Papers by marshall balish
Journal of Neuropsychiatry and Clinical Neurosciences, Aug 1, 2002
Twelve patients with comorbid posttraumatic stress disorder (PTSD) and major depression underwent... more Twelve patients with comorbid posttraumatic stress disorder (PTSD) and major depression underwent repetitive transcranial magnetic stimulation (rTMS) to left frontal cortex as an open-label adjunct to current antidepressant medications. rTMS parameters were as follows: 90% of motor threshold, 1 Hz or 5 Hz, 6,000 stimuli over 10 days. Seventy-five percent of the patients had a clinically significant antidepressant response after rTMS, and 50% had sustained response at 2month follow-up. Comparable improvements were seen in anxiety, hostility, and insomnia, but only minimal improvement in PTSD symptoms. Left frontal cortical rTMS may have promise for treating depression in PTSD, but there may be a dissociation between treating mood and treating core PTSD symptoms.
Neurology, 2017
Objective: To determine relationships between polysomnographic and clinical sleep measures and pe... more Objective: To determine relationships between polysomnographic and clinical sleep measures and performance on cognitive testing in Veterans with mild/moderate traumatic brain injury (TBI) and obstructive sleep apnea (OSA). Background: Patients with TBI are at high risk for the development of sleep disorders, particularly OSA. The combination of TBI and untreated OSA may compound consequences of both, such as cognitive dysfunction, which can greatly impact all areas of functioning and quality of life. Design/Methods: This prospective pilot study examined 19 Veterans diagnosed with TBI and OSA. The Departments of Defense and Veterans Affairs definition of TBI was used. Pearson correlations were calculated between variables. Results: The Hypopnea Index was associated with the Stroop Interference score (r=−.473, p=0.041), which measures executive function and response inhibition. The number of blast injuries were inversely related to sleep efficiency (r=−.621, p=0.005), total sleep time...
Sleep, 2020
Introduction Adherence to positive airway pressure (PAP) therapy continues to be a challenge. The... more Introduction Adherence to positive airway pressure (PAP) therapy continues to be a challenge. The main objective of this study was to determine whether mobile text-message reminders increased PAP adherence in veterans with obstructive sleep apnea. Methods This is a retrospective study of 25 patients with poor adherence to PAP therapy who used the Veterans Affairs ANNIE app to receive nightly mobile text message reminders. PAP adherence was measured at baseline, 1,and 3 months. A one-way repeated measures ANOVA was used to compare the effect of time on PAP adherence, specifically the percentage of overall days used and percentage use >4 hours. A two-way repeated measures ANOVA without replication was used to determine the effects of AHI severity and time on PAP adherence. Results Our sample demographics included a mean age of 59 ±12 years, mean BMI of 33.5% ±5.4, and mean AHI of 26.3 ±25.4. The mean PAP overall percentage use and mean use >4 hours respectively were 32% ± 27 and...
The Journal of Neuropsychiatry and Clinical Neurosciences, Feb 1, 2002
Twelve patients with comorbid posttraumatic stress disorder (PTSD) and major depression underwent... more Twelve patients with comorbid posttraumatic stress disorder (PTSD) and major depression underwent repetitive transcranial magnetic stimulation (rTMS) to left frontal cortex as an open-label adjunct to current antidepressant medications. rTMS parameters were as follows: 90% of motor threshold, 1 Hz or 5 Hz, 6,000 stimuli over 10 days. Seventy-five percent of the patients had a clinically significant antidepressant response after rTMS, and 50% had sustained response at 2-month follow-up. Comparable improvements were seen in anxiety, hostility, and insomnia, but only minimal improvement in PTSD symptoms. Left frontal cortical rTMS may have promise for treating depression in PTSD, but there may be a dissociation between treating mood and treating core PTSD symptoms.
Clinical EEG (electroencephalography), 1989
Advances in neurology, 1990
Fluid Phase Equilibria, 1980
Abstract Isothermal vapor—liquid equilibrium data for the toluene + nitrobenzene, ethylbenzene + ... more Abstract Isothermal vapor—liquid equilibrium data for the toluene + nitrobenzene, ethylbenzene + nitrobenzene, propylbenzene + nitrobenzene and butylbenzene + nitrobenzene systems were obtained at 100°C. The data are found to be consistent. Excess volumes for the same systems were obtained at 25°C. An attempt is made to interpret the data in terms of charge transfer interactions.
Epilepsy Research, 1992
We compared the relative sensitivity of two interictal PET techniques, bolus injection of [I501 l... more We compared the relative sensitivity of two interictal PET techniques, bolus injection of [I501 labeled water for estimation of cerebral blood flow (Hz150 CBF-PET), and '*F 2-deoxyglucose (18FDG-PET) for cerebral glucose metabolism (CMRglc), and TZ-weighted magnetic resonance imaging, in 28 patients with medically intractable complex partial seizures undergoing evaluation for surgery. There were statistically significant associations between lateralization by 18FDG-PET, and MRI, but not Hz"0 CBF-PET, and lateralization of the epileptic focus as defined by scalp-sphenoidal ictal EEG. Fifteen patients had surgery or subdural electrodes. 18FDG-PET was more closely associated with a good outcome than H ~'~0 CBF-PET, which, in addition, showed hypoperfusion contralateral to the epileptic temporal lobe in several cases. H zi50 sensitivity may have been reduced by technical factors, but 18FDG-PET appears to be more specific for localization of epileptic zones.
Annals of Neurology, 1992
We evaluated the role of positron emission tomography (PET) with [18F]deoxyglucose (FDG) (FDG‐PET... more We evaluated the role of positron emission tomography (PET) with [18F]deoxyglucose (FDG) (FDG‐PET) for planning surgery in 53 patients who had temporal lobectomy for uncontrolled seizures at the National Institutes of Health from 1981 to 1990. Investigators blinded to PET data used results of telemetered video‐electroencephalographic ictal monitoring and other standard criteria to decide whether subdural electrodes (22 patients, i.e., the “invasive” group) should be implanted or surgery performed. PET scans were analyzed using a standard regional template. Mean lateral but not mesial temporal asymmetry was significantly higher in patients who became seizure free (p < 0.03). Patients with ≤ 15% hypometabolism were significantly more likely to be seizure free in the entire study population and the invasive subgroup. Visual identification of hypometabolism was less accurate. When a clear temporal ictal surface electroencephalographic focus was present, FDG‐PET provided less addition...
The Annual Meeting of the American Epilepsy Society, Dec 8, 2004
Abstract: Social stigma is one of the unfortunate realities facing persons with epilepsy. Socio-c... more Abstract: Social stigma is one of the unfortunate realities facing persons with epilepsy. Socio-cultural differences are key determinants of this process, and diligent effort is necessary to alleviate this aspect of suffering. However, periodic public surveys in the USA have shown that despite the unchanged level of public knowledge about epilepsy over time, public attitude has improved considerably. Targeted educational campaigns aimed at further improving public attitude towards epilepsy may be designed effectively based on current ...
The 26^ th International Epilepsy Congress, Sep 1, 2005
Abstract: Stigmatization is determined by socio-cultural specificities, and active effort is nece... more Abstract: Stigmatization is determined by socio-cultural specificities, and active effort is necessary to ease its burden. This study was aimed at assessing, for the first time, public attitude towards epilepsy in Croatia, and represents the initial step for a public health awareness campaign.
Electroencephalography and Clinical Neurophysiology, 1993
The electrical potential produced by a dipole in the temporal or frontal lobe was calculated for ... more The electrical potential produced by a dipole in the temporal or frontal lobe was calculated for a realistically shaped scalp, skull, and brain. This potential distribution was then used with a 3-sphere model to predict the position, orientation, and strength of the dipole source. The original and predicted dipole positions differed by an average of 1.97 cm, with a difference of more than 4 cm in some cases. Control calculations demonstrated that this difference was not caused by numerical artifacts in the computation, but instead was due to a true difference between the 3-sphere and realistically shaped head models.
Circulation, 2016
Introduction: Stroke incidence is significantly higher in African-Americans (AA) than in any othe... more Introduction: Stroke incidence is significantly higher in African-Americans (AA) than in any other racial group. Cardiorespiratory fitness (CRF) is associated with a more favorable cardiovascular health. The CRF-stroke incidence association has not been fully explored in AA patients. Hypothesis: We hypothesize that the CRF-stroke incidence association will be inverse and graded. Methods: From 1985 to 2014, we identified 13,511 AA (mean age: 58±11) with a normal response to an exercise tolerance test (ETT) and no prior history of stroke. We established five fitness categories based on age-stratified quintiles of peak metabolic equivalents (MET) achieved: Least-Fit (4.2±1.2 METs; n=2,708); Low-Fit (6.0±1.2; n=2,914); Moderate-Fit (7.9±1.0 METs; n=2,816); Fit (8.6±1.4 METs; n=2,903); and High-Fit (11.5±2.3 METs; n=2,170). Multivariable Cox model, adjusted for age, BMI, gender, cardiac risk factors, blood pressure, sleep apnea, alcohol dependence and medications, was used to estimate ha...
Neurology, 2018
Objective: Our objective was to determine if intensive education and text message reminders impro... more Objective: Our objective was to determine if intensive education and text message reminders improved positive airway pressure (PAP) compliance and cognition in veterans with OSA and TBI. Background: Previous research has shown that patients with both traumatic brain injury (TBI) and obstructive sleep apnea (OSA) have more cognitive problems than patients with TBI alone. Design/Methods: In this randomized, double-blind, controlled trial, nineteen veterans with chronic stage TBI and newly diagnosed OSA were assigned to receive intensive education at the initial visit and nightly text message reminders to use PAP (reminder group) or to a standard-of-care (SOC) group. Mean percentage overall PAP compliance was averaged over the first seven days and at one month. The Epworth Sleepiness Scale (ESS) and cognitive tests were administered at baseline and 1 month. Effect sizes that incorporated both pre/post and between group differences were calculated. Results: The reminder group was signif...
The so-called rubral tremor is a clinical diagnosis that involves involuntary shaking limb moveme... more The so-called rubral tremor is a clinical diagnosis that involves involuntary shaking limb movements during rest and voluntary motion. We report the cases of 2 patients who developed rubral tremor after cardiac catheterization. To our knowledge, this is the 1st report of such an association. In each case, brain magnetic resonance imaging revealed nothing unusual. The onset of tremor after cardiac catheterization may signal the presence of a complex neurologic syndrome, which warrants consultation with a neurologist.
OBJECTIVE: Determine the frequency of Positive Airway Pressure (PAP) adherence in Veterans with T... more OBJECTIVE: Determine the frequency of Positive Airway Pressure (PAP) adherence in Veterans with Traumatic Brain Injury (TBI) and Obstructive Sleep Apnea (OSA) and assess predictors of PAP adherence. BACKGROUND: Patients with TBI are at risk for the development of sleep disorders, particularly sleep apnea. We hypothesize that PAP compliance in TBI patients is poor given cognitive challenges and may impact rehabilitation potential. DESIGN/METHODS: This was a retrospective chart review of 44 consecutively tested, male Veterans with TBI and OSA. The Departments of Defense and Veterans Affairs definition of TBI was used. PAP compliance was defined as greater than 4 hours of use 70[percnt] of the time. We performed an exploratory data analysis to determine contributors to compliance. RESULTS: In our sample the mean age was 42 (range 23-67), mean BMI (Body Mass Index) was 33 (range 23-51), and mean AHI (Apnea Hypopnea Index) was 29 (range 5-90). Nineteen percent (n=6) of patients were PAP ...
The Journals of Gerontology: Series A
Background Antipsychotics are prescribed to treat various symptoms in older adults, however, thei... more Background Antipsychotics are prescribed to treat various symptoms in older adults, however, their safety in this context has not been fully evaluated. The objective was to evaluate mortality risks associated with off-label use of antipsychotics among older adults with no preexisting mental illness or dementia relative to those with diagnosis of dementia. Methods Data (2007–2015) were derived from Department of Veterans Affairs registries for 730,226 patients (≥65 years) with no baseline serious mental illness, dementia). We estimated the cumulative incidence of antipsychotics prescription and 10-year all-cause mortality. The extended Cox models were used to estimate Hazard Ratios (HRs) associated with antipsychotics prescription, adjusted for time-varying covariates, dementia diagnosis, comorbidity index score, and age at time of first exposure to antipsychotics. Results The study included 98% males, 13% African Americans, and 81% Caucasian. Patients with dementia and antipsychotic...
Innovation in Aging
Poor socioeconomic circumstances during childhood have been shown to be associated with negative ... more Poor socioeconomic circumstances during childhood have been shown to be associated with negative health outcomes at older age. Frailty is an important outcome associated with ageing, but research on risk factors of frailty is lacking. We aimed to assess associations of childhood socioeconomic position (CSP) with frailty trajectories at older age. Data on well-being, health, socioeconomic situation, and retrospective life course from 17,916 individuals aged 50 years and over included in the longitudinal Survey of Health, Ageing, and Retirement in Europe study was used. Frailty, including pre-frailty, was operationalized as presenting either weakness, shrinking, exhaustion, slowness, or low activity. Confounder-adjusted multilevel logistic regression models were used to analyze associations of CSP with frailty trajectories. Results showed that disadvantaged CSP was associated with higher risk of (pre)frailty and that this association was mediated by education for both men and women (OR=1.45, p<0.01; OR=1.43, p<0.01, respectively). A lower level of education was associated with a lower risk of (pre)frailty (OR=0.97, p<0.001, both men and women). Also lower skill main occupation class was associated with an increased risk of (pre)frailty in both men and women (OR=1.20, p<0.01; OR=1.28, p<0.001, respectively). Moreover, health behaviors and demographics seemed to increase the risk of being (pre)frail. The findings suggest that CSP is associated with frailty trajectories at older age, which can be explained by adult socioeconomic position, in particular by education. The results can help in improving frailty trajectories by stimulating educational achievement and associated consequences across the life course.
The Endocrine Society's 93rd Annual Meeting & Expo, June 4–7, 2011 - Boston, 2011
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Papers by marshall balish