Lessons Learned From an Integrated Neurology Diversity, Equity, and Inclusion Curriculum
The University of California San Francisco Neurology Department incorporated a formal diversity, equity, and inclusion curriculum into the residency education in 2015. During that time, we have learned a number of lessons that can be useful to other institutions planning similar initiatives including the following: (1) training should be led by a multidisciplinary team with experienced educators, (2) sustainability of the curriculum requires broad departmental buy-in from leadership to junior faculty to the residents themselves, (3) the curriculum needs to balance training on fundamental topics with flexibility to change i...
Source: Neurology Clinical Practice - December 13, 2021 Category: Neurology Authors: Anderson, N., Josephson, S. A., Rosendale, N. Tags: All Clinical Neurology, Underserved populations, Inclusion, Diversity, Equity, Anti-racism, and Social Justice (IDEAS), All Education Commentary Source Type: research

Early Experience With Tenecteplase at a Comprehensive Stroke Center
Purpose of Review Tenecteplase has been studied and recommended as an alternative thrombolytic agent in patients with acute stroke. A brief review of clinical trials and guidelines pertinent to our clinical decision algorithm is described. This is followed by operational steps that were made to create and implement a clinical pathway based on available evidence in which tenecteplase is used in select patients with stroke at our comprehensive stroke center. Recent Findings A number of patients have been treated at our center with IV tenecteplase. A case is presented to illustrate the successful implementation of this new p...
Source: Neurology Clinical Practice - December 13, 2021 Category: Neurology Authors: Panezai, S., Dubinsky, I., Sahito, S., Gadallah, N., Suhan, L., Mehta, S., Kirmani, J. Tags: Other cerebrovascular disease/ Stroke, All Cerebrovascular disease/Stroke, Infarction Review Source Type: research

Recognizing Atypical Dopa-Responsive Dystonia and Its Mimics
We describe a GCH-1–associated late-onset DRD case with a family history of parkinsonism and cervical dystonia whose response to levodopa was poor and complicated with dyskinesia, blepharospasm, and severe nonmotor symptoms. We use this case as a springboard to review the spectrum of atypical DRD, DRD-plus, and DRD mimics. Summary GCH-1–related dystonia may exhibit wide intrafamilial phenotypic variability, no diurnal fluctuation, poor response to l-dopa, and such complications as dyskinesia, epilepsy, sleep disorders, autonomic dysfunction, oculogyric crisis, myoclonus, or tics. More recently, rare GCH-1 vari...
Source: Neurology Clinical Practice - December 13, 2021 Category: Neurology Authors: Salles, P. A., Teran-Jimenez, M., Vidal-Santoro, A., Chana-Cuevas, P., Kauffman, M., Espay, A. J. Tags: All Clinical Neurology, Dystonia, Parkinson's disease/Parkinsonism Review Source Type: research

CSF and Circulating NfL as Biomarkers for the Discrimination of Parkinson Disease From Atypical Parkinsonian Syndromes: Meta-analysis
Purpose of Review To evaluate whether CSF and circulating neurofilament light chain (NfL), a marker of axonal damage, could discriminate Parkinson disease (PD) from atypical parkinsonian syndromes (APSs). Recent Findings MEDLINE and Scopus were systematically searched, and 15 studies were included (1,035 patients with PD and 930 patients with APS). CSF NfL levels were 1.26 SDs higher in the APS group compared to the PD group (g = 1.26 [95% confidence interval 0.99–1.53]), and circulating NfL levels were 1.53 SDs higher in the APS group compared to the PD group (g = 1.53 [95% confidence interval 1.15–1.91]); 4 ...
Source: Neurology Clinical Practice - December 13, 2021 Category: Neurology Authors: Angelopoulou, E., Bougea, A., Papadopoulos, A., Papagiannakis, N., Simitsi, A.-M., Koros, C., Georgakis, M. K., Stefanis, L. Tags: Parkinson's disease/Parkinsonism, Progressive supranuclear palsy, Multiple system atrophy Review Source Type: research

Improved Cognitive Function in the Tromso Study in Norway From 2001 to 2016
Discussion Cognitive results were better in more recent-born birth cohorts compared with earlier born, assessed at the same age. The improvement was present in all cognitive domains, suggesting an overall improvement in cognitive performance. The 80-year-olds assessed in 2015–2016 performed like 60-year-olds assessed in 2001. The improved scores were associated with increased education level, increase in modest drinking frequency, increased physical activity, and, for men, smoking cessation and increased height. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - December 13, 2021 Category: Neurology Authors: Johnsen, B., Strand, B. H., Martinaityte, I., Mathiesen, E. B., Schirmer, H. Tags: Intelligence, Cognitive aging, Cognitive neuropsychology in dementia, Cohort studies, Risk factors in epidemiology Research Source Type: research

Pain Phenotypes in Adults Living With Cerebral Palsy
Discussion Findings suggest that type of pain is variable among adults with CP and may arise through multiple mechanisms. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - December 13, 2021 Category: Neurology Authors: Peterson, M. D., Haapala, H. J., Kratz, A. Tags: Central pain, Neuropathic pain, Developmental disorders, Depression Research Source Type: research

Aspiration Pneumonia in Adults Hospitalized With Stroke at a Large Academic Hospital in Zambia
Discussion PSAP is common and life threatening in Zambia, especially among older participants with severe stroke presentations. PSAP was associated with significantly increased mortality independent of initial stroke severity, suggesting that interventions to mitigate PSAP may improve stroke outcomes in Zambia and other resource-limited settings. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - December 13, 2021 Category: Neurology Authors: Prust, M. L., Nutakki, A., Habanyama, G., Chishimba, L., Chomba, M., Mataa, M., Yumbe, K., Zimba, S., Gottesman, R. F., Bahouth, M. N., Saylor, D. R. Tags: All Cerebrovascular disease/Stroke, All global neurology Research Source Type: research

Erenumab Discontinuation After 12-Month Treatment: A Multicentric, Observational Real-Life Study
Conclusion After treatment discontinuation, a rapid migraine worsening was found, despite the high clinical response during treatment and at retreatment, which might be secondary to an untimely interruption of a potentially disease-modifying pharmacologic intervention. Although clinical improvement was documented after retreatment, given the high frequency and degree of worsening during discontinuation, it seems plausible—even ethical—to re-evaluate current timing of discontinuation. Classification of Evidence This study provides Class III evidence that people with migraine discontinuing erenumab migraine prop...
Source: Neurology Clinical Practice - December 13, 2021 Category: Neurology Authors: Schiano di Cola, F., Caratozzolo, S., Venturelli, E., Balducci, U., Sidoti, V., Pari, E., Costanzi, C., di Summa, A., Sixt, G. J., D'Adda, E., Liberini, P., Rao, R., Padovani, A. Tags: Migraine, Quality of life, Burden of disease, Health policy, Cohort studies Research Source Type: research

Prevalence and Cumulative Incidence of Caregiver-Reported Aggression in Advanced Parkinson Disease and Related Disorders
Conclusion There was a high prevalence and incidence of aggression in our PDRD cohort. This is an understudied issue in PDRD, and our findings highlight the need for increased awareness among neurologists. Providers should consider assessing for aggression when discussing neuropsychiatric symptoms or screening for caregiver burden. Future research should examine the relationship between aggression and patient and caregiver health outcomes. Trial Registration Information Clinical trial registration number: NCT02533921. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - December 13, 2021 Category: Neurology Authors: Macchi, Z. A., Miyasaki, J., Katz, M., Galifianakis, N., Sillau, S., Kluger, B. M. Tags: Parkinson's disease/Parkinsonism, All Neuropsychology/Behavior, All Cognitive Disorders/Dementia, Palliative care Research Source Type: research

Mixed Motor Disorder: Essential Tremor Families With Heterogeneous Motor Phenomenology
We present 4 families, including 14 affected individuals, among whom assigned diagnoses were ET, PD, ET + PD, and ET + dystonia. In those with ET and another movement disorder, the predominant and earliest phenotype was ET. Discussion There are assortments of these 3 involuntary motor disorders, ET, dystonia, and PD, both within individuals and in different individuals within ET families. This observation has mechanistic implications. Furthermore, we believe that the concept of the mixed motor disorder should enter into and inform the clinical dialogue. In assigning diagnoses, clinicians are swayed by family history infor...
Source: Neurology Clinical Practice - December 13, 2021 Category: Neurology Authors: Louis, E. D., Hernandez, N. C., Ottman, R., Clark, L. N. Tags: All Clinical Neurology, Dystonia, Parkinson's disease/Parkinsonism, Tremor, All Genetics Research Source Type: research

Sex Differences in the Risk of 30-Day Death After Acute Ischemic Stroke
Conclusions When adjusting for confounders, the female sex was associated with a lower risk of 30-day death after stroke, which could be explained by a female survival advantage in poststroke infections. Sex-specific strategies are needed to reduce early stroke deaths. Classification of Evidence This is a Class I prognostic study because it is a prospective population-based cohort with objective outcomes. Female sex appears to be protective against early stroke deaths and post stroke infections. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - December 13, 2021 Category: Neurology Authors: Irie, F., Matsuo, R., Nakamura, K., Wakisaka, Y., Ago, T., Kamouchi, M., Kitazono, T., on behalf of the Fukuoka Stroke Registry Investigators, on behalf of the Fukuoka Stroke Registry Investigators Tags: Class I, Inclusion, Diversity, Equity, Anti-racism, and Social Justice (IDEAS), Infarction Research Source Type: research

Cervical Artery Dissection in Young Women: Risk of Recurrence During Subsequent Pregnancies
Conclusion In this study, there were no CAD recurrences during subsequent pregnancies or postpartum, irrespective of the type of delivery. Thus, pregnancy after a history of CAD appears to be safe. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - December 13, 2021 Category: Neurology Authors: Assif, M., Lamy, C., De Gaalon, S., Caroit, Y., Bourcier, R., Preterre, C., Guillon, B. Tags: Stroke in young adults, Carotid artery dissection Research Source Type: research

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