because of this, Elmhurst Hospital has a specially designated TIA Clinic for patients who come to the ER with TIA symptoms and need rapid evaluation and treatment. The clinic has on-site imaging and collaborates with cardiology for echocardiograms and other testing that provide immediate results and treatment options.

“Everyone who has a TIA or stroke symptoms should immediately go to the ER,” says Dr. Muqtadar. Use the acronym BE FAST to recognize the signs of a stroke:

• Balance
• Eyes
• Facial weakness
• Arm weakness
• Speech problems
• Time to call 911

RapidAI

RapidAI is an imaging and workflow software developed to streamline the assessment of stroke imaging to help doctors make faster and more accurate decisions when treating stroke patients.

RapidAI’s stroke imaging software identifies patients whose tissue was irreversibly damaged versus patients whose tissue would respond to life-saving interventions. It also identifies blood vessel blockages and can help doctors determine a diagnosis for time sensitive interventions such as intravenous thrombolytic medications or neurointerventional thrombectomy procedures.

“This software helps us quickly identify patients who are going to benefit the most, such as patients with large blood vessel blockages or who have a significant amount of tissue that's still salvageable,” says Sameer Ansari, M.D., Ph.D., a neurointerventional specialist in interventional neuroradiology.

Doctors immediately receive the RapidAI imaging analysis via email, ensuring they get invaluable information quickly to determine a diagnosis and improve the time to treatment. “We can do this so much faster with computer algorithms and automated real-time notification,” says Dr. Ansari.

Learn more about neurosciences at Edward-Elmhurst Health.