Posts Tagged ‘delirium’

by Amirah Al Idrus

When Nicolas Tremblay put three electroencephalogram (EEG) electrodes into a baseball cap, he was trying to build a tool to track focus in children with ADHD. He was pitching the device at a health hackathon last October when a nurse from the Montreal Heart Institute approached him with an idea: What if it could be modified for use in hospitals to diagnose patients with delirium?

Delirium—a sudden state of confusion characterized by reduced awareness of the sufferer’s environment—comes on suddenly and can last from hours to days. The American Delirium Society estimates the condition affects more than 7 million hospitalized Americans each year and, according to a Harvard Health report, delirium is the most common complication of hospitalization in people 65 and older.

Compared to hospitalized patients without delirium, those who suffer delirium tend to stay longer in the hospital and are more likely to develop dementia or other types of cognitive impairment and need long-term care after leaving hospital. Delirium is commonly detected via the Confusion Assessment Method, which helps health professionals identify problems with attention, memory, orientation and visual ability. Essentially, patients are asked a set of questions to assess their mental state. Though the method is standardized, it is not an objective test for the condition. What’s more, this approach doesn’t detect delirium early.

“Current methods are only able to detect delirium when the brain is already malfunctioning,” Tremblay said. “When delirium is detected at a later stage, it takes longer to bring the patient back. It costs a lot to the hospital because they have to keep the patient in hospital to revert delirium.”

NeuroServo set about creating a device to catch attention problems in hospitalized patients early, before these deficits manifest physically. Its educational tool, the electrode-fitted hat, measures electrical activity in the brain and signals attention—or lack thereof—via a built-in light that changes color. The device can also send EEG results via Bluetooth to a tablet app used by a teacher.

With input from doctors and nurses, NeuroServo developed a sterile version of the device, a disposable plastic strip holding three EEG electrodes that can be adhered to the patient’s forehead. It attaches to a portable EEG module that clips onto the patient’s jacket.

Using EEG to detect delirium isn’t a new concept; there is scientific proof that delirium can be found with EEG, Tremblay said. But using a traditional EEG on large numbers of patients just isn’t practical: The equipment is cumbersome, the process can require as many as 256 electrodes placed all over the scalp and a neurologist is needed to interpret the results.

NeuroServo’s device uses several algorithms specialized in a specific area of signal analysis, Tremblay said.

“The sum of these analyses is then used to return an easy-to-read graph and results to the nurse or caregiver,” he said.

As for the number of electrodes, NeuroServo’s electronics and algorithms are designed to obtain the best medical-grade EEG signal out of the forehead. ”This allows us to carefully track brain signals in the prefrontal cortex who is responsible for executive functions like attention control or cognitive flexibility,” Tremblay said.

He hopes to keep serving the educational market even as NeuroServo makes a push into the medtech sector. The company is still selling the cap for kids with ADHD, and the device is currently in a pilot study in France in children with autism spectrum disorder. As for its use as a delirium diagnostic tool, the Montreal Heart Institute is kicking off a pilot study this month. McGill University Health Centre will start a pilot later this year, and NeuroServo is working on a third study at a hospital in Boston.

What comes next depends on the outcome of those studies.

“We are waiting for the pilot results to be able to apply for approval from Health Canada, the FDA and so on,” Tremblay said.

NeuroServo is just one player working to make EEG possible for an area in which it has historically not been viable. Mountain View, California-based Ceribell came up with a portable device that quickly detects nonconvulsive seizures in ICU patients. Like NeuroServo’s device, Ceribell’s system doesn’t require a specialist to read its results—instead, it converts EEG signals into sound for a yes/no diagnosis within minutes.

https://www.fiercebiotech.com/biotech/neuroservo-s-portable-eeg-could-become-a-better-way-to-detect-delirium

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A new drug that gives people superhuman strength, but leads to violent delusions, is gaining attention.

The drug, which has the street name of Flakka, is a synthetic stimulant that is chemically similar to bath salts. Flakka is fast developing a reputation for what seem to be its nasty side effects, including a tendency to give people enormous rage and strength, along with intense hallucinations.”

Even though addicted, users tell us they are literally afraid of this drug,” said James Hall, an epidemiologist at the Center for Applied Research on Substance Use and Health Disparities at Nova Southeastern University in Florida. “As one user recently reported, it’s $5 insanity.”

From what it is to how it may work, here are five facts about Flakka.

1. What is it?

Flakka, which is also called gravel in some parts of the country, is the street name for a chemical called alpha-PVP, or alpha-pyrrolidinovalerophenone. The chemical is a synthetic cathinone, a category that includes the mild natural stimulant khat, which people in Somalia and the Middle East have chewed for centuries. Chemically, Flakka is a next-generation, more powerful version of bath salts. Flakka was banned by the Drug Enforcement Administration in early 2014.

2. What are its effects?

At low doses, Flakka is a stimulant with mild hallucinatory effects.

Like cocaine and methamphetamine, Flakka stimulates the release of feel-good brain chemicals such as dopamine and norepinephrine, Hall said. The drug also prevents neurons, or brain cells, from reabsorbing these brain chemicals, meaning the effects of the drug may linger in the system longer than people anticipate.

3. What are the dangers?

The danger comes from the drug’s incredible potency. A typical dose is just 0.003 ounces (0.1 grams), but “just a little bit more will trigger very severe adverse effects,” Hall told Live Science. “Even a mild overdose can cause heart-related problems, or agitation, or severe aggression and psychosis.”

Because of the drug’s addictive properties, users may take the drug again shortly after taking their first dose, but that can lead to an overdose, Hall said. Then, users report, “they can’t think,” and will experience what’s known as the excited delirium syndrome: Their bodies overheat, often reaching 105 degrees Fahrenheit, they will strip off their clothes and become violent and delusional, he said. The drug also triggers the adrenaline-fueled fight-or-flight response, leading to the extreme strength described in news reports.

“Police are generally called, but it might take four or five or six officers to restrain the individual,” Hall said.

At that point, emergency responders will try to counteract the effects of the drug in the person’s system by injecting a sedative such as the benzodiazepine Ativan, and if they can’t, the person can die, Hall said.

In the last several months, 10 people have died from Flakka overdoses, he said. (Users of PCP, Ecstasy, cocaine and methamphetamine can also experience the excited delirium syndrome.)

4. How is it sold?

According to Hall’s research, alpha-PVP is often purchased online in bulk from locations such as China, typically at $1,500 per kilogram. Doses typically sell on the street for $4 or $5, and because each dose is so tiny, that means dealers can net about $50,000 from their initial investment, as long as they have the networks to distribute the drug.

5. Why are we only hearing about it now?

Evidence suggests the illegal drug has only recently come on the scene. Crime lab reports from seized drugs reveal that seizures of alpha-PVP have soared, from 699 samples testing positive for the drug in 2010, to 16,500 in 2013, according to the Drug Enforcement Administration’s National Forensic Laboratory Information System.

About 22 percent of the drug seizures that tested positive for alpha-PVP came from South Florida, according to the data.

http://www.livescience.com/50502-what-is-flakka.html