Aneeta Saxena’s research while affiliated with Biogen Idec and other places

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Publications (13)


Vagus Nerve Stimulation Therapy in Epilepsy: An Overview of Technical and Surgical Method, Patient Selection, and Treatment Outcomes
  • Literature Review
  • Full-text available

July 2024

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60 Reads

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2 Citations

Brain Sciences

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Pratik Rohatgi

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Aneeta Saxena

Epilepsy affects over 65 million people worldwide. One-third of people with epilepsy do not respond to medication and may benefit from surgery. Vagus nerve stimulation (VNS) is the first neuromodulation therapy for the treatment of drug-resistant epilepsy. This method is used in combination with anti-seizure medications in adults and in the pediatric population. VNS has also been demonstrated to have benefits for some epilepsy comorbidities, such as depression, and can be used in combination with other neuromodulation therapies in epilepsy. The authors present an overview of VNS physiology, patient selection, surgery and risks, neuromodulation therapy, and application to epilepsy comorbidities.

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A Machine Learning Eye Movement Detection Algorithm using Electrooculography

October 2022

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146 Reads

Sleep

Alicia E Dupre

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[...]

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Study objectives: Eye movement quantification in polysomnograms (PSG) is difficult and resource intensive. Automated eye movement detection would enable further study of eye movement patterns in normal and abnormal sleep, which could be clinically diagnostic of neurologic disorders, or used to monitor potential treatments. We trained a Long Short-Term Memory (LSTM) algorithm that can identify eye movement occurrence with high sensitivity and specificity. Methods: We conducted a retrospective, single-center study using one-hour PSG samples from 47 patients 18-90 years of age. Team members manually identified and trained an LSTM algorithm to detect eye movement presence, direction, and speed. We performed a 5-fold cross validation and implemented a "fuzzy" evaluation method to account for misclassification in the preceding and subsequent 1-second of gold standard manually labeled eye movements. We assessed G-means, discrimination, sensitivity, and specificity. Results: Overall, eye movements occurred in 9.4% of the analyzed EOG recording time from 47 patients. Eye movements were present 3.2% of N2 (lighter stages of sleep) time, 2.9% of N3 (deep sleep), and 19.8% of REM sleep. Our LSTM model had average sensitivity of 0.88 and specificity of 0.89 in 5-fold cross validation, which improved to 0.93 and 0.92 respectively using the fuzzy evaluation scheme. Conclusion: An automated algorithm can detect eye movements from EOG with excellent sensitivity and specificity. Noninvasive, automated eye movement detection has several potential clinical implications in improving sleep study stage classification and establishing normal eye movement distributions in healthy and unhealthy sleep, and in patients with and without brain injury.



Neuropsychiatric Treatment Approaches for Functional Neurological Disorder: A How to Guide

February 2022

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305 Reads

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16 Citations

Seminars in Neurology

There is a growing body of knowledge regarding management of functional neurological disorder (FND). The aim of this article is to guide the clinician through FND clinical management, from delivery of the diagnosis, to creation of a biopsychosocially-informed treatment plan, to troubleshooting common issues that arise throughout longitudinal care. We review the evidence and core principles of both rehabilitative therapies (physical therapy, occupational therapy, and speech and language therapy) and psychological therapies for the treatment of FND, and discuss the benefits of engaging a multidisciplinary and interdisciplinary team. The optimal timing of specific therapeutic interventions is also discussed, emphasizing a patient-centered perspective. Resources for further reading, for both patients and clinicians, are provided throughout. Additional research is needed to further optimize the therapeutic approach to patients with FND, including the need to develop novel treatments for those that do not positively respond to currently available interventions.


Using the Biopsychosocial Model to Guide Patient-Centered Neurological Treatments

February 2022

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518 Reads

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26 Citations

Seminars in Neurology

The biopsychosocial model was defined by George L. Engel to propose a holistic approach to patient care. Through this model, physicians can understand patients in their context to aid the development of tailored, individualized treatment plans that consider relevant biological, psychological, and social-cultural-spiritual factors impacting health and longitudinal care. In this article, we advocate for the use of the biopsychosocial model in neurology practice across outpatient and inpatient clinical settings. To do so, we first present the history of the biopsychosocial model, and its relationships to precision medicine and deep phenotyping. Then, we bring the neurologist up-to-date information on the components of the biopsychosocial clinical formulation, including predisposing, precipitating, perpetuating, and protective factors. We conclude by detailing illustrative neurological case examples using the biopsychosocial model, emphasizing the importance of considering relevant psychological and social factors to aid the delivery of patient-centered clinical care in neurology.


Evaluation and Management of First-Time Seizure in Adults

October 2021

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110 Reads

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5 Citations

Seminars in Neurology

First seizures are often perceived as devastating events by patients and their families due to the fear of having a life-long disease. One in 10 people experiences one or more seizures during their lifetime, while 1 in 26 people develops epilepsy. Acute symptomatic seizures are often related to a provoking factor or an acute brain insult and typically do not recur. Careful history and clinical examination should guide clinicians' management plans. Electroencephalography and brain imaging, preferably with epilepsy-specific magnetic resonance imaging, may help characterize both etiology and risk of seizure recurrence. Antiepileptic drugs should be initiated in patients with newly diagnosed epilepsy. In patients without an epilepsy diagnosis, the decision to prescribe drugs depends on individual risk factors for seizure recurrence and possible complications from seizures, which should be discussed with the patient. Counseling about driving and lifestyle modifications should be provided early, often at the first seizure encounter.



Social aspects of life in patients with functional seizures: Closing the gap in the biopsychosocial formulation

April 2021

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127 Reads

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30 Citations

Epilepsy & Behavior

The human, as a biological system, is an open system embedded within larger systems —including the family, culture, and socio-political environment. In this context, a patient with functional seizures (FS) is embedded in relationships, educational/professional institutions, culture, and society. Both connection to these broader systems and the quality of these connections, as well as the soundness of each system in and of itself, influence the health and well-being of patients in positive or negative ways. The social aspects of life are important determinants of health and quality of life across the lifespan. The current narrative review brings out several overarching themes in patients with FS. Sections on attachment, marriage, social networking, and stigma highlight the central roles of supportive and affirmative relationships across the lifespan. The section on education underscores the importance of keeping children and youth with FS connected within their school environments, as well as managing any barriers – learning difficulties, school response to FS events, stigma, etc.—that can diminish this connection. Finally, the sections on employment and driving highlight the value of being an active participant in one’s society. In summary, FS impacts patients across most social aspects of life domains regardless of age — factors that are important when developing biopsychosocial formulations. This review concludes that the multidisciplinary management of FS requires careful assessment of social aspects of life in patients which can then be targeted for treatment, to improve their quality of life, facilitating recovery, and reducing the risk of relapse.



Citations (9)


... The mechanisms underlying VNS for the treatment of epilepsy have not been fully elucidated but may be associated with the following factors: (1) desynchronization of electroencephalogram (EEG) activity through the nucleus tractus solitarius and the medullary reticular formation pathway and (2) reduction in excitatory neurotransmission and enhancement of inhibitory neurotransmission [48]. ...

Reference:

Mechanism and Applications of Vagus Nerve Stimulation
Vagus Nerve Stimulation Therapy in Epilepsy: An Overview of Technical and Surgical Method, Patient Selection, and Treatment Outcomes

Brain Sciences

... Los TNF no son diagnósticos de exclusión que se hacen después de agotar todos los recursos. Al contrario, solo es necesaria una buena anamnesis y una exploración física detallada que busque signos positivos que permitan afirmar el diagnóstico (15). A pesar de la preocupación de que un paciente con una enfermedad neurológica sea mal clasificado con un TNF, esto ocurre en menos del 1 % de los casos (16) y es igual o menor al error de diagnóstico clínico en otras condiciones neurológicas (por ejemplo, diferenciar entre cefalea tipo migraña y tensional). ...

Toward a Precision Medicine Approach to the Outpatient Assessment and Treatment of Functional Neurologic Disorder
  • Citing Article
  • March 2023

Neurologic Clinics

... Multiple efforts have been made to improve outcomes for patients with FNSDs, including (1) enhancements to medical education (Barnett et al., 2022;Rawlings & Reuber, 2018), (2) guidelines for communication with patients (Finkelstein et al., 2022;Rockliffe-Fidler & Willis, 2019), (3) the development of evidence-based psychotherapeutic interventions (Goldstein et al., 2020;LaFrance et al., 2014), and (4) increased interdisciplinary care (Lidstone et al., 2020;Petrie et al., 2023). Items 1 and 4 are expanded upon below because of their relevance to neuropsychologists. ...

Neuropsychiatric Treatment Approaches for Functional Neurological Disorder: A How to Guide
  • Citing Article
  • February 2022

Seminars in Neurology

... In this way, nurses can learn about patients' needs, establish a therapeutic relationship, and increase satisfaction with care [1]The communicative process may be influenced by nurses' attitudes [2,3], these attitudes being facilitating factors or barriers towards their communication with the patient [4]. The biopsychosocial model [5] highlights that patient-centered communication is essential in achieving better adherence to treatment, better assessment of services, better quality of life, and better survival outcomes [6]. ...

Using the Biopsychosocial Model to Guide Patient-Centered Neurological Treatments
  • Citing Article
  • February 2022

Seminars in Neurology

... A seizure is a short-term change in regular electrical activity in the brain that leads to changes in perception, awareness, movement, or behavior (1). Seizures, broadly classified as febrile and non-febrile, account for approximately 1% of emergency department admissions (2). ...

Evaluation and Management of First-Time Seizure in Adults
  • Citing Article
  • October 2021

Seminars in Neurology

... It comes as no surprise that youth with FND are at risk of school absenteeism, 4 which can be exacerbated by parent over-protection. 5 However, ongoing absenteeism has been empirically identified as a perpetuating factor in ongoing functional symptoms. 6 Thus, supporting consistent school engagement is a primary treatment target for youth with FND. 7 ...

Social aspects of life in patients with functional seizures: Closing the gap in the biopsychosocial formulation
  • Citing Article
  • April 2021

Epilepsy & Behavior

... Regarding their role in the management of FND, CZ-SK and Italian neurologists believed they should 'make a diagnosis and recommend adequate treatment' (with a higher proportion among CZ-SK neurologists) and 'follow-up the treatment together with other specialists (psychiatrist, psychotherapist, physiotherapist)' . In line with current recommendations, this suggests that neurologists in different European countries favour an active role in FND management in a multidisciplinary team [37,38]. However, recent surveys have suggested important knowledge gaps regarding FND among psychiatrists, psychotherapists, physiotherapists, and other health professionals [39][40][41], potentially further limiting patient care quality and contributing to limited satisfaction of neurologists with managing FND. ...

Towards an Outpatient Model of Care for Motor Functional Neurological Disorders: A Neuropsychiatric Perspective

... Higher BPS values were associated with more severe psychopathology, consistent with previous findings linking PPU to psychopathology or poor mental health (Bibi et al., 2022;Borgogna et al., 2018;Hernández et al., 2023;Hernandez-Mora & Varescon, 2022;Shirk et al., 2021;Whitfield et al., 2018). Correlations between the BPS and measures of depression and anxiety were also reported in the validation study of BPS in a general population (Islam et al., 2024). ...

Predicting Problematic Pornography Use among Male Returning US Veterans
  • Citing Article
  • September 2020

Addictive Behaviors

... Inconsistent with our findings, there are several examples of active involvement in dissemination of information useful for neurological patients, such as for example the WFN, or AAN or EAN or EFNA or WFNR guidelines for management of neurological patients, or for provision of neurorehabilitation, or the development of a website for neurological guidelines created since April 2020 by a task force of 15 neurologists belonging to Boston University Medical Center data. For this last the analyses of web analytics showed a great interest of neurologists to get knowledge about current treatment recommendations as well as about tele neurological examination [32]. ...

Rapid Dissemination of Protocols for Managing Neurology Inpatients with COVID‐19

Annals of Neurology