Diagnosis and Workup of Intellectual Disability in Adults: Suggested Strategies for the Adult Neurologist
Purpose of Review
Etiologic investigations for adults with intellectual disability (ID) pose a special challenge to many adult neurologists. The adaptability of pediatric guidelines for workup of ID to adult populations has not been clearly established. We review the current recommendations on etiologic workup of ID in children and adults and provide initial guidance for adult neurologists who care for individuals with ID of unknown etiology.
Recent Findings
Etiologic workup, including genetic testing, is recommended in individuals with ID of unknown origin. Workup should be guided by a thoughtful history and physical exa...
Source: Neurology Clinical Practice - December 13, 2021 Category: Neurology Authors: Frueh, J. S., Press, D. Z., Sanders, J. S. Tags: All Clinical Neurology, Intelligence, Developmental disorders, Mental retardation, All Genetics Review Source Type: research
Review of Neurologic Comorbidities in Hospitalized Patients With Opioid Abuse
Purpose of Review
To determine the prevalence and burden of neurologic comorbidities in hospitalized patients with opioid abuse.
Recent Findings
From 1 year of hospital discharges, 2,182 patients with opioid abuse were identified (prevalence 6.3%), with abuse greater among younger patients (p < 0.0001), women (p < 0.0001), Whites (p < 0.0001), and urban population (p = 0.028). Matching for age, sex, race, and urban-rural residence, 347 patients were reviewed, and 179 (52%) had a neurologic comorbidity. The comorbidities frequently overlapped and included encephalopathy (130), neuromuscular disorders (42), seizure...
Source: Neurology Clinical Practice - December 13, 2021 Category: Neurology Authors: Nelson, K. R., Dolbec, K., Watson, W., Yuan, H., Ibraheem, M. Tags: Opiates, Burden of disease, Structural and social determinants of health, Prevalence studies Review Source Type: research
Delivering Bad News in Amyotrophic Lateral Sclerosis: Proposal of Specific Technique ALS ALLOW
Purpose of Review
Physician communication skills are a critical part of care for amyotrophic lateral sclerosis (ALS) patients and caregivers. They shape the development of autonomy and quality of life, and they mitigate emotional trauma. Communication skills are especially critical at 2 different time points in the course of the disease: early when delivering and establishing the diagnosis, and later when clarifying goals of care.
Recent Findings
Several techniques for physician communication of difficult information are available, including SPIKES (Setting up the interview, assessing the patient's Perception, obtaining t...
Source: Neurology Clinical Practice - December 13, 2021 Category: Neurology Authors: Edwards, W. F., Malik, S., Peters, J., Chippendale, I., Ravits, J. Tags: Quality of life, Decision analysis, Amyotrophic lateral sclerosis, Palliative care, Professional conduct and ethics Review Source Type: research
Effects of Percutaneous Endoscopic Gastrostomy in Patients With Huntington Disease
Conclusions
PEG tube placement in advanced HD provided benefit in the length of life, but weight, other nutritional measures, and the rate of pneumonia were either not impacted or worsened with the insertion of a PEG tube. Impact on quality of life needs further study, but providers, patients, and families should consider all options when discussing preferences for interventions.
Classification of Evidence
This study provides Class IV evidence that for patients with advanced HD, PEG tube placement increases the length of life but has no or negative impacts on nutritional measures. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - December 13, 2021 Category: Neurology Authors: Frank, E., Dyke, A., MacKenzie, S., Maskwa, E., Frank, S. Tags: All Movement Disorders, Huntington's disease, All Cognitive Disorders/Dementia, Class IV, Palliative care Research Source Type: research
Neurologists' Attitudes Toward Use and Timing of Deep Brain Stimulation
Conclusions
There remains a lack of consensus on several aspects of DBS, including medical management before offering DBS and the appropriate timing of its consideration for patients. Given the effect of such lack of consensus on patients' outcomes and recent evidence on positive DBS results, it is essential to update DBS professional guidelines with a focus on medical management and the timely use of DBS. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - December 13, 2021 Category: Neurology Authors: Cabrera, L. Y., Young Han, C., Ostendorf, T., Jimenez-Shahed, J., Sarva, H. Tags: Parkinson's disease/Parkinsonism, All Ethics in Neurology/Legal issues Research Source Type: research
Predictive Modeling for Clinical Features Associated With Neurofibromatosis Type 1
Conclusions
Using readily available clinical and EHR data, we successfully recapitulated several important and clinically relevant patterns in NF1 semiology specifically based on demographic and clinical characteristics. Naive machine learning techniques can be potentially used to develop and validate predictive phenotype complexes applicable to risk stratification and disease management in NF1. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - December 13, 2021 Category: Neurology Authors: Morris, S. M., Gupta, A., Kim, S., Foraker, R. E., Gutmann, D. H., Payne, P. R. O. Tags: Prognosis, Primary brain tumor, ADHD, Natural history studies (prognosis), Neurofibromatosis Research Source Type: research
Patient Experiences With Ambulatory Telehealth in Neurology: Results of a Mixed-Methods Study
Conclusion
In ambulatory telehealth, patients valued convenience, safety, and physician relationship. Barriers were observed but can be addressed. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - December 13, 2021 Category: Neurology Authors: Olszewski, C., Thomson, S., Strauss, L., Graham, R., Ezzeddine, M., Dodenhoff, K., Ambrosini, A., Smith, L. D., Silla, L., Schreiber, A., Caraci, C., Guzik, A., Strowd, R. E. Tags: All Clinical Neurology, Clinical neurology examination, All Practice Management, COVID-19, All Education Research Source Type: research
Patient and Clinician Perspectives of New and Return Ambulatory Teleneurology Visits
Discussion
Teleneurology was robustly adopted for both new and return ambulatory neurology patients during the COVID-19 pandemic. Return patient visits were preferred over new patient visits, but both were feasible. These results provide a foundation for developing targeted guidelines for sustaining teleneurology in ambulatory care. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - December 13, 2021 Category: Neurology Authors: Kling, S. M. R., Falco-Walter, J. J., Saliba-Gustafsson, E. A., Garvert, D. W., Brown-Johnson, C. G., Miller-Kuhlmann, R., Shaw, J. G., Asch, S. M., Yang, L., Gold, C. A., Winget, M. Tags: Outcome research Source Type: research
Integrating Advanced Practice Providers in an Academic Department of Neurology
Discussion
Common challenges and success strategies identified can inform the design of a formal curriculum for onboarding neurology APPs. Our findings suggest that an optimal APP training process involves graded responsibility and support for self-directed learning, employs peer mentors, and targets education of the multidisciplinary team including physicians and patients. Our results may inform other institutions recruiting, hiring, and training APPs. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - December 13, 2021 Category: Neurology Authors: Gheihman, G., Vgontzas, A., Paulson, J., Pilgrim, D., Batchelor, T., O'Neal, M. A., Doughty, C. T. Tags: All Clinical Neurology, Models of care, All Education, Methods of education, Other Education Research Source Type: research
Varenicline for the Treatment of Postural and Gait Dysfunction in Parkinson Disease
Conclusion
The results did not suggest that varenicline had an effect on balance in patients with PD. Furthermore, varenicline did not seem to affect cognition. Perhaps, if an objective measure of balance had been used in place of the BBS, the analysis would show a difference between the groups. However, the authors do not recommend further study.
Classification of Evidence
This study provides Class III evidence that in patients with PD with Hoehn and Yahr stages 2, 3, or 4, varenicline does not improve balance as assessed by the BBS. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - December 13, 2021 Category: Neurology Authors: Kapur, S., Vaughan, C., Hawkins, J., Stebbins, G., Hall, D. Tags: All Movement Disorders, Parkinson's disease/Parkinsonism, All Clinical trials, Class III Research Source Type: research
An Appreciation: John Corboy, MD, FAAN
I offer my warmest congratulations to John Corboy, who is soon to end his tenure as editor of Neurology® Clinical Practice. The job of creating and nurturing a new journal is not trivial, and it takes considerable skill and sound insight. John stepped up and brilliantly succeeded. To appreciate this substantial accomplishment, I offer some background—a bit of an origin story. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - December 13, 2021 Category: Neurology Authors: Gross, R. A. Tags: Special Editorial Source Type: research
Inclusion as a Key to Shaping the Future of Neurology(R) Clinical Practice: Calling for Authors
I write this editorial transition statement with mixed feelings. Our patients, communities, and families have all been affected by the COVID-19 pandemic, and the scars will require quite some time to heal. For physicians, the pandemic has brought about unique challenges to the way we practice medicine. We have felt united by a sense of purpose, fighting together against a common enemy. We have also learned to rely on technology more than ever as a way of connecting with each other and with our patients. During this global emergency, virtual meetings have brought us together, and telehealth has eliminated barriers and signi...
Source: Neurology Clinical Practice - December 13, 2021 Category: Neurology Authors: Bartolini, L. Tags: Special Editorial Source Type: research
Amnestic Syndrome and Bilateral Hippocampal Diffusion Abnormalities From Opioid Use
Patients with acute opioid intoxication may develop an isolated and transient amnestic syndrome characterized by reduced diffusion of the hippocampi on brain MRI. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 11, 2021 Category: Neurology Authors: Ahlbach, C., Holmes, B. B., Narvid, J., Rosendale, N. Tags: MRI, All Clinical Neurology, Memory, Executive function, Opiates Case Source Type: research
Thrombotic Thrombocytopenic Purpura Without Schistocytes: Beware of Misdiagnosis
A 43-year-old woman was admitted for acute unusual headache, vertigo, and left upper limb weakness. She had been complaining of asthenia for the past few weeks. Her medical history included uterine cervix cancer treated with conisation and 2 pregnancies without serious complications. No allergy or recent drug introduction was noted. After ruling out current pregnancy, magnetic resonance imaging (MRI) was immediately performed and showed recent ischemic strokes in multiple territories. Doppler ultrasound imaging showed no carotid or vertebral arteries lesion. Electrocardiogram showed no ST elevation or atrial fibrillation, ...
Source: Neurology Clinical Practice - October 11, 2021 Category: Neurology Authors: Decker, P., Moulinet, T., Revuz, S., Perez, P., Jaussaud, R. Tags: Autoimmune diseases, Hematologic, All Cerebrovascular disease/Stroke Case Source Type: research
Familial Cerebral Cavernous Malformation Mimicking Cerebral Amyloid Angiopathy
A 67-year-old man was referred from ophthalmology for possible cerebral amyloid angiopathy (CAA) discovered during work-up of possible optic neuropathy. MRI (figure) demonstrated innumerable periventricular, brainstem, and cortical cerebral microhemorrhages (CMHs). Scattered, nonspecific white matter hyperintensities were seen on T2-weighted imaging without surrounding hypointense rim. He had no hypertension, and the distribution was uncharacteristic for CAA. Despite absent family history of stroke or seizure, testing for familial cerebral cavernous malformation (FCCM) identified a pathogenic mutation of KRIT1 (c.382G>T...
Source: Neurology Clinical Practice - October 11, 2021 Category: Neurology Authors: Ridha, M., Aziz, Y., Broderick, J. Tags: All Cerebrovascular disease/Stroke, Intracerebral hemorrhage Case Source Type: research
