Achieving effective patient and public involvement in international clinical trials in neurology
We report the outcomes of PPI and make recommendations on its use in other neurology clinical trials. By sharing our model for PPI, we aim to maximize effectiveness of future public involvement and to allow its effect to be better evaluated. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 8, 2020 Category: Neurology Authors: Tallantyre, E. C., Evangelou, N., Bale, C., Chaudhry, B. Z., Gray, E. H., LaRocca, N., Pavitt, S., Miller, D. M., Planchon, S. M., Ontaneda, D., Manzano, A. Tags: Clinical trials Methodology/study design, All global neurology, Multiple sclerosis Commentary Source Type: research

Comorbid disease drives short-term hospitalization outcomes in patients with multiple sclerosis
Conclusions Comorbid diseases were associated with the readmission for persons with multiple sclerosis. Evaluations of the real-world effectiveness for DMTs in reducing hospitalizations in patients with MS may need to consider comorbid disease burden and management. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 8, 2020 Category: Neurology Authors: Mendizabal, A., Thibault, D. P., Crispo, J. A., Paley, A., Willis, A. W. Tags: All Health Services Research, Outcome research, Multiple sclerosis, Cohort studies Source Type: research

PSP-like syndrome after aortic surgery in adults (Mokri syndrome)
Conclusion This syndrome following adult thoracic aortic bypass surgery with deep hypothermia remains unexplained. It follows a biphasic course and is characterized by the triad of SNGP, unsteady gait, and a predominantly ataxic dysarthria. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 8, 2020 Category: Neurology Authors: Tisel, S. M., Ahlskog, J. E., Duffy, J. R., Matsumoto, J. Y., Josephs, K. A. Tags: All Imaging, All Movement Disorders, Progressive supranuclear palsy, Ocular motility, Cardiac; see Cerebrovascular Disease/Cardiac Research Source Type: research

Treatment and outcome of childhood cerebral sinovenous thrombosis
Objective To test our hypothesis that anticoagulation is associated with better neurologic outcomes in childhood cerebral sinovenous thrombosis (CSVT), we analyzed treatment and outcomes in a population of 410 children from the International Pediatric Stroke Study (IPSS). Methods We included patients enrolled in the IPSS registry with a diagnosis of CSVT at age>28 days with radiologic confirmation, in isolation or with concomitant arterial ischemic stroke. The primary outcome was the neurologic status at discharge. We defined unfavorable outcome as severe neurologic impairment or death at discharge. The Pediatric Strok...
Source: Neurology Clinical Practice - June 8, 2020 Category: Neurology Authors: Felling, R. J., Hassanein, S. M. A., Armstrong, J., Aversa, L., Billinghurst, L., Goldenberg, N. A., Lee, J. E., Maxwell, E. C., Noetzel, M. J., Lo, W., on behalf of the International Pediatric Stroke Study Group Tags: Childhood stroke, Hematologic, Pediatric stroke; see Cerebrovascular Disease/ Childhood stroke, Intracerebral hemorrhage, Cerebral venous thrombosis Research Source Type: research

Technology-enabled assessments to enhance multiple sclerosis clinical care and research
Conclusions Integration of technology-enabled data capture in routine clinical practice allows acquisition of comprehensive standardized data for use in patient care and clinical research. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 8, 2020 Category: Neurology Authors: Macaron, G., Moss, B. P., Li, H., Baldassari, L. E., Rao, S. M., Schindler, D., Alberts, J. L., Weber, M., Ayers, M., Bethoux, F., Boissy, A., Chizmadia, D., Conway, D. S., Fink, C., Fox, R. J., Gales, S., Green, B., Hara-Cleaver, C., Jordan, N., Mahajan, Tags: Electronic medical records, Multiple sclerosis Research Source Type: research

Quality improvement strategies improve pediatric neurology inpatient discharges before noon
Conclusions Our study successfully identified the factors associated with late discharge and developed effective strategies to improve DBN in an inpatient pediatric neurology setting. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 8, 2020 Category: Neurology Authors: Eksambe, P., Shah, Y. D., Singh, K., Stennett, J., Lauretta, E., Sy-Kho, R. M., Kim, J., Ascher, C., Karkare, S., Kothare, S. Tags: All Health Services Research Source Type: research

Clinical factors associated with mood affective disorders among adults with cerebral palsy
Conclusions Among young and middle-aged adults with CP, mood (affective) disorders were associated with pain, sleep disorders, and fatigue, and increasing co-occurrence of these factors further increased the likelihood of mood (affective) disorders. Further, comorbid neurodevelopmental conditions were also associated with mood (affective) disorders among adults with CP. Study findings could be used to improve screening strategies for mood (affective) disorders among adults with CP in the clinical setting. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 8, 2020 Category: Neurology Authors: Whitney, D. G., Warschausky, S. A., Whibley, D., Kratz, A., Murphy, S. L., Hurvitz, E. A., Peterson, M. D. Tags: All Clinical Neurology, All Psychiatric disorders, All Rehabilitation, All epidemiology, Cohort studies Research Source Type: research

Remote telemedicine evaluation of deep brain stimulation candidacy: Retrospective cohort analysis
Conclusions VTEL can be used to facilitate presurgical screening for DBS and saves costs. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 8, 2020 Category: Neurology Authors: Witek, N., Heath, S. L., Ouyang, B., Tanner, C. M., Galifianakis, N. B. Tags: Dystonia, Parkinson's disease/Parkinsonism, Tremor Research Source Type: research

Validity of the Patient Health Questionnaire-9 in neurologic populations
Conclusions Despite theoretical concerns about its validity, the PHQ-9 performed well at its standard cut-point of 10. Consistent with the literature, being able to use a validated, brief tool that is available publicly should improve case finding of depression in neurologic populations. When considering clinical practicality along with the findings of this analyzed, this study confirmed that the PHQ-9 is valid in a general outpatient neurologic population. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 8, 2020 Category: Neurology Authors: Williams, K. G., Sanderson, M., Jette, N., Patten, S. B. Tags: Cost effectiveness/economic, Diagnostic test assessment, All Clinical Neurology, Depression, All epidemiology Research Source Type: research

Making public and patient involvement in clinical trials more than aspirational
There is growing evidence that including patients and public participants in the planning and execution of clinical trials can improve the applicability of research questions to real patient concerns and may more meaningfully affect patients' quality of life.1 In contrast to targeting metrics that may be far removed from patient experience, patient-centered outcomes research seeks to "provide patients and the public information they can use to make decisions that reflect their desired health outcomes."2 The pathway to this laudable goal is not always straightforward, however. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 8, 2020 Category: Neurology Authors: Hinson, H. E., Hamilton, R. H., Matchar, D. B. Tags: Clinical trials Methodology/study design, All global neurology, Multiple sclerosis Editorial Source Type: research

Can and should neurologists screen their patients for depression? Yes, and...
The boundary between neurology and psychiatry is often an artificial one. Sharing an organ system, neurologists refer to diseases of the brain and nervous system, whereas psychiatrists diagnose and treat disorders of the mind. The distinction is one more of perspective than the actual state of our respective patients. The elegant approach of neuroanatomical localization does not neatly accommodate mood and thought disorders, whereas focal neurologic diseases are considered outside the spectrum of psychiatric disease. However, the prevalence of psychiatric disease in the neurologic population is considerable. Patients suffe...
Source: Neurology Clinical Practice - June 8, 2020 Category: Neurology Authors: Ney, J. P., Satya-Murti, S. Tags: Cost effectiveness/economic, Diagnostic test assessment, All Clinical Neurology, Depression, All epidemiology Editorial Source Type: research

Issue highlights
Williams et al. (p. 190) evaluated the validity of the Patient Health Questionnaire-9 (PHQ-9), a brief, publicly available depression screening tool, in neurologic populations. The authors report that the PHQ-9 had an appropriate balance of sensitivity (90% confidence interval [CI] 81–97) and specificity (85% CI 79–90) for a screening tool. In an accompanying editorial, Ney and Satya-Murti (p. 186) discuss the high prevalence of psychiatric disease in the neurologic population along with the benefits and limitations of the PHQ-9 tool. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 8, 2020 Category: Neurology Authors: Corboy, J. R. Tags: From the Editor ' s Desk Source Type: research

Pharmacological, physiological, and familial factors in propranolol-induced visions
Beta-blockers should be considered as a source of psychotic symptoms in patients taking potentially psychotropic medications (i.e., monoamine oxidase inhibitors) or with physiologic or genetic risk factors for psychotic disease. When beta-blockade is medically indicated, less lipophilic agents should be used. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 8, 2020 Category: Neurology Authors: Schindler, E. A. D. Tags: Migraine, All Neuropsychology/Behavior, Hallucinations Case Source Type: research

Late-onset ataxia plus syndromes: Extending the phenotype of senataxin-related disease
Consider α fetoprotein testing in later-onset ataxia as a screening marker as, if elevated, the differential diagnosis narrows considerably. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 8, 2020 Category: Neurology Authors: Street, D., O'Driscoll, M., Taylor, M., Nicholl, D. Tags: All Clinical Neurology, Gait disorders/ataxia, Ocular motility, Spinocerebellar ataxia, Cerebellum Case Source Type: research

A case of co-occurrence of radiation-induced leukoencephalopathy and CADASIL
Consider an underlying genetic cause in patients with progressive deterioration and leukoencephalopathy after prophylactic radiotherapy. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 8, 2020 Category: Neurology Authors: Donker Kaat, L., van der Wielen-Jongen, J. C. F., Kruit, M. C., Bromberg, J. E. C., Baas, F., Lesnik Oberstein, S. A. M. J. Tags: MRI, Radiation therapy-tumor, CADASIL Case Source Type: research

Team conflict and the neurologist
Collaboration within a complicated organization is inherently challenging and can be fraught with discord. Recent emphasis on interdisciplinary and collaborative teamwork in neurology has brought this issue to the forefront of daily practice. The health care system can be complex and opaque, and the stakes—human life—are high. Medical team conflict has been associated with decreased subjective effectiveness, less job satisfaction, and increase in errors. As specialists, neurologists are necessarily embedded within a network of providers and must be adept in the understanding and management of conflictual situat...
Source: Neurology Clinical Practice - April 6, 2020 Category: Neurology Authors: Richie, M., Josephson, S. A. Tags: Models of care, Other Education, Error in medicine Commentary Source Type: research

Immediate reactions with glatiramer acetate: Diagnosis of allergy and desensitization protocols
Purpose of review Diverse adverse events have been associated with administration of glatiramer acetate (GA), mainly local reactions at the injection site. Other, less frequent generalized reactions include isolated postinjection reactions and anaphylaxis, which may lead to discontinuation of GA. Recent findings Close collaboration between the allergy and neurology departments is needed to study adverse reactions to GA. The allergy study should include a detailed history and skin prick and intradermal tests with GA and, if possible, determination of specific IgE levels. Furthermore, the implication of other drugs should b...
Source: Neurology Clinical Practice - April 6, 2020 Category: Neurology Authors: Marco-Martin, G., Tornero, P., Prieto, A., La Rotta, A., Herrero, T., Baeza, M. L. Tags: Multiple sclerosis Review Source Type: research

Apraxia of speech involves lesions of dorsal arcuate fasciculus and insula in patients with aphasia
Objective To determine the contributions of apraxia of speech (AOS) and anomia to conversational dysfluency. Methods In this observational study of 52 patients with chronic aphasia, 47 with concomitant AOS, fluency was quantified using correct information units per minute (CIUs/min) from propositional speech tasks. Videos of patients performing conversational, how-to and picture-description tasks, word and sentence repetition, and diadochokinetic tasks were used to diagnose AOS using the Apraxia of Speech Rating Scale (ASRS). Anomia was quantified by patients' scores on the 30 even-numbered items from the Boston Naming Te...
Source: Neurology Clinical Practice - April 6, 2020 Category: Neurology Authors: Chenausky, K., Paquette, S., Norton, A., Schlaug, G. Tags: MRI, All Cerebrovascular disease/Stroke, Aphasia, Apraxia Research Source Type: research

Levodopa-induced dyskinesia in dementia with Lewy bodies and Parkinson disease with dementia
Objective To investigate the frequency of levodopa-induced dyskinesia in dementia with Lewy bodies (DLBs) and Parkinson disease with dementia (PDD) and compare these frequencies with patients with incident Parkinson disease (PD) through a population-based cohort study. Methods We identified all patients with DLB, PDD, and PD without dementia in a 1991–2010 population-based parkinsonism-incident cohort, in Olmsted County, Minnesota. We abstracted information about levodopa-induced dyskinesia. We compared patients with DLB and PDD with dyskinesia with patients with PD from the same cohort. Results Levodopa use and dy...
Source: Neurology Clinical Practice - April 6, 2020 Category: Neurology Authors: Turcano, P., Stang, C. D., Bower, J. H., Ahlskog, J. E., Boeve, B. F., Mielke, M. M., Savica, R. Tags: Parkinson's disease/Parkinsonism, Dementia with Lewy bodies, Frontotemporal dementia, Parkinson's disease with dementia, Cohort studies Research Source Type: research

Neurology consults in emergency departments: Opportunities to streamline care
Conclusion A systematic approach to identify variability in neurology consultation utilization and its effect on ED LOS helps pinpoint the conditions most likely to benefit from protocolized pathways. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - April 6, 2020 Category: Neurology Authors: Zhao, C., Lee, K., Do, D. Tags: Patient safety, Health systems Research Source Type: research

Worldwide survey of neurologists on approach to autoimmune encephalitis
Conclusions Our results highlight the heterogeneous management of AE. Neuroimmunologists and those treating more AE cases generally take a more proactive approach to testing and immunotherapy than peers. Results highlight the need for higher-quality cohorts and trials to guide empiric immunotherapy, and evidence-based guidelines aimed at both experts and nonexperts. Because the average AE patient is unlikely to be first seen by a neuroimmunologist, ensuring greater uniformity in our approach to suspected cases is essential to ensure that patients are appropriately managed. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - April 6, 2020 Category: Neurology Authors: Ganesh, A., Bartolini, L., Wesley, S. F. Tags: Autoimmune diseases, Encephalitis, All Cognitive Disorders/Dementia, Practice Current Research Source Type: research

Ataxic-hypotonic cerebral palsy in a cerebral palsy registry: Insights into a distinct subtype
Conclusions Our results suggest a predominantly genetic or prenatal etiology for ataxic-hypotonic CP and imply that a diagnosis of ataxic-hypotonic CP does not impart a worse prognosis with respect to comorbidities or functional impairment. This study contributes toward a better understanding of ataxic-hypotonic CP as a distinct nosologic entity within the spectrum of CP with its own pathogenesis, risk factors, clinical profile, and prognosis compared with other CP subtypes. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - April 6, 2020 Category: Neurology Authors: Levy, J. P., Oskoui, M., Ng, P., Andersen, J., Buckley, D., Fehlings, D., Kirton, A., Koclas, L., Pigeon, N., van Rensburg, E., Wood, E., Shevell, M. Tags: Gait disorders/ataxia, All Pediatric, Developmental disorders, Neonatal, All epidemiology Research Source Type: research

Factors associated with 30-day readmission for patients hospitalized for seizures
Conclusion Readmission is common after hospitalization for seizures. Prevention strategies should focus on recurrent seizures, the most common readmission diagnosis. Many factors were associated with readmission, although readmissions remain challenging to predict. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - April 6, 2020 Category: Neurology Authors: Terman, S. W., Guterman, E. L., Hill, C. E., Betjemann, J. P., Burke, J. F. Tags: All Health Services Research, Outcome research, Status epilepticus, Incidence studies, All Epilepsy/Seizures Source Type: research

Cerebral venous thrombosis: Associations between disease severity and cardiac markers
Conclusions In this single-center cohort study, markers of CVT severity were associated with increased odds of cTn elevation; further investigation is needed to elucidate causality and significance. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - April 6, 2020 Category: Neurology Authors: Johansen, M. C., Gottesman, R. F., Urrutia, V. C. Tags: Other cerebrovascular disease/ Stroke, All Clinical Neurology, All Cerebrovascular disease/Stroke, Cerebral venous thrombosis Research Source Type: research

Risk of stroke after emergency department visits for neurologic complaints
Conclusions Among patients discharged from the ED without a diagnosis of TIA or stroke, the occurrence of a head CT and/or specific neurologic symptoms established a clinically meaningful risk gradient for subsequent stroke. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - April 6, 2020 Category: Neurology Authors: Rosenman, M. B., Oh, E., Richards, C. T., Mendelson, S., Lee, J., Holl, J. L., Naidech, A. M., Prabhakaran, S. Tags: CT, All Cerebrovascular disease/Stroke Research Source Type: research

Machine learning as a diagnostic decision aid for patients with transient loss of consciousness
Conclusions A tool based on patient symptoms/comorbidities and witness reports separates well between syncope and other common causes of TLOC. It can help to differentiate epilepsy and PNES. Validated decision rules may improve diagnostic processes and reduce misdiagnosis rates. Classification of evidence This study provides Class III evidence that for patients with TLOC, patient and witness questionnaires discriminate between syncope, epilepsy and PNES. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - April 6, 2020 Category: Neurology Authors: Wardrope, A., Jamnadas-Khoda, J., Broadhurst, M., Grünewald, R. A., Heaton, T. J., Howell, S. J., Koepp, M., Parry, S. W., Sisodiya, S., Walker, M. C., Reuber, M. Tags: Clinical neurology history, Cardiac; see Cerebrovascular Disease/Cardiac, Syncope, Class III, All Epilepsy/Seizures, Nonepileptic seizures Research Source Type: research

Diagnosing spells: Machines or humans?
In the current era of technological advances in medicine, public interest seems focused on advances in laboratory testing, imaging, and surgical instrumentation. Modern-day expectations in the diagnostic part of medicine appear to demand answers which are instant, specific, and without ambiguity. This is consistent with the idea of developing the science of medicine. However, many still consider obtaining a diagnosis through a careful and thoughtful history as an example of the art of medicine. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - April 6, 2020 Category: Neurology Authors: O'Donovan, C. A. Tags: Clinical neurology history, Syncope, Class III, All Epilepsy/Seizures, Nonepileptic seizures Editorial Source Type: research

Neurology and baseball: Who wants to win?
Teams fail when they cannot achieve a common goal. They also fail when they do not have one. In baseball, different goals between players and staff are unusual. Everyone wants to win. In neurology, where teams may be loosely defined and comprise people from many disciplines, goals differ. A win for you may not be a win for me. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - April 6, 2020 Category: Neurology Authors: Cohen, A. B. Tags: Models of care, Other Education, Error in medicine Editorial Source Type: research

Author response: Functional neurologic disorders: Bringing the informal and hidden curriculum to light
Dr. Sethi raises an excellent point about the term functional neurologic disorder (FND) in his comment on the editorial.1 It seems clear that reticence to use the term functional creates the ambiguity he mentions. Medically unexplained symptoms, categorized in the international classification of diseases as undifferentiated somatoform disorders, are a diagnosis that many providers are loathed to give. Whether that is because of concern about missing a diagnosis is not clear. Having evaluated and treated more than 400 of these individuals in the FND clinic at the University of Colorado, I can attest to the fact that patient...
Source: Neurology Clinical Practice - April 6, 2020 Category: Neurology Authors: Strom, L. A. Tags: The Nerve! Readers Speak Source Type: research

Reader response: Functional neurologic disorders: Bringing the informal and hidden curriculum to light
I read with interest the editorial by Strom1 about functional neurologic disorders (FNDs). As a treating physician, I have struggled with the multiple diagnostic labels attached to these patients by physicians of different medical specialties during the course of their clinical disease presentation. A neurologist may assign a patient who presents with chronic fatigue the diagnostic labels of narcolepsy, idiopathic hypersomnia, or chronic Lyme disease. A rheumatologist may assign the label of collagen vascular disease, and a psychiatrist may diagnose depression. This diagnostic ambiguity is troublesome for patients and clin...
Source: Neurology Clinical Practice - April 6, 2020 Category: Neurology Authors: Sethi, N. K. Tags: The Nerve! Readers Speak Source Type: research

Author response: Symptom burden among individuals with Parkinson disease: A national survey
We appreciate the readers' comments on the prevalence and impact of apathy on quality of life among individuals with Parkinson disease. In constructing our survey instrument, we discussed the inclusion of apathy as a symptom. However, we ultimately opted against inclusion because of concerns about the specificity of terminology in our online survey. Patients and care partners may not be familiar with the term "apathy,"and near-synonyms such as "reduced motivation" have substantial overlap with other nonmotor features. Still, as the readers point out, apathy is extremely common and under-recognized. Simi...
Source: Neurology Clinical Practice - April 6, 2020 Category: Neurology Authors: Tarolli, C. G. Tags: The Nerve! Readers Speak Source Type: research

Reader response: Symptom burden among individuals with Parkinson disease: A national survey
We read with great interest the study by Tarolli et al.,1 which explored the burden of disease in Parkinson disease (PD) by evaluating the prevalence of nonmotor symptoms and their association with quality of life. The authors selected nonmotor symptoms based on literature review, expert opinions, and patient interviews. We note that apathy, which has major consequences for patients and carers, was not included as a relevant nonmotor symptom in their study. We performed a subcohort analysis of 60 patients from a study of pain in PD in 110 outpatients (PaCoMo-study, registered trial number: NL6311402917 [toetsingonline.nl])...
Source: Neurology Clinical Practice - April 6, 2020 Category: Neurology Authors: Overvliet, G. M., Meijer van Dun, R. E., Lampe, I. K., Vlaar, A. M. Tags: The Nerve! Readers Speak Source Type: research

Issue Highlights
Wardrope et al. (p. 96) reported on the feasibility of using an artificial intelligence tool to distinguish reliably between syncope, epilepsy, and psychogenic nonepileptic seizures in patients presenting with transient loss of consciousness. In an accompanying editorial, Cormac O'Donovan (p. 94) observes that "the likelihood of a one-size-fits-all diagnostic method is unlikely but should not deter the very important research in this field that needs to be performed." (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - April 6, 2020 Category: Neurology Authors: Corboy, J. R. Tags: From the Editor ' s Desk Source Type: research

Progressive supranuclear palsy and pawpaw
Consider consumption of annonacin-containing plant products, including pawpaw, as a possible environmental risk factor for atypical parkinsonism. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - April 6, 2020 Category: Neurology Authors: Kaas, B., Hillis, A. E., Pantelyat, A. Tags: Parkinson's disease/Parkinsonism, Progressive supranuclear palsy, Other toxicology Case Source Type: research

Serial 18F-FDG PET/CT findings in a patient with neurocutaneous melanosis
With high sensitivity in detecting acute brain events such as seizures, FDG PET can be used as an important tool for neurocutaneous melanosis disease monitoring. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - April 6, 2020 Category: Neurology Authors: Deng, Y., Shen, X., Zhang, W. Tags: MRI, Tremor, Aphasia, PET in epilepsy Case Source Type: research

Unusual and important cause of acute neck pain: Longus colli calcific tendinitis
Early recognition of longus colli calcific tendinitis can prevent unnecessary interventions including antibiotics and surgical procedures. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - April 6, 2020 Category: Neurology Authors: Tong, O., Herskovitz, S. Tags: All Headache, MRI, All Clinical Neurology, Clinical neurology examination, All Pain Case Source Type: research

Primary CNS lymphoma initially diagnosed as vasculitis
This report describes the clinical presentation and histopathologic findings in 2 patients who initially received a diagnosis of primary CNS vasculitis, but did not show long-term response to treatment. In both cases, a second biopsy was performed, and the final diagnosis was primary CNS lymphoma (PCNSL). Summary Analyzing diagnostically challenging cases can increase recognition of PCNSL and improve outcomes in this rare condition. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - February 10, 2020 Category: Neurology Authors: Feldman, L., Li, Y., Ontaneda, D. Tags: Vasculitis, Primary brain tumor Review Source Type: research

Rheumatoid meningitis: A case report and review of the literature
Purpose of review Rheumatoid arthritis is a systemic inflammatory disorder, which can involve many organs; among which, CNS involvement, as in rheumatoid meningitis (RM), is rare and difficult to recognize. Our goal is to present collective data of RM cases to better characterize this disease process and to start new discussions about pathophysiology, diagnosis, and treatment. Recent findings Since Kato et al., 39 cases of RM have been reported. Approximately 59% were women, presenting with neurologic deficits (56%) and diagnosed by MRI findings, leptomeningeal enhancement (69%), after CSF analysis. Seventy-four percent w...
Source: Neurology Clinical Practice - February 10, 2020 Category: Neurology Authors: Qin, Z., Kim, J., Valencia, D., Hamoodi, L., Neltner, J., Sizemore, T., Lightfoot, R. Tags: Autoimmune diseases, Meningitis Review Source Type: research

Symptom burden among individuals with Parkinson disease: A national survey
Conclusions In this national survey of individuals with PD, we identified poor QOL, frequent critical events, and numerous uncontrolled symptoms among a substantial proportion of respondents. Although motor symptoms were common, only nonmotor symptoms were associated with poor QOL. Many of these symptoms and events are treatable or preventable, highlighting the need for better identification and management to improve QOL among those with PD. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - February 10, 2020 Category: Neurology Authors: Tarolli, C. G., Zimmerman, G. A., Auinger, P., McIntosh, S., Horowitz, R. K., Kluger, B. M., Dorsey, E. R., Holloway, R. G. Tags: Quality of life, All Movement Disorders, Parkinson's disease/Parkinsonism, Parkinson's disease with dementia, Palliative care Research Source Type: research

Assessment of Parkinson disease quality measures on 12-month patient outcomes
Conclusions We found no clinically important improvement in patient outcomes with higher adherence levels. It is important that QM developers validate QMs to ensure that they fulfill the intended goal of improved patient outcomes. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - February 10, 2020 Category: Neurology Authors: Martello, J., Shulman, L. M., Barr, E., Gruber-Baldini, A., Armstrong, M. J. Tags: Outcome research, Quality of life, Parkinson's disease/Parkinsonism Source Type: research

Painful diabetic peripheral neuropathy: Health care costs and complications from 2010 to 2015
Objective To quantify health care resource utilization and risk of complications in painful diabetic peripheral neuropathy (pDPN). Methods Adult patients diagnosed with diabetes mellitus or diabetic peripheral neuropathy (DPN) were identified in MarketScan from January 2010 to December 2015. Subgroups (pDPN and nonpainful DPN) were based on the use of pain medications 6 months before a new indexed diagnosis and 1 year thereafter. Health care costs were collected for up to 5 years, and complications charted for those with at least 1 and 2 years of follow-up. Complication comparisons were made using 2 or Fisher exact tests,...
Source: Neurology Clinical Practice - February 10, 2020 Category: Neurology Authors: Kiyani, M., Yang, Z., Charalambous, L. T., Adil, S. M., Lee, H.-J., Yang, S., Pagadala, P., Parente, B., Spratt, S. E., Lad, S. P. Tags: Cost effectiveness/economic, Endocrine, Peripheral neuropathy, Neuropathic pain Research Source Type: research

Serum FGF-21, GDF-15, and blood mtDNA copy number are not biomarkers of Parkinson disease
Conclusion In this study, serum FGF-21, serum GDF-15, and blood mtDNA levels were similar in patients with PD and healthy controls and therefore unlikely to be satisfactory indicators of mitochondrial dysfunction in patients with PD. Classification of evidence This study provides Class III evidence that serum FGF-21, serum GDF-15, and blood mtDNA copy number levels do not distinguish patients with PD from healthy controls. There was no diagnostic uncertainty between patients with PD and healthy controls. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - February 10, 2020 Category: Neurology Authors: Davis, R. L., Wong, S. L., Carling, P. J., Payne, T., Sue, C. M., Bandmann, O. Tags: Mitochondrial disorders; see Genetics/Mitochondrial disorders, All Movement Disorders, Parkinson's disease/Parkinsonism, Class III, Mitochondrial disorders Research Source Type: research

Visual tests predict dementia risk in Parkinson disease
Objective To assess the role of visual measures and retinal volume to predict the risk of Parkinson disease (PD) dementia. Methods In this cohort study, we collected visual, cognitive, and motor data in people with PD. Participants underwent ophthalmic examination, retinal imaging using optical coherence tomography, and visual assessment including acuity and contrast sensitivity and high-level visuoperception measures of skew tolerance and biological motion. We assessed the risk of PD dementia using a recently described algorithm that combines age at onset, sex, depression, motor scores, and baseline cognition. Results O...
Source: Neurology Clinical Practice - February 10, 2020 Category: Neurology Authors: Leyland, L.-A., Bremner, F. D., Mahmood, R., Hewitt, S., Durteste, M., Cartlidge, M. R. E., Lai, M. M.- M., Miller, L. E., Saygin, A. P., Keane, P. A., Schrag, A. E., Weil, R. S. Tags: Parkinson's disease/Parkinsonism, Retina, Visual processing, Parkinson's disease with dementia Research Source Type: research

Interventions to minimize complications in hospitalized patients with Parkinson disease
This study was designed as a prospective cohort study. A hospital-wide alert system was incorporated into the electronic medical record (EMR) system. The alert was triggered when a patient with PD or on dopaminergic therapy was admitted prompting the inpatient pharmacy to confirm medication details. A warning was also triggered if antidopaminergic medications were ordered. In-services were performed for nursing staff and physicians regarding these measures. Charts of patients with PD admitted 6 months before and after the intervention were reviewed to serve as the 2 comparison groups. Results There were 73 patients (mean ...
Source: Neurology Clinical Practice - February 10, 2020 Category: Neurology Authors: Aslam, S., Simpson, E., Baugh, M., Shill, H. Tags: Outcome research, Medical care, All Clinical Neurology, Parkinson's disease/Parkinsonism, Patient safety Source Type: research

The neurologic phenotype of South African patients with HIV-associated neurocognitive impairment
We describe the neurologic phenotype in South African patients with predominant HIV-1 subtype C infection on ART and its association with neurocognitive impairment and efavirenz and 8-hydroxy-efavirenz concentrations. Methods We conducted a cross-sectional analysis of the neurologic examination findings of HIV+ patients with neurocognitive impairment and used multiple linear regression to explore associations with neurocognitive impairment, efavirenz, and 8-hydroxy-efavirenz pharmacokinetics (plasma and CSF). Results We included 80 participants established on ART (median 40 months) of which 72 (90%) were female. The medi...
Source: Neurology Clinical Practice - February 10, 2020 Category: Neurology Authors: Anderson, S. G., McCaul, M., Khoo, S., Wiesner, L., Sacktor, N., Joska, J. A., Decloedt, E. H. Tags: HIV, Clinical neurology examination, Clinical trials Observational study (Cohort, Case control), HIV dementia Research Source Type: research

Neurotoxicity from intrathecal gadolinium administration: Case presentation and brief review
Intrathecal administration of gadolinium may result in catastrophic neurologic injury. Policies that prevent accidental injection of high-dose intrathecal gadolinium should be advocated. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - February 10, 2020 Category: Neurology Authors: Calvo, N., Jamil, M., Feldman, S., Shah, A., Nauman, F., Ferrara, J. Tags: Other toxicology, Status epilepticus Case Source Type: research

Video research visits for atypical parkinsonian syndromes among Fox Trial Finder participants
Conclusions Video research visits are feasible and reliable in those with an atypical parkinsonian syndrome. These visits represent a promising option for reducing burden and extending the reach of clinical research to individuals with these rare and disabling conditions. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - February 10, 2020 Category: Neurology Authors: Tarolli, C. G., Zimmerman, G. A., Goldenthal, S., Feldman, B., Berk, S., Siddiqi, B., Kopil, C. M., Chowdhury, S., Biglan, K. M., Dorsey, E. R., Adams, J. L. Tags: All Movement Disorders, Progressive supranuclear palsy, Multiple system atrophy, Dementia with Lewy bodies, Corticobasal degeneration Research Source Type: research

Fourteen-year serial MRIs of patients with mild and severe courses of MS
Serial MRIs from 2 patients with relapsing-remitting MS displaying mild (video 1, baseline age: 42 years; disease duration: 1.2 years) and severe (video 2, baseline age: 43 years; disease duration: 1.6 years) brain atrophy with plots of brain parenchymal fraction (BPF),1 a measure of normalized brain volume, and Expanded Disability Status Scale (EDSS) are presented. Patients were scanned every 6–12 months over 14 years using standardized protocols on 3 scanners (Siemens Vision, Symphony, and Trio).2 BPF was calibrated across scanners using scan-rescan measurements. During the first year, the severe patient had 10 con...
Source: Neurology Clinical Practice - February 10, 2020 Category: Neurology Authors: Nakamura, K., Rudick, R. A., Ontaneda, D., Fox, R. J., Trapp, B. D., Fisher, E. Tags: MRI, Volumetric MRI, Multiple sclerosis Case Source Type: research

Quality measures in Parkinson disease: What do the outcomes show?
Since the passage of the Affordable Care Act in 2010, there has been an increasing push to link physician and other health care provider reimbursements to the quality and value of care delivered, rather than the pure fee for service model that dominated medical payments over the prior 2 decades.1 The Centers for Medicare and Medicaid Services (CMS), which provides nearly 40% of all reimbursements in the United States,2 has focused primarily on hospital-based quality measures to date. However, since 2017, CMS has outlined measures specific to various diseases in the ambulatory care setting as well.3 Many of these are derive...
Source: Neurology Clinical Practice - February 10, 2020 Category: Neurology Authors: Tarolli, C. G., Barbano, R. Tags: Cost effectiveness/economic, Outcome research, Medical care, Parkinson's disease/Parkinsonism, Health care reform Editorial Source Type: research

The hidden costs of painful diabetic neuropathy revealed
The objective of the study was to quantify the health care resources used in the care of patients with pDPN and to assess the risk of complications in this population. Patients with diabetes mellitus (DM) with or without incident diabetic neuropathy (DPN) over a 5-year period were identified using a large health care database. Those using neuropathic pain medications for 6 months before or 1 year after the index diagnosis were categorized as having pDPN. Health care costs were calculated for up to 5 years after diagnosis, and complications were queried. In total, 360,559 patients with DM were identified, of which 23% had p...
Source: Neurology Clinical Practice - February 10, 2020 Category: Neurology Authors: Smith, A. G., Zivkovic, S. Tags: Cost effectiveness/economic, Endocrine, Peripheral neuropathy, Neuropathic pain Editorial Source Type: research