Intersegmental artery dissection resulting in spinal infarction
Intersegmental artery dissection is a rare but treatable cause of spinal cord infarction. Conventional spinal angiography may be necessary to establish the diagnosis of arterial dissection. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - December 7, 2020 Category: Neurology Authors: Gailloud, P., Deib, G., Pearl, M. S., Khoshnoodi, M., Johansen, M. C. Tags: All Clinical Neurology, All Spinal Cord, Spinal cord infarction Case Source Type: research
Neurology clinicians' views on palliative care communication: "How do you frame this?"
Conclusions There is a need for a systematic, structured approach to communication that can be applied early in the disease trajectory and considered when developing integrated neuro-palliative care programs. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - December 7, 2020 Category: Neurology Authors: Zehm, A., Hazeltine, A. M., Greer, J. A., Traeger, L., Nelson-Lowe, M., Brizzi, K., Jacobsen, J. Tags: All Clinical Neurology, Amyotrophic lateral sclerosis, All Cognitive Disorders/Dementia, All Ethics in Neurology/Legal issues, Palliative care Research Source Type: research
Considering learning disabilities and attention-deficit hyperactivity disorder when assessing for neurodegenerative disease
This article offers clinical guidance for practicing neurologists in the identification and assessment of neurodevelopmental disorders in older adult patients, which informs management and treatment. Consideration of lifetime functioning has become increasingly important with research linking neurodevelopmental disabilities to increased risk of specific neurodegenerative diseases. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - December 7, 2020 Category: Neurology Authors: Colvin, M. K., Sherman, J. C. Tags: Developmental disorders, ADHD, Dyslexia, Cognitive neuropsychology in dementia, Assessment of cognitive disorders/dementia Review Source Type: research
Lymphocyte reconstitution after DMF discontinuation in clinical trial and real-world patients with MS
Background Delayed-release dimethyl fumarate (DMF) has demonstrated robust efficacy in treating patients with relapsing-remitting multiple sclerosis. Decreases in absolute lymphocyte count (ALC) are a well-known pharmacodynamic effect of DMF treatment, but lymphocyte recovery dynamics are not well characterized after discontinuation of DMF. Methods Data sources included the Biogen DMF integrated clinical trial data set, a retrospective US chart abstraction study, and data from MSBase. We assessed rate and time course of lymphocyte reconstitution after DMF discontinuation. Results The majority of patients who developed ly...
Source: Neurology Clinical Practice - December 7, 2020 Category: Neurology Authors: Chan, A., Rose, J., Alvarez, E., Bar-Or, A., Butzkueven, H., Fox, R. J., Gold, R., Gudesblatt, M., Haartsen, J., Spelman, T., Wright, K., Ferraro, D., Sola, P., Hodgkinson, S., Kalincik, T., Lechner-Scott, J., McGuigan, C., Spach, K., Chen, C., Fam, S., W Tags: All Clinical trials, Multiple sclerosis Research Source Type: research
Sphenopalatine ganglion block in primary headaches: An American Headache Society member survey
Conclusions The variety of responses strongly suggests that clinicians would benefit from formalized protocols for SPG blocks. More experienced clinicians may have developed individualized protocols that they feel are more effective. The lack of evidence-based protocols contribute to clinicians not performing SPG blocks more frequently. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - December 7, 2020 Category: Neurology Authors: Burkett, J. G., Robbins, M. S., Robertson, C. E., Mete, M., Saikali, N. P., Halker Singh, R. B., Ailani, J. Tags: All Headache, Migraine, Cluster headache Research Source Type: research
Dengue and chikungunya infection in neurologic disorders from endemic areas in Brazil
Conclusion DENV and CHIKV are a frequent cause of emerging and reemerging infections. It increases the number of cases with neurologic complications worldwide. We demonstrated that the combined use of molecular and immunologic tests in CSF/serum might support more widely the diagnosis of neurologic disorders caused by arbovirus in endemic areas. The detection of intrathecal synthesis of specific IgG antibodies may be promising for the retrospective diagnosis of neuroinvasive disorders caused by arbovirus. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - December 7, 2020 Category: Neurology Authors: Mello, C. d. S., Cabral-Castro, M. J., Silva de Faria, L. C., Peralta, J. M., Puccioni-Sohler, M. Tags: Encephalitis, Viral infections, Cerebrospinal Fluid Research Source Type: research
Treatment of migraine in patients with CADASIL: A systematic review and meta-analysis
Conclusions Migraine in CADASIL remains a formidable therapeutic challenge, with patients often tried on several medications. Antimigraine prophylaxis with beta-blockers may be contraindicated relative to other common therapies in CADASIL. Controlled studies are needed to rigorously evaluate the safety and efficacy of antimigraine therapies in this population. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - December 7, 2020 Category: Neurology Authors: Glover, P. A., Goldstein, E. D., Badi, M. K., Brigham, T. J., Lesser, E. R., Brott, T. G., Meschia, J. F. Tags: Migraine, Other cerebrovascular disease/ Stroke, All Cerebrovascular disease/Stroke, Clinical trials Systematic review/meta analysis, CADASIL Source Type: research
Cautionary notes on diagnosing functional neurologic disorder as a neurologist-in-training
Functional neurologic disorder (FND), although neglected for much of the 20th century, is among the most common conditions encountered by neurologists across clinical settings. High prevalence rates and limited provider expertise in FND have created a considerable need to develop educational initiatives and practical suggestions to guide neurologists in training working with this population. To help avoid diagnostic errors, trainees should keep in mind that (1) marginally positive functional examination signs have low specificity; (2) FND can coexist with other neurologic comorbidities; and (3) bizarre, not previously enco...
Source: Neurology Clinical Practice - December 7, 2020 Category: Neurology Authors: Perez, D. L., Hunt, A., Sharma, N., Flaherty, A., Caplan, D., Schmahmann, J. D. Tags: Conversion Commentary Source Type: research
Spinal cord transient ischemic attack: Insights from a series of spontaneous spinal cord infarction
Conclusions sTIAs are possible but rare in patients who subsequently have a SCI. Clinical features are similar to those of SCI, with rapid onset of severe myelopathic deficits, followed by prompt resolution. Vascular risk factors are common in these patients. Thus, recognition of a sTIA may represent a valuable opportunity for vascular risk factor modification and stroke prevention. However, given the rarity, physicians should explore other possible explanations when sTIA is considered. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - December 7, 2020 Category: Neurology Authors: English, S. W., Rabinstein, A. A., Flanagan, E. P., Zalewski, N. L. Tags: Spinal cord infarction Research Source Type: research
Smartphone use and primary headache: A cross-sectional hospital-based study
Objective To determine the association of smartphone use with occurrence of new-onset headache and/or increased severity of headaches in patients with primary headache. Methods In a cross-sectional study between June 2017 and December 2018, patients with primary headache were divided into 2 groups: smartphone users (SUs) and non-smartphone users (NSUs). A questionnaire was administered for headache characteristics and treatment taken. The primary objective was to determine the association of smartphone use with new-onset headache or increase severity. The secondary objective was to determine any differences in the require...
Source: Neurology Clinical Practice - December 7, 2020 Category: Neurology Authors: Uttarwar, P., Vibha, D., Prasad, K., Srivastava, A. K., Pandit, A. K., Dwivedi, S. N. Tags: All Headache, Screening in epidemiology Research Source Type: research
Functional neurologic disorders: Bringing the informal and hidden curriculum to light
Functional neurologic disorders (FND) are among the most common conditions a neurologist will encounter. In 2014, after the publication of an updated Cochrane report on nonepileptic seizures (NES) concluded that there was little reliable evidence supporting any treatment modality, there was a call for further randomized controlled trials, highlighting the lack of priority given to the treatment of NES on the part of both psychiatrists and neurologists.1 Controversy exists about where patients with FND should "live" for their treatment, given a presentation that has symptoms in common with both psychiatric and neu...
Source: Neurology Clinical Practice - December 7, 2020 Category: Neurology Authors: Strom, L. A. Tags: Editorial Source Type: research
Diagnosing spinal cord ischemia: Are we doing enough catheter angiography?
Spinal cord ischemia is an important and potentially treatable cause of acute myelopathy. Similar to brain ischemia, the accurate diagnosis of spinal cord ischemia is necessary to begin timely treatment and avoid debilitating and/or permanent morbidity. Diagnosis in the absence of obvious inciting traumatic, procedural or vascular source (e.g., aortic aneurysm), however, may be elusive for many patients. The recently proposed diagnostic criteria specify the presence of a T2 hyperintensity and/or diffusion-restricted intramedullary spinal cord lesion and supporting factors of associated vertebral body infarction and/or arte...
Source: Neurology Clinical Practice - December 7, 2020 Category: Neurology Authors: Young, R. J., Huang, J. H., Thiex, R. Tags: All Clinical Neurology, All Spinal Cord, Spinal cord infarction Editorial Source Type: research
Smartphone use and headaches: Are we ready to accept a link?
Technology is an essential part of everyday life. There is a great deal of speculation among the lay population regarding the effect of computers and mobile phones on ailments such as headaches and neck pain. However, although there are anecdotal stories suggesting a link between technology use and pain, there is little evidence of either a definitive relationship or data absolving mobile phones or computers from a link to recurrent pain. Smartphone users may rely on the devices for many hours per day—while on the go, resting, or working—which puts a strain on the eyes, neck, and back. As people are becoming mo...
Source: Neurology Clinical Practice - December 7, 2020 Category: Neurology Authors: Moawad, H., Jones, E. Tags: All Headache, Screening in epidemiology Editorial Source Type: research
Transient hyperreflexia: An early diagnostic clue in later-onset spinal muscular atrophy
Hyperreflexia can be an early clinical sign in individuals with spinal muscular atrophy. Early recognition and diagnosis are important to minimize time to treatment initiation. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - December 7, 2020 Category: Neurology Authors: Oskoui, M., Kim, D. H., Mentis, G. Z., De Vivo, D. C. Tags: Clinical neurology examination, All Neuromuscular Disease, All Pediatric Case Source Type: research
Effect of switching from natalizumab to moderate- vs high-efficacy DMT in clinical practice
Conclusion Patients switching from NTZ to Mod DMT vs HET were at relatively increased risk of disease activity within the first 6 months of NTZ withdrawal that was sustained at 24 months, yielding greater disability progression. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - December 7, 2020 Category: Neurology Authors: Hersh, C. M., Harris, H., Conway, D., Hua, L. H. Tags: Multiple sclerosis Research Source Type: research
Author response: Therapeutic benefits of early electrophysiological testing in a functional neurology case
We entirely agree with the comments expressed by Professor Hallett et al. in response to our article1 regarding the use of electrophysiology to investigate probable functional neurologic disorders (FNDs). We point out in our article that electrophysiology is typically normal in FNDs and, indeed, is important evidence to support that diagnosis. However, we also mention that a small proportion of FNDs can demonstrate transient electrophysiologic abnormalities and that these seem consistent with other reported abnormal functional imaging, perfusion, and morphometric MRI studies in this group. FNDs are unlikely to be homogeneo...
Source: Neurology Clinical Practice - December 7, 2020 Category: Neurology Authors: Powell, A. C., Hayes, M. W. Tags: The Nerve! Readers Speak Source Type: research
Reader response: Therapeutic benefits of early electrophysiological testing in a functional neurology case
We read the article by Powell et al.1 with interest. We advocate using clinical neurophysiology to help make the diagnosis of functional neurologic disorders (FND). Such testing can improve diagnostic certainty. We agree that the testing is valuable but for the opposite reason that the authors suggest. The clinical findings themselves were suggestive of FND. The neurophysiology points to a cerebral abnormality of motor and sensory functions. Despite the normal neuroimaging, this still could have been an episode of demyelination or another disorder. Functional disorders are often seen together with other neurologic disorder...
Source: Neurology Clinical Practice - December 7, 2020 Category: Neurology Authors: Hallett, M., LaFaver, K., Maurer, C. W., Merchant, S. H. I., Vial, F. Tags: The Nerve! Readers Speak Source Type: research
Author response: Smartphone use and primary headache: A cross-sectional hospital-based study
We thank Dr. Jacob for the comment on our research article1 and share similar observations noted in your practice. Because headache is a common neurologic problem and smartphone use is practically unavoidable in the modern era, drawing an association may be possible in your quoted case but to prescribe decreasing its use among all primary headache patients is something that requires more longitudinal studies. It may be added to the list of triggers of headache once there is more evidence. Our cross-sectional study provides the necessary association to carry this hypothesis further. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - December 7, 2020 Category: Neurology Authors: Vibha, D. Tags: The Nerve! Readers Speak Source Type: research
Reader response: Smartphone use and primary headache: A cross-sectional hospital-based study
I read the article by Uttarwar et al.1 with interest. We are reporting special cases of bikers using mobile phone by inserting it inside their helmet over the pinnae, resulting in difficult-to-treat headache. One of our first patients was a building engineer who used to converse with his workers continuously during his ride, with phone over the ear inside the helmet. Several medications were tried for his headache until, during one of his visits, we found out his peculiar habit. Although mobile handsets are known to cause headaches, it is something inevitable in day-to-day life.2,3 This is because during the past few decad...
Source: Neurology Clinical Practice - December 7, 2020 Category: Neurology Authors: Jacob, J. Tags: The Nerve! Readers Speak Source Type: research
Clinical neuro-oncology for the neurologist
Purpose of review Neuro-oncologic patients are routinely encountered in clinical practice. Neuro-oncology is a rapidly evolving field, so understanding the most classic paradigms and contemporary advances will optimize patient care. Recent findings We discuss the recent reclassification of tumors via molecular characteristics as it applies to direct clinical practice and review the contemporary standard of care for infiltrating gliomas, meningiomas, brain metastases, and CNS lymphoma. Summary We provide a straightforward primer on neuro-oncology with a focus on the brain tumors most commonly encountered by the adult neur...
Source: Neurology Clinical Practice - October 12, 2020 Category: Neurology Authors: Lukas, R. V., Taylor, J. W., Kurz, S. C., Mohile, N. A. Tags: All Oncology, Primary brain tumor, Metastatic tumor, Chemotherapy-tumor, Radiation therapy-tumor Review Source Type: research
Mechanisms of calcification in Fahr disease and exposure of potential therapeutic targets
Purpose of review There is growing interest in disorders involved in ectopic mineralization. Fahr disease or idiopathic basal ganglia calcification can serve as a model for ectopic mineralization in the basal ganglia, which is fairly common in the general population. In this review, we will focus on causative gene mutations and corresponding pathophysiologic pathways in Fahr disease. Recent findings Patients with Fahr disease have a variability of symptoms, such as movement disorders, psychiatric signs, and cognitive impairment, but can also be asymptomatic. Fahr disease is mostly autosomal dominant inherited, and there a...
Source: Neurology Clinical Practice - October 12, 2020 Category: Neurology Authors: Peters, M. E. M., de Brouwer, E. J. M., Bartstra, J. W., Mali, W. P. T. M., Koek, H. L., Rozemuller, A. J. M., Baas, A. F., de Jong, P. A. Tags: CT, Other cerebrovascular disease/ Stroke, Gene expression studies, Basal ganglia Review Source Type: research
Improving access to care for patients with migraine in a remote Pacific population
Conclusion Increased access to care provided benefits in reduction of specialist overutilization, reduction in hospitalizations, and reduction in disability. Patients with chronic migraine did not have increased use of medical resources or decreased productivity in this cohort. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 12, 2020 Category: Neurology Authors: Baker, V., Hack, N. Tags: Migraine, Cost effectiveness/economic, Access to care, Burden of disease, Training-international, Cross-cultural care Research Source Type: research
Comparison of children with acute flaccid myeltis before and after 2014
Conclusion The groups had more similarities than differences but with a more inflammatory picture in the post-2014 patients. The constellation of cervical cord gray matter, brainstem, and nerve root/CE thickening should raise suspicion for AFM in the appropriate clinical setting. Most post-2014 patients had associated enterovirus infections, and over half tested for EV-D68 were positive. There was minimal clinical improvement in both groups despite various immunotherapies. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 12, 2020 Category: Neurology Authors: Marcus, L., Singh, S., Ness, J. Tags: MRI, Viral infections, All Pediatric Research Source Type: research
Quantitative sensory testing predicts histological small fiber neuropathy in postural tachycardia syndrome
Background Retrospective investigation of the somatosensory profile and prediction of histologic small fiber neuropathy (SFN) in postural orthostatic tachycardia syndrome (POTS) was performed using quantitative sensory testing (QST) as a standardized noninvasive test. Methods In this investigation, full data sets from 30 patients (age: 34.03 ± 10.82 years, n = 6 males), including results of autonomic function testing, norepinephrine values, skin biopsy, and QST, were retrospectively analyzed. The QST data were compared with healthy controls (HCs) (age: 34.20 ± 10.5 years, n = 6 males, t test: 0.95). Results...
Source: Neurology Clinical Practice - October 12, 2020 Category: Neurology Authors: Billig, S. C. I., Schauermann, J. C., Rolke, R., Katona, I., Schulz, J. B., Maier, A. Tags: Research Source Type: research
Outcomes of interfacility helicopter transportation in acute stroke care
Objective To evaluate the long-term functional outcome of interhospital transfer of patients with stroke with suspected large vessel occlusion (LVO) using Helicopter Emergency Medical Services (HEMS). Methods Records of consecutive patients evaluated through 2 telestroke networks and transferred to thrombectomy-capable stroke centers between March 2017 and March 2018 were reviewed. Inverse probability of treatment weighting (IPTW) using the propensity score was performed to address confounding factors. Multivariate logistic regression analysis with IPTW was used to determine whether HEMS were associated with good long-ter...
Source: Neurology Clinical Practice - October 12, 2020 Category: Neurology Authors: Almallouhi, E., Al Kasab, S., Nahhas, M., Harvey, J. B., Caudill, J., Turner, N., Debenham, E., Giurgiutiu, D.-V., Leira, E. C., Switzer, J. A., Holmstedt, C. A. Tags: Outcome research, All Cerebrovascular disease/Stroke Source Type: research
Ultrasound imaging of nerves in the neck: Correlation with MRI, EMG, and clinical findings
Conclusion Ultrasound is effective in the visualization and diagnostic evaluation of the SSN, LTN, SAN, and phrenic nerve. Classification of evidence This study provides Class IV evidence that ultrasound can effectively visualize and diagnose neuropathy of the SSN, LTN, SAN, and phrenic nerve in the neck. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 12, 2020 Category: Neurology Authors: Casaletto, E., Lin, B., Wolfe, S. W., Lee, S. K., Sneag, D. B., Feinberg, J. H., Nwawka, O. K. Tags: Diagnostic test assessment, Ultrasound, Peripheral neuropathy, Class IV Research Source Type: research
Novel and known morbidities of leukodystrophies identified using a phenome-wide association study
Conclusions PheWAS analysis from a national database demonstrates shared and unique features of leukodystrophies. Developmental delay, cardiac dysrhythmias, fluid and electrolyte disturbances, and respiratory issues were common to all 4 leukodystrophy diseases. Use of a PheWAS in leukodystrophies and other pediatric neurologic diseases offers a method for targeting improved care for patients by identification of morbidities. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 12, 2020 Category: Neurology Authors: Bonkowsky, J. L., Wilkes, J., Ying, J., Wei, W.-Q. Tags: All Medical/Systemic disease, Leukodystrophies, All Pediatric, All Demyelinating disease (CNS) Research Source Type: research
Cryptogenic stroke: Contemporary trends, treatments, and outcomes in the United States
Conclusions In a large contemporary nationwide registry, CS accounted for 20% of ISs among patients with a documented stroke etiology. Patients with CS had a distinct profile of treatments and outcomes relative to other subtypes. Improved subtype documentation and further research into CS are warranted to improve care and outcomes for patients with stroke. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 12, 2020 Category: Neurology Authors: Prabhakaran, S., Messe, S. R., Kleindorfer, D., Smith, E. E., Fonarow, G. C., Xu, H., Zhao, X., Lytle, B., Cigarroa, J., Schwamm, L. H. Tags: All Cerebrovascular disease/Stroke Research Source Type: research
Synchronous neurology-primary care collaboration in a medical home
Conclusions Synchronous collaboration between neurologists and PCPs may improve timely access to neurologic expertise, downstream utilization, and PCP satisfaction. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 12, 2020 Category: Neurology Authors: Young, N. P., Burkholder, D. B., Philpot, L. M., McKie, P. M., Ebbert, J. O. Tags: Cost effectiveness/economic, Models of care, Health care reform, Access to care, Health systems Research Source Type: research
Worldwide survey on laboratory testing of vestibular function
Background The function of the peripheral vestibular system can nowadays be quantified. The video head impulse test (vHIT) and caloric irrigation are used for the semicircular canals, cervical vestibular evoked myogenic potentials (cVEMP) for the sacculus, and ocular vestibular evoked myogenic potentials (oVEMP) for the utriculus. Because there is no agreement on normal and pathologic values, we performed a worldwide survey. Methods A web-based standardized survey questionnaire was used to collect data on "reference values" and "cutoff" values. Thirty-eight centers from all continents (except Africa) r...
Source: Neurology Clinical Practice - October 12, 2020 Category: Neurology Authors: Strupp, M., Grimberg, J., Teufel, J., Laurell, G., Kingma, H., Grill, E. Tags: Nystagmus, All Neurotology, Vertigo Research Source Type: research
Robot doctors: Teleneurology pros and cons
As the landscape of health care changes, it is important for neurologists to explore and embrace new practice models and technologies for meeting the needs of patients and referring providers. In the issue of Neurology: Clinical Practice, Young et al.1 assessed a way to improve immediate access to a consulting neurologist and explored how this affected care, costs, and patient/provider satisfaction. This is a great first step at looking at these issues, and benefits were indeed suggested by their results. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 12, 2020 Category: Neurology Authors: Jones, E. C. Tags: Cost effectiveness/economic, Models of care, Health care reform, Access to care, Health systems Editorial Source Type: research
"Retrofitting" established genetic disorders and diseases through big data and phenomics
Throughout the history and evolution of medical diagnostics, astute clinicians used "gestalt" (or pattern recognition) methods to identify and describe specific neurologic disorders, neurodegenerative diseases, and genetic syndromes. The application of innovative technologies allowed valid clinical observations to be corroborated by various biomarkers, such as laboratory measurements and histopathology, and ultimately by DNA sequencing. In the current era of "omics" sciences (e.g., genomics, proteomics, or metabolomics), advances in bioinformatics and large health care databases demonstrate the potentia...
Source: Neurology Clinical Practice - October 12, 2020 Category: Neurology Authors: Graf, W. D., Shprintzen, R. J. Tags: Leukodystrophies, Case control studies, Association studies in genetics Editorial Source Type: research
FOSMN: A possible TDP-43 proteinopathy to consider in a patient with facial sensory symptoms
Facial onset sensory and motor neuronopathy should be considered in the differential diagnosis of facial sensory disturbances, unilateral or bilateral, especially when blink reflex is pathologic. Because bulbar and lower motor neuron dysfunction may appear years after the facial sensory onset, long follow-up is recommended in suspected patients. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 12, 2020 Category: Neurology Authors: Agirre-Beitia, G., Moreno-Estebanez, A., Gonzalez-Pinto Gonzalez, T., Melgar Jimenez, B., Campos Rodriguez, I., Cabral Martinez, L., Jauregui Barrutia, A., Gonzalez Eizaguirre, A., Caballero Romero, I., Barcena Llona, J., Gomez-Esteban, J. C. Tags: Case Source Type: research
Double antiglutamatergic therapy in a case of postanoxic super-refractory status epilepticus
Double antiglutamatergic therapy may be a promising option for super-refractory postanoxic status epilepticus. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 12, 2020 Category: Neurology Authors: Stabile, A., Beretta, S., Coppo, A., Padovano, G., Bogliun, G., Ferrarese, C., Avalli, L. Tags: Coma, Critical care, Status epilepticus, Epilepsy monitoring Case Source Type: research
Malignant cerebral edema secondary to hyperammonemia in setting of acquired carnitine deficiency
In cases with refractory or potentially life-threatening idiopathic hyperammonemia, consider evaluating for carnitine deficiency and initiating empiric carnitine trial. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 12, 2020 Category: Neurology Authors: Long, D., Derani, T., Gheith, T., Aburashed, R., Saeed, A. Tags: Gastrointestinal, Nutritional, Coma Case Source Type: research
Looking ahead: The risk of neurologic complications due to COVID-19
The rapid spread of Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 has become a public health emergency of international concern. The outbreak was characterized as a pandemic by the World Health Organization (WHO) in March 2020. The most characteristic symptom of patients with COVID-19 is respiratory distress. Some patients may also show neurologic signs and symptoms ranging from headache, nausea, vomiting, and confusion to anosmia, ageusia, encephalitis, and stroke. Coronaviruses are known pathogens with neuroinvasive potential. There is increasing evidence that coronavirus i...
Source: Neurology Clinical Practice - August 9, 2020 Category: Neurology Authors: Perez, C. A. Tags: Viral infections, All global neurology, Public health, COVID-19 Commentary Source Type: research
Practice Current: How do you manage mild cognitive impairment?
Mild cognitive impairment (MCI) is characterized by evidence of cognitive impairment with minimal disruption of instrumental activities of daily living and carries a substantial risk of progression of dementia. Whereas current guidelines support a relatively minimalistic workup to identify reversible or structural causes, the field has witnessed the rapid development of various sophisticated imaging, biomarker, and genetic investigations in the past few years. The role of these investigations in routine practice is uncertain. Similarly, although there are no approved treatments for MCI, neurologists may experience uncertai...
Source: Neurology Clinical Practice - August 9, 2020 Category: Neurology Authors: Bartolini, L., Ganesh, A., Genesh, P., Adil, M. M., Varma, M., Smith, E. E. Tags: All Cognitive Disorders/Dementia, Practice Current, Cognitive aging, Cognitive neuropsychology in dementia, Assessment of cognitive disorders/dementia, MCI (mild cognitive impairment) Commentary Source Type: research
Pediatric and adult neurologist perspectives on the challenges of sustaining a transfer clinic
We present a novel epilepsy fellow–driven transfer clinic model and discuss the challenges experienced in finding sustainability; this is timely as many pioneering transition clinics are dissolving across North America. The goal of this clinic was to improve patient care and satisfaction, as measured by a post-visit telephone survey. Unfortunately, our transfer clinic model proved unsustainable due to several factors, broadly categorized as (1) cultural-societal differences between the pediatric and adult health care environments, (2) staffing issues, (3) lack of an established standardized process for transfer of ca...
Source: Neurology Clinical Practice - August 9, 2020 Category: Neurology Authors: Fantaneanu, T. A., Jacobs, C. S., De Gusmao, C., Bergin, A. M., Milligan, T. A., Pearl, P. L., Dworetzky, B. A. Tags: All Health Services Research, All Clinical Neurology, Adolescence, All Epilepsy/Seizures Commentary Source Type: research
Clinical utility of therapeutic drug monitoring of antiepileptic drugs: Systematic review
Conclusions If optimally implemented, TDM may enhance clinical care, particularly for phenytoin and other AEDs with complex pharmacokinetics. However, the ideal method for implementation is unclear, and serum drug levels should be considered in context with patient-reported clinical data regarding seizure control and adverse events. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 9, 2020 Category: Neurology Authors: Al-Roubaie, Z., Guadagno, E., Ramanakumar, A. V., Khan, A. Q., Myers, K. A. Tags: All Epilepsy/Seizures, Antiepileptic drugs Review Source Type: research
Cervical spinal dural fistulas leading to remote thoracolumbar myelopathy: A diagnostic pitfall
We describe 3 cases of cervical SDAVFs (at C1, C4, and C7) presenting with a myelopathy that spared the cervical spinal cord and, in 2 instances, the upper thoracic cord. This is to our knowledge the first observations of cervical SDAVFs with MRI showing absent or subtle flow voids and presenting remote thoracolumbar myelopathy without cervical cord involvement. Summary A considerable distance may separate low-flow spinal arteriovenous fistulas from the spinal cord damage they produce. These observations emphasize the importance of performing a complete spinal angiogram when investigating a vascular myelopathy of any loca...
Source: Neurology Clinical Practice - August 9, 2020 Category: Neurology Authors: Martinez, M., Hedjoudje, A., Pardo, C., Tamargo, R. J., Gailloud, P. Tags: All Imaging, CT, MRI, Arteriovenous malformation Review Source Type: research
Association between recent cannabinoid use and acute ischemic stroke
Conclusion This is one of the few studies analyzing the association of recent cannabis use and AIS using admission urine toxicology test independent of polysubstance use. Although our study has limitations, we did not find an independent association between recent cannabis use and the incidence of AIS. Further studies using urine toxicology tests with larger sample size and including dosage of cannabis exposure should be conducted. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 9, 2020 Category: Neurology Authors: San Luis, C. V., O'Hana S. Nobleza, C., Shekhar, S., Sugg, R., Villareal, D. J., Mehta, T., Gangadhara, S. Tags: All Cerebrovascular disease/Stroke, Other toxicology Research Source Type: research
Deep brain stimulation for orthostatic tremor: A single-center case series
Conclusions Bilateral thalamic DBS improved OT symptoms with benefit lasting up to 6 years. A modest increase in standing time of several minutes was associated with meaningful improvement in standing ADLs. Microlesional effect and bilateral stimulation are likely favorable features, while baseline standing time of several minutes may be unfavorable. These findings may inform clinician and patient counseling and require confirmation in larger studies. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 9, 2020 Category: Neurology Authors: Hewitt, A. L., Klassen, B. T., Lee, K. H., Van Gompel, J. J., Hassan, A. Tags: Tremor, EMG, Surgery/Stimulation Research Source Type: research
Cognitive outcomes following laser interstitial therapy for mesiotemporal epilepsies
Conclusions Compared with the outcome literature of dominant open anterior temporal lobectomies (ATLs), where postsurgical decline has been documented in up to 40%–60% of cases, our LiTT case series exhibited a much lower incidence of postoperative language or verbal memory decline. Moreover, promising rates of postoperative improvements were also observed across multiple cognitive domains. Future studies exploring cognitive outcomes following LiTT should include comprehensive neuropsychological findings, rather than only select domains, as clinically significant change can occur in areas other than those typically a...
Source: Neurology Clinical Practice - August 9, 2020 Category: Neurology Authors: Bermudez, C. I., Jermakowicz, W. J., Kolcun, J. P. G., Sur, S., Cajigas, I., Millan, C., Ribot, R., Serrano, E. A., Velez-Ruiz, N., Lowe, M. R., Tornes, L., Palomeque, M., Kanner, A. M., Jagid, J. R., Rey, G. J. Tags: All Neuropsychology/Behavior, Memory, All Epilepsy/Seizures, Epilepsy surgery Research Source Type: research
Ultrasound-guided lumbar puncture improves success rate and efficiency in overweight patients
Background Approximately 400,000 diagnostic lumbar punctures (LPs) are performed by neurologists yearly in the United States. There has been a transition from neurologists performing>40% of LPs 2 decades ago to now 35 kg/m2. Methods A prospective intervention study was conducted from March 2017 to March 2018 at an academic medical center. Patients were divided into ultrasound-guided LP or conventional LP. The primary outcome was the success rate of LP. The secondary outcome was the parameters regarding LP performance, the patients' feedback after procedures, and the residents' feedback about the learning modules. Resu...
Source: Neurology Clinical Practice - August 9, 2020 Category: Neurology Authors: Li, Y., Carandang, R. A., Ade, S., Flahive, J., Daniello, K. Tags: All Clinical Neurology, Models of care Research Source Type: research
Diagnostic experience reported by caregivers of patients with frontotemporal degeneration
Conclusions This study, which quantifies the patient with FTD and caregiver burden before receiving the FTD diagnosis, can inform clinical practice, interventions to address diagnostic delays, and programs and services to support patients/caregivers during and following the diagnosis. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 9, 2020 Category: Neurology Authors: Besser, L. M., Galvin, J. E. Tags: All Health Services Research, Medical care, All Clinical Neurology, All Cognitive Disorders/Dementia, Frontotemporal dementia Source Type: research
Teriflunomide-exposed pregnancies in a French cohort of patients with multiple sclerosis
Conclusions Despite specific TERIF guidelines for pregnancy-related issues and the availability of alternative therapies, some pregnancies exposed to TERIF were identified. Most of the cases were because of the absence of the recommended accelerated elimination procedure and appeared to be mostly unplanned pregnancies that probably reflect a lack of effective contraception. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 9, 2020 Category: Neurology Authors: Barataud-Reilhac, A., Kerbrat, S., Roux, J., Guilleux, A., Polard, E., Leray, E. Tags: All Clinical Neurology, Patient safety, Multiple sclerosis, Cohort studies Research Source Type: research
Disease severity and quality of life in homebound people with advanced Parkinson disease: A pilot study
Background As Parkinson disease (PD) progresses, symptoms increase, quality of life (QoL) declines, and individuals may become homebound, often losing access to neurologic care. We aimed to determine whether facilitating expert in-home care could improve our understanding of disease progression, treatment options, and unmet needs in this vulnerable population, and whether such a model could mitigate decline in QoL. Methods Patients with PD meeting Medicare homebound criteria were eligible for quarterly interdisciplinary home visits over 12 months. Each visit entailed an evaluation by a movement disorders neurologist, soci...
Source: Neurology Clinical Practice - August 9, 2020 Category: Neurology Authors: Fleisher, J. E., Sweeney, M. M., Oyler, S., Meisel, T., Friede, N., Di Rocco, A., Chodosh, J. Tags: Medical care, Parkinson's disease/Parkinsonism Research Source Type: research
Can an epilepsy transfer clinic be sustained in the United States?
In the United States, over the next year, approximately 25,000 teens with epilepsy will turn 18.1 Most will have psychosocial issues and/or conditions comorbid with epilepsy, for which physicians familiar with epilepsy are used to dealing with.2 Approximately half of this number will have ongoing seizures requiring care by a knowledgeable professional and will benefit from a comprehensive approach to management. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 9, 2020 Category: Neurology Authors: Hauser, W. A., Camfield, C. S., Camfield, P. R. Tags: All Health Services Research, All Clinical Neurology, Adolescence, All Epilepsy/Seizures Editorial Source Type: research
Fleisher et al. (p. 277) conducted a pilot study on disease severity and quality of life (QoL) in homebound individuals with advanced Parkinson disease. The authors report high retention and satisfaction with quarterly interdisciplinary home visits and stabilization of QoL in an often-overlooked population. Hewitt et al. (p. 324) evaluated a single case series of 5 patients with medication-refractory orthostatic tremor who were treated with bilateral VIM thalamic deep brain stimulation. Patients experienced a modest increase of up to several minutes in standing time, which translated to meaningful improvement in standing a...
Source: Neurology Clinical Practice - August 9, 2020 Category: Neurology Authors: Corboy, J. R. Tags: From the Editor ' s Desk Source Type: research
Selective plasma exchange for multiple sclerosis with optic neuritis
Selective plasma exchange could preserve fibrinogen and is a useful treatment for multiple sclerosis. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 9, 2020 Category: Neurology Authors: Mimori, M., Sato, T., Omoto, S., Sakai, K., Mitsumura, H., Iguchi, Y. Tags: All Immunology, All Clinical Neurology, Visual loss, Multiple sclerosis, Optic neuritis; see Neuro-ophthalmology/Optic Nerve Case Source Type: research