Ocular Flutter in Acute Doxylamine Intoxication
Doxylamine is a widely available first-generation antihistamine used as a sleep aid. Some first-generation antihistamines, such as doxylamine and diphenhydramine, may block voltage-gated sodium channels. Doxylamine toxicity could include ocular flutter in addition to an antihistaminic/antimuscarinic syndrome, causing encephalopathy and mydriasis. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 11, 2021 Category: Neurology Authors: Li, D. Z., Williams, Z. R., Nacca, N., Lizarraga, K. J. Tags: Clinical neurology examination, Ocular motility Case Source Type: research
Hemiplegic Cerebral Palsy Complicated by Acute Hemidystonia in Adulthood
Dystonia after perinatal injury can have a long latency period, in decades, is sometimes difficult to treat, and may not respond to medical therapy, in which case deep brain stimulation is another treatment option. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 11, 2021 Category: Neurology Authors: Goel, A., Narayan, S. K., Sugumaran, R. Tags: All Movement Disorders, Dystonia, Surgery/Stimulation, Motor Control, Basal ganglia Case Source Type: research
Overnight Ictal Magnetoencephalography
In patients with drug-resistant epilepsy for whom nocturnal seizures are recorded during an admission for EEG telemetry, overnight ictal MEG is a viable methodology that can help localize the seizure onset zone. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 11, 2021 Category: Neurology Authors: Moreau, J. T., Simard-Tremblay, E., Albrecht, S., Rosenblatt, B., Baillet, S., Dudley, R. W. R. Tags: Magnetic Source Imaging (MSI), All Pediatric, Epilepsy surgery, Functional neuroimaging, Cortical dysplasia Case Source Type: research
Temporal Seizure Emerging From a Cluster of Eyelid Myoclonia in a Teenager With Jeavon Syndrome
In addition to focal occipital seizures, eyelid myoclonia with absences (EMA) can present with focal seizures arising from the temporoperisylvian region. Recognition of focal seizures in EMA can have implications in the management and can be helpful in avoiding focal resections in this generalized epilepsy syndrome. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 11, 2021 Category: Neurology Authors: Zawar, I., Franic, L., Pestana Knight, E. Tags: Case Source Type: research
Bruxism: A Rare, Nonlateralizing Temporal Lobe Ictal Phenomenon
A 32-year-old man presents with intractable right temporal lobe epilepsy of currently unknown etiology described as focal unaware seizures with teeth grinding and rhythmic left leg movements with and without spread to bilateral tonic-clonic (video 1). The patient and caregivers report episodes of bruxism during wakefulness and sleep. MRI shows an incidental left frontal developmental venous anomaly, and the temporal lobes are symmetrical with normal architecture and without signal abnormalities. Fluorodeoxyglucose-PET shows hypometabolism in the lateral right temporal lobe, right medial prefrontal cortex, and adjacent late...
Source: Neurology Clinical Practice - October 11, 2021 Category: Neurology Authors: Doshi, H., Kataria, M., Shah, A. K., Zutshi, D. Tags: EEG; see Epilepsy/Seizures, Epilepsy semiology, Video/ EEG use in epilepsy, Partial seizures Case Source Type: research
A Roadmap to Patient Engagement: Facioscapulohumeral Muscular Dystrophy and the ReSolve Clinical Trial
We describe our efforts to overcome barriers to patient engagement in facioscapulohumeral muscular dystrophy (FSHD) and offer a roadmap that can be replicated in other rare neurologic disorders. We implemented an engagement plan during Clinical Trial Readiness to Solve Barriers to Drug Development for FSHD (ReSolve), an 18-month, multisite, observational study of individuals with FSHD. Elements of our engagement plan included conducting focus groups during protocol development, patient involvement on the ReSolve external advisory committee, creation of a patient advisory committee, and collaboration with patient advocacy g...
Source: Neurology Clinical Practice - October 11, 2021 Category: Neurology Authors: LoRusso, S., Eichinger, K., Higgs, K., Lewis, L., Walker, M., Albert, J., Langer, M., Tawil, R., Statland, J. M., Kimminau, K. S., on behalf of the FSHD Clinical Trial Research Network Tags: All Neuromuscular Disease, All Clinical trials, Clinical trials Methodology/study design, Clinical trials Observational study (Cohort, Case control) Commentary Source Type: research
Eastern Equine Encephalitis: Case Series in Southern New England and Review of the Literature
Purpose of Review
To describe the clinical presentation, diagnosis, management, and outcomes of 4 confirmed Eastern equine encephalitis (EEE) cases and a review of the literature.
Recent Findings
There was a sharp rise in the number of EEE cases in the United States in 2019, with 38 confirmed cases and 15 deaths. Our institution cared for 10% of patients with neuroinvasive EEE nationwide. These were the first cases seen locally since 2010.
Summary
EEE virus causes one of the most lethal types of arboviral encephalitis in the United States with a mortality of 30%–40%. Manifestations of EEE infections can range from ...
Source: Neurology Clinical Practice - October 11, 2021 Category: Neurology Authors: Montalvo, M., Ayoub, D., McGary, M., Byrd, K., Mahmoud, L., Mermel, L., Thompson, B., Wendell, L. Tags: MRI, Encephalitis, Viral infections, Critical care Review Source Type: research
Acute Bilateral Blindness in the Setting of Sudden Onset of Bilateral Proptosis and Ophthalmoplegia: A Case Report With Literature Review
Purpose of Review
Acute bilateral blindness has an extensive differential diagnosis that requires a careful history and physical examination to narrow down. In this article, we discuss the pathophysiology and radiographic findings of each possible diagnosis for acute bilateral blindness.
Recent Findings
Visual pathology with respect to bilateral blindness can be broadly broken down into 3 anatomic categories: media (i.e., the anterior and posterior chamber of the eye), retina, and neural visual pathway. Possible causes of rapid onset bilateral blindness include bilateral occipital infarcts, endogenous bacterial endophthal...
Source: Neurology Clinical Practice - October 11, 2021 Category: Neurology Authors: Zarei, S., Vo, P., Sam, C., Crow, R. W., Stout, C., Al-Khoury, L. Tags: All Neuro-ophthalmology, Visual loss Review Source Type: research
Deep Brain Stimulation and Swimming Performance: A Randomized Within-Person Crossover Study
Conclusion
Overall DBS did not impair swimming performance, although 1 patient demonstrated a stimulation-induced drowning hazard. There were no anatomic or clinical features unique to the individual with swimming impairment. Patients should be warned about the possibility of DBS-induced drowning hazard and should swim with capable supervision after DBS.
Classification of Evidence
This study provides Class IV evidence that for patients with implanted DBS electrodes, the stimulation on condition, compared with stimulation off, did not significantly impair swimming performance. A formal assessment of unblinding would have b...
Source: Neurology Clinical Practice - October 11, 2021 Category: Neurology Authors: Morgan, S. K., Bangash, O. K., Benjanuvatra, N., Thorburn, M., Du Plessis, I., Jacques, A., Powers, G., Lind, C. R. P. Tags: Parkinson's disease/Parkinsonism, Tremor, Surgery/Stimulation, Basal ganglia, Class IV Research Source Type: research
Multiple Spinal CSF Leaks in Spontaneous Intracranial Hypotension: Do They Exist?
Conclusions
Among patients with SIH, multiplicity of CSF leaks was observed radiographically in none of the patients with ventral leaks, in 6% of patients with lateral leaks, and in 9% of patients with CSF-venous fistulas. These results suggest that patients with SIH can be reassured that the occurrence of multiple CSF leaks is negligible to uncommon at most, depending on the type of CSF leak. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 11, 2021 Category: Neurology Authors: Schievink, W. I., Maya, M. M., Moser, F., Prasad, R., Wadhwa, V., Cruz, R., Nuno, M. Tags: All Headache, Low pressure syndrome, Cerebrospinal Fluid Research Source Type: research
Increased Incidence of Functional (Psychogenic) Movement Disorders in Children and Adults Amid the COVID-19 Pandemic: A Cross-sectional Study
Conclusions
Within our patient population, there has been increased incidence of FMDs in the setting of the COVID-19 pandemic, possibly reflecting increased psychological and other stressors during this period. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 11, 2021 Category: Neurology Authors: Hull, M., Parnes, M., Jankovic, J. Tags: All Movement Disorders, Pediatric conversion, Conversion, COVID-19 Research Source Type: research
Long-term Safety and Efficacy of Mexiletine in Myotonic Dystrophy Types 1 and 2
Conclusions
These findings support that mexiletine is both safe and effective when used long-term in myotonic dystrophy.
Classification of Evidence
This study provides Class IV evidence that mexiletine is a well-tolerated and effective treatment for myotonic dystrophy types 1 and 2. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 11, 2021 Category: Neurology Authors: Mousele, C., Matthews, E., Pitceathly, R. D. S., Hanna, M. G., MacDonald, S., Savvatis, K., Carr, A., Turner, C. Tags: All Health Services Research, All Clinical Neurology, All Neuromuscular Disease, Class IV, Cohort studies Source Type: research
Utility of Routine EEG in Emergency Department and Inpatient Service
Conclusions
Routine EEG is useful in the ED, even in patients with a normal CT or MR brain image, because it helps determine clinical management or AED changes. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 11, 2021 Category: Neurology Authors: Rodriguez Quintana, J. H., Bueno, S. J., Zuleta-Motta, J. L., Ramos, M. F., Velez-van-Meerbeke, A., , the Neuroscience Research Group (NeuRos) Tags: Decision analysis, EEG; see Epilepsy/Seizures, Class IV, All epidemiology, EEG Research Source Type: research
Efficacy and Tolerability of Clobazam in Adults With Drug-Refractory Epilepsy
Conclusions
Clobazam is effective and safe as a long-term adjunctive therapy for adults with drug-resistant epilepsy; efficacy in off-label use is similar to that in LGS.
Classification of Evidence
This study provides Class IV evidence that clobazam is an effective treatment for adults with drug-resistant epilepsy, independent of epilepsy classification. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 11, 2021 Category: Neurology Authors: Jamil, A., Levinson, N., Gelfand, M., Hill, C. E., Khankhanian, P., Davis, K. A. Tags: Class IV, All Epilepsy/Seizures, Antiepileptic drugs, Generalized seizures, Partial seizures Research Source Type: research
Preventing Cardiomyopathy in DMD: A Randomized Placebo-Controlled Drug Trial
Conclusions
Combination therapy was well tolerated. Consistent with the previous prophylactic perindopril heart study, there was no evidence of group benefit after 36-month treatment.
Classification of Evidence
This study provides Class I evidence that combination perindopril-bisoprolol therapy was well tolerated but did not change decline in LVEF significantly in boys with DMD. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - October 11, 2021 Category: Neurology Authors: Bourke, J. P., Watson, G., Spinty, S., Bryant, A., Roper, H., Chadwick, T., Wood, R., McColl, E., Bushby, K., Muntoni, F., Guglieri, M., for the DMD Heart Study Group Tags: Muscle disease, Clinical trials Randomized controlled (CONSORT agreement), All Pediatric, Cardiac; see Cerebrovascular Disease/Cardiac Research Source Type: research
