Institutional Evaluation of Fetal Neurology Consults and Postnatal Outcomes: A 10-Year Retrospective Cohort Review
The objectives were to summarize clinical characteristics, agreement of prenatal and postnatal diagnoses based on best available imaging, and postnatal outcomes.
Results
Of the 174 maternal-fetal neurology consults placed, 130 qualified for inclusion based on data available for review. Of the 131 anticipated fetuses, 5 experienced fetal demise, 7 underwent elective termination, and 10 died in the postnatal period. The majority were admitted to the neonatal intensive care unit; 34 (31%) required supportive intervention for feeding, breathing, or hydrocephalus, and 10 (8%) experienced seizures during their neonatal intensiv...
Source: Neurology Clinical Practice - January 19, 2023 Category: Neurology Authors: Gumayan, R. L. F., Klamer, B., Ream, M. Tags: Research Article Source Type: research
Pediatric Moyamoya Syndrome Secondary to Tuberculous Meningitis: A Case Report
We report the case of a female patient who initially presented at 6 years of age with TBM and developed moyamoya syndrome requiring revascularization surgery.
Results
She was found to have basilar meningeal enhancement and right basal ganglia infarcts. She was treated with 12 months of antituberculosis therapy and 12 months of enoxaparin and maintained on daily aspirin indefinitely. However, she developed recurrent headaches and transient ischemic attacks and was found to have progressive bilateral moyamoya arteriopathy. At age 11 years, she underwent bilateral pial synangiosis for the treatment of her moyamoya syndrome.
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Source: Neurology Clinical Practice - January 18, 2023 Category: Neurology Authors: Kappel, A. D., Lehman, L. L., Northam, W. T., See, A. P., Smith, E. R. Tags: Clinical/Scientific Note Source Type: research
Enrollment of Participants From Marginalized Racial and Ethnic Groups: A Comparative Assessment of the STEADY-PD III and SURE-PD3 Trials
This study used data from The Safety, Tolerability, and Efficacy Assessment of Isradipine for Parkinson Disease (STEADY-PD III; NCT02168842) and the Study of Urate Elevation in Parkinson’s Disease (SURE-PD3; NCT02642393). (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - January 18, 2023 Category: Neurology Authors: Di Luca, D. G., Macklin, E. A., Hodgeman, K., Lopez, G., Pothier, L., Callahan, K. F., Lowell, J., Chan, J., Videnovic, A., Lungu, C., Lang, A. E., Litvan, I., Schwarzschild, M. A., Simuni, T. Tags: Parkinson's disease/Parkinsonism, Clinical trials Methodology/study design, Inclusion, Diversity, Equity, Anti-racism, and Social Justice (IDEAS), Health disparities, Structural and social determinants of health RESEARCH ARTICLE Source Type: research
Exploring Stroke Risk Factors and Outcomes in Sexual and Gender Minority People
Discussion
SGM people may have different risk factors, different mechanisms of stroke, and higher risk of recurrent stroke compared with non-SGM people. Standardized collection of sexual orientation and gender identity would enable larger studies to further understand disparities, leading to secondary prevention strategies. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - January 18, 2023 Category: Neurology Authors: Diaz, M. A., Rosendale, N. Tags: Research Article Source Type: research
Howl: Nightmare or REM Sleep Behavior Disorder?
We present the case of a 41-year-old man referred for vivid and unpleasant dreams, beginning in the last year, related to work stress.
Results
The polysomnography showed the loss of atony in the REM phase and emission of a prolonged howl after which the patient continues in the REM phase.
Discussion
Prolonged howling is a very rare symptom in sleep disorders, and very atypical in RSBD, so polysomnography is essential to confirm the diagnosis and rule out other parasomnias. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - January 18, 2023 Category: Neurology Authors: Abenza-Abildua, M. J., Lores-Gutierrez, V., Gutierrez-Cueto, G., Suarez-Gisbert, E., Perez-Lopez, C. Tags: Clinical/Scientific Note Source Type: research
Sleep Assessment in Long COVID Clinics: A Necessary Tool for Effective Management
As we adapt to SARS-CoV-2, it has become apparent that the acute illness is not the only threat from this virus. Long COVID has emerged as a potentially disabling condition with multiple varied symptoms. We propose that querying patients about their sleep may allow for the assessment of a sleep-related disorder that is amenable to treatment. In addition, hypersomnolence is a prominent feature and may mimic other organic hypersomnias; therefore, inquiring about COVID-19 infection in sleepy patients is suggested. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - January 18, 2023 Category: Neurology Authors: Khosla, S., Cheung, J., Gurubhagavatula, I., on behalf of the COVID-19 Task Force of the American Academy of Sleep Medicine Tags: Commentary Source Type: research
Implementation of a Standardized Shared Decision-making Bundle to Improve Communication Practices in the Neurocritical Care Unit
Discussion
A team-driven, standardized SDM bundle that integrates with health care team workflows enabled SDM conversations to occur earlier and resulted in improved documentation of SDM conversations. Team-driven SDM bundles have the potential to improve communication and promote early alignment with patient family goals, preferences, and values. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - January 17, 2023 Category: Neurology Authors: Waseem, H., Keegan, J., Farrell, K., Hwang, D. Y., Oliver, B., Olm-Shipman, C., Pepin, R., Mecchella, J. Tags: Research Article Source Type: research
The Best Seizure Diagnostic Tool Is Not a Medical Device: Why Stand-Alone Video Review Needs a Current Procedural Terminology Code
The diagnosis of seizures and epilepsy is primarily based on the history, but history-taking is fraught with difficulties and has serious limitations, which is one reason for the common misdiagnosis of seizures. EEG is a very useful tool, but routine EEG has poor sensitivity, and prolonged EEG-video monitoring, the gold-standard for diagnosis, is only useful for patients with frequent events. Smartphones are ubiquitous, and their videos are increasingly used as an extension of the history and a diagnostic tool. Stand-alone videos should be considered a diagnostic tool and treated as such, including with a Current Procedura...
Source: Neurology Clinical Practice - January 17, 2023 Category: Neurology Authors: Benbadis, S. R. Tags: Commentary Source Type: research
Practice Current: Variability in Smoking Cessation Intervention Practice Patterns After Ischemic Stroke and Transient Ischemic Attack
People who continue to smoke after ischemic stroke and transient ischemic attack (TIA) are at increased risk for subsequent stroke and cardiovascular events. Although effective smoking cessation strategies exist, smoking rates after stroke remain high. Through case-based discussions with 3 international vascular neurology panelists, this article seeks to explore practice patterns and barriers to smoking cessation for patients with stroke/TIA. We sought to answer these questions: What are the barriers to using smoking cessation interventions for patients with stroke/TIA? Which interventions are most used for hospitalized pa...
Source: Neurology Clinical Practice - January 17, 2023 Category: Neurology Authors: Ganesh, A., Parikh, N. S., Restifo, D., Ganesh, A., Kamel, H. Tags: Commentary Source Type: research
Sequential Gaze-Shifting Approach to Reconstruct Self-portrait and Daily Activities in Hemispatial Neglect After Stroke: A Case Report
Discussion
The effects of existing rehabilitation approaches can be difficult to generalize and apply to the performance of each individual ADL in patients with hemispatial neglect after stroke. Sequential gaze shifting may be a viable compensation strategy in directing attention to the neglected space and restoring the ability to perform each ADL. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - January 17, 2023 Category: Neurology Authors: Takaya, S., Kato, T. Tags: Clinical/Scientific Note Source Type: research
Antiseizure Medication Withdrawal Practice Patterns: A Survey Among Members of the American Academy of Neurology and EpiCARE
Discussion
Most surveyed neurologists would consider withdrawing ASMs in seizure-free individuals. Seizure probability was the largest factor driving decisions, yet estimating seizure probabilities was the greatest challenge. Respondents on average indicated that they may withdraw ASM after a minimum seizure-free duration of 2 years, yet also on average were willing to withdraw when seizure risk decreased below 15%–30%, which is lower than most patients' postwithdrawal risk at 2-year seizure freedom and lower than the equivalent even of a first seizure of life. These findings will inform future efforts at developing ...
Source: Neurology Clinical Practice - January 17, 2023 Category: Neurology Authors: Terman, S. W., Slinger, G., Rheaume, C. E., Haque, A. S., Smith, S. N., van Griethuysen, R., van Asch, C. J. J., Otte, W. M., Burke, J. F., Braun, K. P. J. Tags: All Clinical Neurology, All Epilepsy/Seizures, Antiepileptic drugs Research Article Source Type: research
Health Care Utilization in Functional Neurologic Disorders: Impact of Explaining the Diagnosis of Functional Seizures on Health Care Costs
The objectives of this study were to investigate health care utilization costs of patients with video-electroencephalography (VEEG)–confirmed functional seizures (FS), determine whether patients who received a satisfactory functional neurologic disorder (FND) diagnosis explanation had reduced health care utilization compared with those with a poor explanation; and to quantify the overall health care costs 2 years prediagnosis and postdiagnosis for those receiving a different explanation.
Methods
Patients with VEEG-confirmed pure FS (pFS) or mixed (functional seizure plus epileptic seizures) diagnosis between July 1,...
Source: Neurology Clinical Practice - January 11, 2023 Category: Neurology Authors: Lagrand, T. J., Jones, M., Bernard, A., Lehn, A. C. Tags: Research Article Source Type: research
Health Services in Huntington Disease: A Systematic Literature Review
Purpose of Review
Clinical trials for Huntington disease (HD) have primarily focused on managing chorea and, more recently, the development of disease-modifying therapies (DMTs). Nonetheless, understanding health services among patients with HD is essential for assessing new therapeutics, development of quality metrics, and overall quality of life of patients and families with HD. Health services assess health care utilization patterns, outcomes, and health care–associated costs, which can help shape the development of therapeutics and aid in policies that affect patients with a specific condition. In this systematic...
Source: Neurology Clinical Practice - January 11, 2023 Category: Neurology Authors: Mendizabal, A., Diaz, J. M., Bustamante, A. V., Bordelon, Y. Tags: Review Source Type: research
Racial and Ethnic Differences in Antiseizure Medications Among People With Epilepsy on Medicaid: A Case of Potential Inequities
Discussion
Generally, racial and ethnic minoritized people with epilepsy have lower odds of being on newer-generation ASMs. Greater adherence by people who were only on newer ASMs, their greater use among people seeing a neurologist, and the opportunity of a new diagnosis point to actionable leverage points for reducing inequities in epilepsy care. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - January 11, 2023 Category: Neurology Authors: Bensken, W. P., Fernandez Baca Vaca, G., Alberti, P. M., Khan, O. I., Ciesielski, T. H., Jobst, B. C., Williams, S. M., Stange, K. C., Sajatovic, M., Koroukian, S. M. Tags: Research Article Source Type: research
Cost and Return on Investment of a Team-Based Palliative Care Program for Parkinson Disease
Implementation of palliative care (PC) in neurology settings may improve symptom control and quality of life and reduce acute care admissions. The benefits of team-based PC for patients with Parkinson disease have been established through rigorous evidence standards including randomized controlled trials. However, evidence on implementation costs and return on investment (ROI) is unknown and may guide other providers and systems considering this model of care. We applied time-driven activity-based costing with reimbursable visits calculated using Medicare reimbursement rates in Colorado and current procedural technology co...
Source: Neurology Clinical Practice - December 13, 2022 Category: Neurology Authors: McQueen, R. B., Gritz, M., Kern, D., Bemski, J. L., Shelton, I., Meyer, M., Kluger, B. M. Tags: Commentary Source Type: research
