Utilizing the Axon Registry(R) for quality improvement
This article includes 2 case studies of how the Axon Registry has been implemented in neurology practices to date. In the future, implementation of patient-reported outcome data and additional outcome measures will be necessary to expand the reach and effectiveness of the Axon Registry as a quality improvement tool. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Patel, A. D., Fritz, J. V., Evans, D. A., Lundgren, K. B., Hentges, K., Jones, L. K. Tags: Commentary Source Type: research

Rheumatoid meningitis: A rare cause of aseptic meningitis with frequently stroke-like episodes
Conclusions RM is a rare manifestation of RA and often presents with stroke-like episodes. It is currently not implemented in the workup of aseptic meningitis in national guidelines. Crucial clues for diagnosis included recurrent stroke-like episodes refractory to antiepileptic treatment, headache and constitutional symptoms, meningeal enhancement on MRI, CSF pleocytosis, and positive serology findings for ACPA and RF. Prognosis is favorable with early immunosuppressive treatment. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Schuster, S., Braass, H., Iking-Konert, C., Schnoor, U., Matschke, J., Gerloff, C., Thomalla, G., Magnus, T. Tags: Autoimmune diseases, Meningitis, All Clinical Neurology Review Source Type: research

"Is there a neurologist on this flight?": An update
This article provides a synthesis of current best practices for in-flight emergencies including epidemiology, airline responsibility, available health care equipment on jetliners, legal ramifications of helping, and pathophysiology of why in-flight neurologic emergencies are so common. Summary In-flight neurologic emergencies are common and all physicians are increasingly being asked to respond to in-flight emergencies. Understanding one's responsibility, available equipment, and how to best prevent these scenarios with one's own patients may help to make this complex situation more manageable. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Sirven, J. I. Tags: All Clinical Neurology, Patient safety, All Ethics in Neurology/Legal issues, Professional conduct and ethics Review Source Type: research

Body mass index and survival from amyotrophic lateral sclerosis: A meta-analysis
This study systematically evaluated the relationship between BMI and survival in patients with ALS. Methods The PubMed database was searched to identify all available studies reporting time-to-event data. Eight studies with 6,098 patients fulfilled the eligibility criteria. BMI was considered a continuous and ordered variable. Interstudy heterogeneity was assessed by the Cochran Q test and quantified by the I2 metric. Fixed- or random-effects odds ratios summarized pooled effects after taking interstudy variability into account. Significance was set at p
Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Dardiotis, E., Siokas, V., Sokratous, M., Tsouris, Z., Aloizou, A.-M., Florou, D., Dastamani, M., Mentis, A.-F. A., Brotis, A. G. Tags: Amyotrophic lateral sclerosis Review Source Type: research

Review process for IVIg treatment: Lessons learned from INSIGHTS neuropathy study
Conclusions Our expert review finds that the diagnosis of immune neuropathies made by providers, and subsequently approved for IVIg therapy by payers, is incorrect in a large percentage of cases. If payers include an expert in their review process, it would improve patient selection, appropriate use, and continuation of treatment with this expensive therapeutic agent. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Levine, T. D., Katz, J. S., Barohn, R., Vaughan, L. J., Dimachkie, M. M., Saperstein, D. S., Mozaffar, T., Wolfe, G. I., Mayo, M. S., Badger, G. J., Katzin, L., Ritt, E., Greer, M., DiStefano, J., Schmidt, P. M. Tags: All Clinical Neurology, All Neuromuscular Disease, Chronic inflammatory demyelinating polyneuropathy Review Source Type: research

Presentation and management of community-onset vs hospital-onset first seizures
Background New-onset seizures are frequently encountered in community and hospital settings. It is likely that seizures presenting in these distinct settings have different etiologies and prognoses, requiring different investigation and treatment approaches. We directly compare the presentation and management of patients with community- and hospital-onset first seizures attending the same hospital. Methods We reviewed the medical records of patients aged 18 years or older with discharge International Classification of Diseases, Australian Classification (ICD-10-AM) codes of G40 (epilepsy), G41 (status epilepticus), and R5...
Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Foster, E., Holper, S., Chen, Z., Kwan, P. Tags: Medical care, Cohort studies, All Epilepsy/Seizures, Antiepileptic drugs, EEG Research Source Type: research

Everolimus for treatment-refractory seizures in TSC: Extension of a randomized controlled trial
In this study, we evaluate the long-term efficacy and safety of everolimus for tuberous sclerosis complex (TSC)-associated treatment-refractory seizures. Methods After completion of the core phase, patients could enter an open-label extension phase and receive everolimus (target exposure, 3–15 ng/mL) for ≥48 weeks. Efficacy end points included change from baseline in average weekly SF expressed as response rate (RR, ≥50% reduction) and median percentage reduction (PR). Results Of 366 patients, 361 received everolimus in core/extension phases. The RR was 31% (95% CI, 26.2–36.1; N = 352) at week 18, 46.6%...
Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Franz, D. N., Lawson, J. A., Yapici, Z., Ikeda, H., Polster, T., Nabbout, R., Curatolo, P., de Vries, P. J., Dlugos, D. J., Voi, M., Fan, J., Vaury, A., Pelov, D., French, J. A. Tags: Class IV, All Epilepsy/Seizures Research Source Type: research

Sport concussion and attention deficit hyperactivity disorder in student athletes: A cohort study
Conclusions The results of this study support our hypothesis that ADHD is an antecedent risk factor for SRC and may contribute to a more complicated course of recovery from SRC. Future research should focus on determining whether screening, diagnosis, and treating ADHD in youth athletes may prevent SRC. Providers that care for youth athletes with ADHD should be aware of the vulnerabilities of this population toward SRC and its complications. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Iaccarino, M. A., Fitzgerald, M., Pulli, A., Woodworth, K. Y., Spencer, T. J., Zafonte, R., Biederman, J. Tags: Executive function, Brain trauma, ADHD, ADHD; see Neuropsychology/Behavior Research Source Type: research

Late-onset Lennox-Gastaut syndrome: Diagnostic evaluation and outcome
Conclusions Late-onset LGS represents a rare, treatment-resistant generalized epilepsy that is disabling and may be associated with progressive cognitive impairment. The elevated CSF protein level in our cohort could have been due to high seizure burden but increases the possibility of an inflammatory component to the pathophysiology of this disorder. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Smith, K. M., Britton, J. W., Cascino, G. D. Tags: EEG, Generalized seizures Research Source Type: research

Clinical characteristics of Alice in Wonderland syndrome in a cohort with vestibular migraine
Conclusions This study characterizes the clinical features of AIWS in patients with VM. We observed several rare and highly unusual AIWS misperceptions (frosted-glass vision, underwater vision, dolly zoom effect, sensation of the brain coming out of the head, closed-eye visual hallucinations, and headlight glare–induced marco/microsomatognosia), and resolution or improvement in AIWS and VM with migraine preventive treatment. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Beh, S. C., Masrour, S., Smith, S. V., Friedman, D. I. Tags: Migraine, All Neuro-ophthalmology, All Neurotology Research Source Type: research

Presentation, etiology, and outcome of brain infections in an Indonesian hospital: A cohort study
Conclusion In this setting, patients with CNS infections present late with severe disease and often associated with advanced HIV infection. Tuberculosis, toxoplasmosis, and cryptococcosis are common. High mortality and long-term morbidity underline the need for service improvements and further study. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Imran, D., Estiasari, R., Maharani, K., Sucipto, , Lestari, D. C., Yunus, R. E., Yunihastuti, E., Karyadi, T. H., Oei, D., Timan, I. S., Wulandari, D., Wahyuningsih, R., Adawiyah, R., Kurniawan, A., Mulyadi, R., Karuniawati, A., Jaya, U. A., Safari, D., Tags: Encephalitis, Meningitis, HIV, Prognosis Research Source Type: research

Student athlete concussions and postconcussion syndrome: ADHD as a risk factor
Concussion affects an estimated 1.1 million persons in the United States annually and 1 person in 3 during their lifetime.1,2 Approximately 20% of head injuries are related to sports or physical activities.3 Concussion, known medically as mild traumatic brain injury, is a topic of considerable public interest, given the growing awareness about chronic traumatic encephalopathy among professional athletes. Student athletes have an increased risk of concussions compared with nonathlete students, which raises concerns about consequences. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Nuwer, M. R., Nuwer, J. M., Tsao, J. W. Tags: Brain trauma, Other trauma, ADHD, ADHD; see Neuropsychology/Behavior Editorial Source Type: research

Inflammatory theory of diseases: What has it got to do with late-onset LGS?
Lennox-Gastaut syndrome (LGS) is the most common epileptic encephalopathy in children presenting between 3 and 5 years of age. It is a complex age-related epilepsy syndrome with multiple possible etiologies such as hypoxic ischemic injuries, genetic syndromes, cerebral cortical malformations, and tumors. The etiology may remain elusive in approximately 25% of the cases.1 Similar to many other childhood epilepsy syndromes, the age at onset can be variable but can be delayed into adulthood. LGS is characterized by multiple seizure types, abnormal EEG characteristics, and cognitive decline. Nonconvulsive status epilepticus, p...
Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Singh, A. Tags: All Neuropsychology/Behavior, All Epilepsy/Seizures, Antiepileptic drugs, EEG Editorial Source Type: research

Towards a healthier provider-payer tandem: Messages from IVIg utilization reviews
In the third-party insurance realm, good relationships among patients, providers, and payers are essential. Within this triad, the provider–payer interactions are often dysfunctional. Even in 1798, as the young Union was laying its foundation for prepaid medical insurance, there was cognizance of the potential for misuse of funds.1 Such deep roots lend some credence to prevailing assumptions that providers and payers, while interdependent, are also at odds, each party viewing the other as difficult and unyielding. One author viewed the Medicare payer as an "unrecognized...nonparty" in the provider–pay...
Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Satya-Murti, S. Tags: All Clinical Neurology, All Neuromuscular Disease, Chronic inflammatory demyelinating polyneuropathy Editorial Source Type: research

Author Response: Rabies encephalitis presenting with new-onset refractory status epilepticus (NORSE)
We thank Drs. Jackson and Del Bigio for their comments on our case report.1 The authors argue that there were insufficient data to support a diagnosis of rabies encephalitis, but do not offer an alternative, more cohesive explanation for the reported findings. The history of a fulminant and fatal course of new-onset refractory status epilepticus would be consistent, in our viewpoint, with what they believe does not qualify for a "rapid progressive neurologic deterioration." It is certainly possible that the nonspecific symptoms of personality change and declining academics in the preceding month were unrelated. (...
Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Smith, J. H., Nuovo, G. J., Villamar, M. F. Tags: The Nerve! Readers Speak Source Type: research

Reader Response: Rabies encephalitis presenting with new-onset refractory status epilepticus (NORSE)
We read the recent case report by Villamar et al.1 and have concerns about the conclusion that the patient died of rabies. First, it would be useful to know when the case occurred and whether there was any history of an animal exposure. This is basic historical information that should be sought in a case of suspected rabies and could be obtained postmortem if the diagnosis was not considered during life. Second, the initial 1-month history of personality change and declining academic performance and the 2-week gap between the initial seizure and the status epilepticus are incompatible with rabies encephalitis, which i...
Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Jackson, A. C., Del Bigio, M. R. Tags: The Nerve! Readers Speak Source Type: research

Reader Response: Clinical factors associated with Guillain-Barre syndrome following surgery
I read with interest the article by Hocker et al.1 I took care of a 45-year-old man several years ago with neurotropic squamous cell carcinoma of the oropharynx (T2N0M0). His brother and paternal uncle had testicular cancer, and his mother had breast cancer. Three months after his initial resection, he developed neuropathic pain of the tongue, and MRI showed tumor recurrence. Two weeks later, he developed classic Miller-Fisher syndrome with mild ophthalmoparesis, ataxia, areflexia, elevated CSF protein, and an elevated anti-Gq1b. He was treated with IV immunoglobulin and did well. Two weeks later, he underwent repeat surge...
Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Robbins, N. M. Tags: The Nerve! Readers Speak Source Type: research

Author Response: Ask a neurologist: What primary care providers ask, and reducing referrals through eConsults
We are pleased to see that our article1 has sparked discussion within the neurology community and introduced the premise that patient care can be improved with fast and secure communication between primary care providers (PCPs) and specialists. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Bradi, A. C. Tags: The Nerve! Readers Speak Source Type: research

Reader Response: Ask a neurologist: What primary care providers ask, and reducing referrals through eConsults
I read with interest the article by Bradi et al.1 and the editorial by Nuwer and Corboy2 about the eConsults program. I am part of the military teleconsultation group cited in the editorial,3 and as of March 2018 I have provided input to over 360 requests. Similar to the authors' experience, most requests involved management guidance, particularly whether the patient would be able to remain in place or would need transfer for further evaluation. Besides this program, I routinely receive e-consult requests on aeromedical issues from Air Force providers worldwide. These requests generally do not involve acute management, but...
Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Hesselbrock, R. R. Tags: The Nerve! Readers Speak Source Type: research

Author Response: Exercise for cognitive brain health in aging: A systematic review for an evaluation of dose
We thank Dr. Pase for his comments regarding our systematic review.1 We share Dr. Pase's concern that a very large number of different cognitive tasks have been used in past studies on the effects of exercise, which poses substantial challenges to systematic reviews. Furthermore, as pointedly stated by Colcombe and Kramer2 in a review of exercise and cognitive function, considerable overlap in cognitive constructs exists. We appreciate Dr. Pase's suggestion of considering the framework offered by cognitive maps and agree with their promise and value. Having the ability to prescribe the correct exercise dose for a specific ...
Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Morris, T. P., Gomes-Osman, J., Pascual-Leone, A. Tags: The Nerve! Readers Speak Source Type: research

Reader Response: Exercise for cognitive brain health in aging: A systematic review for an evaluation of dose
One of the 3 aims of the review by Gomes-Osman et al.1 was to identify consistent patterns of exercise on domains of cognition. The authors are to be commended for such an ambitious task. The creation of cognitive composite scores requires careful attention to eliminate bias and to ensure that outcomes are theoretically valid and meaningful. In their study, the authors grouped neuropsychological tests from the reviewed studies into 5 outcomes: executive function, processing speed/attention, global cognition, working memory, and visuospatial processing/memory. However, the validity of these broad cognitive domains is uncert...
Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Pase, M. P. Tags: The Nerve! Readers Speak Source Type: research

Author Response: FACETS of health disparities in epilepsy surgery and gaps that need to be addressed
We appreciate the comment by Dr. Sethi highlighting the reluctance of some patients to obtain surgery. The disparity seen in epilepsy surgery utilized by African American and Hispanic patients compared to non-Hispanic white patients suggests that specific factors disproportionately affect these groups. We proposed FACETS as a framework to begin to understand and study these potential factors.1 We agree that dedication, perseverance, and continuity of care are valuable interventions that may drive epilepsy surgery. We are also concerned that delay in epilepsy surgery may lead to preventable morbidity and mortality.2 We shou...
Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Gutierrez, C. A. Tags: The Nerve! Readers Speak Source Type: research

Reader Response: FACETS of health disparities in epilepsy surgery and gaps that need to be addressed
I read with interest the commentary by Nathan and Gutierrez1 on the causes of health disparities in epilepsy surgery and how these can be addressed. Many patients initially resist epilepsy surgery for the simple reason that it is surgery. I have patients who are good candidates for resective epilepsy surgery and in spite of my best efforts they have steadfastly resisted the surgical option. Maintaining continuity of care over years with reassurance and gentle persuasion, I have succeeded in guiding some of these patients towards a surgical option with gratifying results. It is important for us physicians to remember that m...
Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Sethi, N. K. Tags: The Nerve! Readers Speak Source Type: research

Author Response: Practice Current: When do you order ancillary tests to determine brain death?
We thank Machado and Estévez for their comment on our article.1 We agree that ancillary tests clearly have a role in the diagnosis of brain death, but the issue is complex, as the 3 experts pointed out in their commentaries. We also agree that the case 3 they cited in their article (Jahi McMath) is an important case that requires further study to interpret correctly.2 (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Robbins, N. M., Bernat, J. L. Tags: The Nerve! Readers Speak Source Type: research

Reader Response: Practice Current: When do you order ancillary tests to determine brain death?
We recently reported a case (case 3 in our article)1 contributing to the discussion of using ancillary tests in brain death.2 This case showed brain death clinical features leading to a death certification. We studied the case 9 months later.1 We found preservation of intracranial structures, with a huge lesion at the brainstem.1 Conceptually, brain death is characterized by absence of cerebral blood flow.3 Conservancy of brain structures rejects brain death diagnosis.1,3 EEG signal was found in this case. EEG signal may persist in posterior fossa catastrophes.2 Using heart rate variability (HRV) methodology, we found pres...
Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Machado, C., Estevez, M. Tags: The Nerve! Readers Speak Source Type: research

Strength in numbers
Articles in this issue of Neurology® Clinical Practice (NCP) discuss ways we can share our data and expertise with colleagues to improve patient care. "Is there a neurologist on this flight?" is an anxiety-producing question that many physicians have faced while passengers on a commercial airplane. Joseph Sirven (p. 445) provides a timely, practical update on best practices for neurologists confronted with in-flight emergencies. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Corboy, J. R. Tags: From the Editor ' s Desk Source Type: research

Concomitant delayed posthypoxic leukoencephalopathy and critical illness microbleeds
MRI with inclusion of T2-weighted fluid-attenuated inversion recovery (FLAIR) and susceptibility-weighted imaging sequences may be helpful in identifying delayed posthypoxic leukoencephalopathy and critical illness microbleeds in patients at risk. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Breit, H., Jhaveri, M., John, S. Tags: MRI, Leukodystrophies, Critical care Case Source Type: research

Isolated third nerve palsies as the initial manifestation of multiple sclerosis
Consider demyelinating disease in the differential diagnosis of cranial nerve III palsy, particularly in a younger patient without typical microvascular risk factors. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Scelfo, C., Chaudhry, S., Hainline, C., Peeler, C. Tags: MRI, Ocular motility, Diplopia (double vision), Multiple sclerosis Case Source Type: research

Successful pallidal surgery for tardive stereotypy: A video case report
Consider pallidal surgery as a treatment option for tardive stereotypy. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Hashimoto, T., Isobe, T., Goto, T. Tags: Clinical neurology examination, All Movement Disorders, Chorea, Surgery/Stimulation, Basal ganglia Case Source Type: research

Subclavian steal syndrome due to dialysis fistula corrected with subclavian artery stenting
Consider stenting of the proximal subclavian artery to correct symptomatic subclavian steal syndrome due to dialysis arteriovenous fistula. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Agarwal, S., Schwartz, L., Kwon, P., Selas, G., Farkas, J., Arcot, K., Tiwari, A. Tags: All Imaging, All Cerebrovascular disease/Stroke Case Source Type: research

Lumbosacral plexus palsy and pelvic myositis after gluteal muscle injection
A 55-year-old man presented with left leg weakness, incontinence, and fever. Three weeks prior, he had undergone gluteal infiltration for pain related to coxarthrosis. C-reactive protein (197 mg/L) and leukocytes (12.5 G/L) were elevated; CSF was normal. MRI (figure) demonstrated left lumbosacral plexus and pelvic muscle swelling with contrast enhancement and chronic femoral head necrosis. Needle EMG motor unit action potentials were normal in the vastus lateralis muscle but could not be recorded from the left-sided tibialis anterior and gastrocnemius muscles due to a lack of volitional activity. We suggest an infectious m...
Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Westphal, L. P., Guggenberger, R., Ho, M., Jung, H.-H., Petersen, J. A. Tags: MRI, All Infections Case Source Type: research

Uncontrolled inflammation of the nervous system: Inherited CD59 deficiency
Eculizumab may be effective in reversing neurologic symptoms of inherited CD59 deficiency. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 15, 2018 Category: Neurology Authors: Yuksel, D., Oguz, K. K., Azapagası, E., Kesici, S., Cavdarli, B., Konuskan, B., Topaloglu, H. Tags: Childhood stroke, Peripheral neuropathy, All Spinal Cord, All Demyelinating disease (CNS), All Genetics Case Source Type: research

Challenges of diagnosing and treating Charles Bonnet syndrome
Charles Bonnet syndrome (CBS) is characterized by complex visual hallucinations in visually impaired but otherwise psychologically normal individuals.1 CBS is primarily diagnosed in patients with an ophthalmic disease but is also seen in stroke patients with hemianopsia.2 Treatment of these vivid hallucinations is challenging and there is no standard treatment. Here, we present a stroke patient with CBS successfully treated with melperone. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Franke, M., Rauschenberger, L., Fluri, F. Tags: Visual loss, All Cerebrovascular disease/Stroke, Hallucinations Case Source Type: research

Overshunting-associated myelopathy: Flattened spinal cord compressed by epidural venous plexus
A 50-year-old woman presented with a 1-month history of progressive spastic quadriparesis. She had undergone nonprogrammable ventriculoperitoneal (VP) shunt placement after intraventricular hemorrhage due to a ruptured arteriovenous malformation 16 years previously. Neurologically, she had neck extensor weakness (Medical Research Council [MRC] grade 4), symmetrical weakness of her upper extremities (right/left MRC grades 4/4), and weakness of her right proximal lower extremity (MRC grade 4). She also had spasticity and hyperreflexia in all 4 extremities with extensor plantar reflexes. Light touch and vibratory sensation wa...
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Koge, J., Nakamura, Y., Hashimoto, T., Tanaka, E., Kawajiri, M., Yamada, T. Tags: MRI, All Spinal Cord, Cerebrospinal Fluid Case Source Type: research

Arc de cercle as a manifestation of focal epileptic seizures
Since its description in 1885 in the Études cliniques sur l'hystéro-épilepsie ou grand hystérie by Raul Richer, the arc de cercle, or circular arc (figure 1A), has become synonymous of psychogenic nonepileptic seizures (PNES) and automatically interpreted as such by physicians. The development of extracranial and intracranial EEG recording has not confirmed the clinical importance of the arc de cercle. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Pestana Knight, E. M., Grinenko, O., Bulacio, J., Bingaman, W., Gupta, A., Chauvel, P. Tags: Intracranial electrodes, Video/ EEG use in epilepsy, SPECT in epilepsy, Partial seizures Case Source Type: research

Rare presentation of essential lingual myoclonus
A 74-year-old woman presented to the Oral Medicine Department with a constant throbbing sensation affecting her entire tongue. She reported sudden onset of constant twitching of the tongue since January 2016. She described it as if "my heart is in my mouth." She had visited both her dentist and her doctor, and was given a multitude of topical agents including Difflam, Nystatin, and Corsodyl, but none was effective. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Patel, K., Tappuni, A. Tags: MRI, Tremor, Myoclonus, EMG, Myoclonus; see Movement Disorders/myoclonus Case Source Type: research

Autoimmune limbic encephalitis in association with acute stroke
A 60-year-old woman with no known medical history presented with acute-onset altered mental status and aphasia. She was in her usual state of health until the time of presentation. She was found to have left middle and posterior cerebral artery (MCA and PCA) acute ischemic strokes and subsequently developed refractory status epilepticus. CT angiography showed moderate stenosis of the proximal left internal carotid artery (ICA), occlusion of the right ICA at its origin, and near-complete occlusion of the left vertebral artery (figure). Strokes were attributed to large-vessel atherosclerotic disease in the setting of multipl...
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Kaas, B., Zeiler, S. R., Bahouth, M. N., Llinas, R. H., Probasco, J. C. Tags: All Immunology, All Cerebrovascular disease/Stroke Case Source Type: research

The burnout patient
Physician and patient experiences of health care delivery are inextricably intertwined. Accelerating physician burnout has reached epidemic proportions in the United States. In parallel, health care has become a different experience for our patients. As a practicing neurologist over the last 40 years, I have observed changes in the expectations of colleagues and patients, whose feelings and concerns continually educate me. While I am not alone in advocating for intervention in current health care delivery methodology, not all are convinced. In discussing the repercussion of the "burnout patient," I seek to amplif...
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Sergay, S. M. Tags: Commentary Source Type: research

FACETS of health disparities in epilepsy surgery and gaps that need to be addressed
This article explains possible reasons outlined by FACETS for the health disparities in epilepsy surgery that exist in patients of a certain race, socioeconomic status, and language proficiency. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Nathan, C. L., Gutierrez, C. Tags: Epilepsy surgery, All Ethics in Neurology/Legal issues Review Source Type: research

Antiepileptic drugs and suicide-related behavior: Is it the drug or comorbidity?
Conclusions The peak of SRB prior to and rapid reduction in SRB after initiation of AED, and the finding that individuals eventually prescribed a mood-stabilizing AED (vs other AED or levetiracetam) had higher odds of SRB, suggests a strong possibility that the relationship of AED and SRB is one of residual confounding. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Raju Sagiraju, H. K., Wang, C.-P., Amuan, M. E., Van Cott, A. C., Altalib, H. H., Pugh, M. J. V. Tags: All Neuropsychology/Behavior, All Epilepsy/Seizures, Antiepileptic drugs Review Source Type: research

Safety and efficacy of plasma exchange in pediatric transverse myelitis
Conclusions TPE can be a useful treatment for pediatric transverse myelitis. The retrospective nature of this study without a comparator group limits conclusions about efficacy. However, controlled trials would help to validate our results. Classification of evidence This study provides Class IV evidence that plasma exchange is safe and effective in pediatric transverse myelitis. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Noland, D. K., Greenberg, B. M. Tags: All Pediatric, Class IV, All Demyelinating disease (CNS), Transverse myelitis Research Source Type: research

Diagnoses and other predictors of patient absenteeism in an outpatient neurology clinic
Conclusions Certain chronic neurologic diseases, such as medication overuse headache and depression, were associated with a significantly lower odds of honoring scheduled follow-up conditions. As these conditions influence quality of life and productivity, patients with these illnesses may benefit from selective targeting to encourage adherence with scheduled follow-up appointments. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Do, D. H., Siegler, J. E. Tags: Medical care, Administration Research Source Type: research

Traumatic and spontaneous intracranial hemorrhage in atrial fibrillation patients on warfarin
Background Intracranial hemorrhage is the most devastating complication in patients with atrial fibrillation (AF) receiving oral anticoagulation (OAC). It can be either spontaneous or caused by head trauma. We sought to address the prevalence, clinical characteristics, and prognosis of traumatic and spontaneous intracranial hemorrhages in AF patients on OAC. Methods Multicenter FibStroke registry of 5,629 patients identified 592 intracranial hemorrhages during warfarin treatment between 2003 and 2012. Results A large proportion (40%) of intracranial hemorrhages were traumatic. Of these, 64% were subdural hemorrhages (SDH...
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Lehtola, H., Palomäki, A., Mustonen, P., Hartikainen, P., Kiviniemi, T., Sallinen, H., Nuotio, I., Ylitalo, A., Airaksinen, K. E. J., Hartikainen, J. Tags: Intracerebral hemorrhage Research Source Type: research

Post-acute care discharge delays for neurology inpatients: Opportunity to improve patient flow
Conclusion Unnecessary hospital days represent a large burden for patients with neurologic illness requiring post-acute care on discharge. These discharge delays present an opportunity to improve hospital-wide patient flow. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Roberts, D. E., Holloway, R. G., George, B. P. Tags: All Health Services Research, All Rehabilitation, Models of care, All Practice Management, Health systems Source Type: research

Discontinuation and comparative effectiveness of dimethyl fumarate and fingolimod in 2 centers
Background Dimethyl fumarate (DMF) and fingolimod (FTY) are approved oral disease-modifying therapies for relapsing multiple sclerosis (MS). Observational studies are valuable when randomized clinical trials cannot be done due to ethical or practical reasons. Two-site studies allow investigators to further ascertain external validity of previously examined treatment effect differences. Limited head-to-head 2-site studies exist comparing DMF and FTY. Methods Patients prescribed DMF (n = 737) and FTY (n = 535) from 2 academic multiple sclerosis (MS) centers (Cleveland Clinic and University of Colorado) were identified. Disc...
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Vollmer, B., Ontaneda, D., Bandyopadhyay, A., Cohn, S., Nair, K., Sillau, S., Bermel, R. A., Corboy, J. R., Fox, R. J., Vollmer, T., Cohen, J. A., Alvarez, E., Hersh, C. M. Tags: Multiple sclerosis Research Source Type: research

Increased prevalence of brain tumors classified as T2 hyperintensities in neurofibromatosis 1
Background We sought to define the radiologic features that differentiate neoplastic from non-neoplastic T2 hyperintensities (T2Hs) in neurofibromatosis type 1 (NF1) and identify those lesions most likely to require oncologic surveillance. Methods We conducted a single-center retrospective review of all available brain MRIs from 68 children with NF1 (n = 190) and 46 healthy pediatric controls (n = 104). All T2Hs identified on MRI were characterized based on location, border, shape, degree of T1 hypointensity, and presence of mass effect or contrast enhancement, and subsequently classified using newly established radiologi...
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Griffith, J. L., Morris, S. M., Mahdi, J., Goyal, M. S., Hershey, T., Gutmann, D. H. Tags: MRI, Primary brain tumor, Neurofibromatosis Research Source Type: research

"Waiting for placement?": Waiting for solutions
The most humbling aspect of inpatient medicine is often not the severity of the illness treated, the ability to effect diagnosis and treatment where we were previously left to guesswork and acquiescence, or the complex array of psychosocial issues that accompany explaining a loved one's condition to family. Rather, patient placement is the overriding issue in so many cases for inpatient neurology. Neurologists are often confronted with more than half of the neurology ward census, where we have done the good work of making the diagnosis, exhausted the treatment opportunities, and now are waiting for the patient to be accept...
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Ney, J. P., Weathers, A. L. Tags: Medical care, Patient safety, Administration Editorial Source Type: research

Patients are harmed by physician burnout
The growing prevalence of physician burnout and its grave harms are now recurring headlines. Among specialists, neurologists have a particularly high risk of burnout.1 In recognition of the seriousness of this problem to American neurology, the American Academy of Neurology (AAN) empaneled a task force to study the problem in all its dimensions, including career satisfaction, work–life balance, and well-being. Their recent reports on the prevalence, causes, consequences, and mitigation of the epidemic of neurologist burnout and the possible strategies to enhance career satisfaction should be studied carefully by all ...
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Bernat, J. L., Busis, N. A. Tags: Editorial Source Type: research

What predicts falls in Parkinson disease? Observations from the Parkinson's Foundation Registry
(Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Tags: Correction Source Type: research

A practical approach to detection and treatment of depression in Parkinson disease and dementia
(Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Tags: Correction Source Type: research