Linked Patient and Provider Impressions of Outpatient Teleneurology Encounters
In this study, we describe patient impressions about a teleneurology encounter and evaluate concordance with provider impressions about the same encounter.
Methods
Patients and providers at the University of Pennsylvania Hospital Neurology Department were surveyed about their impressions of teleneurology between April 27, 2020, and June 16, 2020. A convenience sample of patients, whose providers completed a questionnaire, were contacted by telephone to solicit their impressions about the same encounter. Unique questionnaires for patients and providers focused on similar themes, such as adequacy of technology, assessment o...
Source: Neurology Clinical Practice - May 1, 2023 Category: Neurology Authors: James, J. G., Park, J., Oliver, A., Xie, S. X., Siderowf, A., Spindler, M., Wechsler, L. R., Tropea, T. F. Tags: All Movement Disorders Research Article Source Type: research
Stroke in Patients With Common Noncancerous Gynecologic Diseases: A Multicenter Study in Japan
Discussion
In patients with common noncancerous gynecologic diseases, hypercoagulopathy may play a role in the pathogenesis of ischemic stroke/TIA without CSMs. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - April 27, 2023 Category: Neurology Authors: Yamashiro, K., Sato, T., Nito, C., Ueno, Y., Kawano, H., Chiba, T., Nishihira, T., Mizuno, T., Ishizuka, K., Iguchi, Y., Kimura, K., Kitagawa, K., Koga, M., Hirano, T., Kameda, T., Takekawa, H., Urabe, T., Taneichi, A., Fujiwara, H., Fujimoto, S., Hattori Tags: All Cerebrovascular disease/Stroke Research Article Source Type: research
Total Tau Level in Cerebrospinal Fluid as a Predictor of Survival in Creutzfeldt-Jakob Disease: A Retrospective Analysis
This study aims to fill this gap by examining the relationship between CSF total tau (t-tau) levels and time to death in patients with CJD.
Methods
We use cases with CJD recorded in the electronic health record of a tertiary academic medical center from 2010 to 2022.
Results
We identified 29 cases with diagnosis of CJD. Using a Cox proportional hazards model, we find that elevated t-tau levels (>4,000 pg/mL) are associated with 9.62 (95% confidence interval: 1.93–47.92) times the hazard of death compared with CJD patients with t-tau less than 4,000 pg/mL.
Discussion
This finding supports the use of CSF t-tau as...
Source: Neurology Clinical Practice - April 27, 2023 Category: Neurology Authors: Coban, H., Nadella, P., Tu, D., Shinohara, R., Berger, J. R. Tags: Prion, Prognosis Research Article Source Type: research
Structural MRI Ratios Fail to Distinguish Progressive Supranuclear Palsy From Parkinson Disease in Individual Patients
Discussion
These results indicate that MRI measures of brain structures were not effective at predicting diagnosis in individual patients. We conclude that the search for a biomarker that can differentiate PSP from PD must continue. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - April 27, 2023 Category: Neurology Authors: Dewey, C., Feltrin, F., Shah, B., Pinho, M., DeBevits, J., Achilleos, M., McCreary, M., Lynch, S., Chitnis, S., Dewey, R. Tags: Parkinson's disease/Parkinsonism, Progressive supranuclear palsy Research Article Source Type: research
Autoimmune Encephalitis Consensus Criteria: Lessons Learned From Real-World Practice
Autoimmune encephalitis (AE) encompasses a spectrum of neurologic disorders caused by brain inflammation, a subset of which is associated with autoantibodies to neuronal cell-surface antigens such as anti-N-methyl-d-aspartate (NMDA) receptor AE or anti-leucine-rich glioma-inactivated 1 (LGI1) AE.1 Up to half of patients with AE, however, do not have abnormal neuronal or glial autoantibodies identified and are classified as having "seronegative" AE.2 Clinical antibody testing can take several days to result, a time in which clinicians caring for patients with suspected AE may wish to initiate empiric immunosuppressive thera...
Source: Neurology Clinical Practice - April 25, 2023 Category: Neurology Authors: Gelfand, J. M., Guo, C.-Y. Tags: Autoimmune diseases, Encephalitis, All Clinical Neurology Editorial Source Type: research
Clinical Practice Guidelines for the Detection and Treatment of Depression in Multiple Sclerosis: A Systematic Review
Purpose of Review
The association of multiple sclerosis (MS) with depression has been well documented; however, it frequently remains undiagnosed, untreated, or undertreated, with consequences to the person, family, and economy. The aim of this study was to determine the quality, scope, and consistency of available guidelines and consensus statements to guide clinicians managing people with comorbid MS and depression.
Recent Findings
Based on our systematic search of the literature, 6 guidelines and consensus statements met the inclusion criteria. Of these, 4 presented recommendations on depression screening in MS and 5 o...
Source: Neurology Clinical Practice - April 25, 2023 Category: Neurology Authors: McIntosh, G. E., Liu, E. S., Allan, M., Grech, L. B. Tags: Depression, Multiple sclerosis Review Source Type: research
Autoimmune Encephalitis Criteria in Clinical Practice
Discussion
The 2016 AE guidelines permit autoimmune causation assessment in subacute encephalopathy and are highly specific. Inclusion could be improved by incorporating AE-IgG–positive patients with isolated seizures or brainstem disorders. Some patients with atypical presentations but with findings supportive of autoimmunity may be immune therapy responsive. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - April 25, 2023 Category: Neurology Authors: Orozco, E., Valencia-Sanchez, C., Britton, J., Dubey, D., Flanagan, E. P., Lopez-Chiriboga, A. S., Zalewski, N., Zekeridou, A., Pittock, S. J., McKeon, A. Tags: All Immunology, Autoimmune diseases, All Psychiatric disorders, All Cognitive Disorders/Dementia, All Epilepsy/Seizures Research Article Source Type: research
Examining the Role of Narrative in Palliative Care for Parkinson Disease: Changing the Story
Recent years have seen growing interest in neuropalliative care as a subspecialty. Simultaneously, the rise of narrative medicine in patient support groups and clinician training programs offers a way to listen deeply to the stories of those living with chronic illness and may inform corresponding health interventions. This commentary examines the ways in which an understanding of illness narrative schemata, particularly the so-called "chaos narrative," can contribute to patient and care partner distress, which in turn can be alleviated by a palliative care approach. Through examples of stories of people with Parkinson dis...
Source: Neurology Clinical Practice - April 18, 2023 Category: Neurology Authors: Trahair, E. D., Mantri, S. Tags: Parkinson's disease/Parkinsonism, Palliative care Commentary Source Type: research
Association of Early Seizure Prophylaxis With Posttraumatic Seizures and Mortality: A Meta-analysis With Evidence Quality Assessment
Purpose of the Review
To evaluate the quality of evidence about the association of primary seizure prophylaxis with antiseizure medication (ASM) within 7 days postinjury and the 18- or 24-month epilepsy/late seizure risk or all-cause mortality in adults with new-onset traumatic brain injury (TBI), in addition to early seizure risk.
Results
Twenty-three studies met the inclusion criteria (7 randomized and 16 nonrandomized studies). We analyzed 9,202 patients, including 4,390 in the exposed group and 4,812 in the unexposed group (894 in placebo and 3,918 in no ASM groups). There was a moderate to serious bias risk based on ...
Source: Neurology Clinical Practice - March 30, 2023 Category: Neurology Authors: Coelho, L. M. G., Blacker, D., Hsu, J., Newhouse, J. P., Westover, M. B., Zafar, S. F., Moura, L. M. V. R. Tags: Clinical trials Systematic review/meta analysis, Brain trauma, All Epilepsy/Seizures, Antiepileptic drugs Source Type: research
Imaging Spectrum of HTLV-1-Related Neurologic Disease: A Pooled Series and Review
In this study, we summarize the imaging features of HTLV-1–related neurologic disease, providing both a pictorial review and pooled series of the less well-recognized presentations.
Recent Findings
35 cases of acute/subacute HAM and 12 cases of HTLV-1–related encephalopathy were found. In subacute HAM, cervical and upper thoracic longitudinally extensive tranverse myelitis was noted, while in HTLV-1–related encephalopathy, confluent lesions in the frontoparietal white matter and along the corticospinal tracts were the most prevalent finding.
Summary
There are varied clinical and imaging presentations of...
Source: Neurology Clinical Practice - March 27, 2023 Category: Neurology Authors: Dixon, L., McNamara, C., Dhasmana, D., Taylor, G. P., Davies, N. Tags: MRI, Encephalitis, Viral infections Review Source Type: research
Autonomic Neuropathy as a Predictor of Morbidity and Mortality in People Living With HIV: A Retrospective, Longitudinal Cohort Study
This study aimed to evaluate whether HIV-AN is predictive of important adverse clinical outcomes.
Method
The electronic medical records of HIV-infected participants who underwent autonomic function tests at the Mount Sinai Hospital between April 2011 and August 2012 were reviewed. The cohort was stratified into those who had no or mild autonomic neuropathy (HIV-AN [–], CASS ≤3) and those with moderate or severe autonomic neuropathy (HIV-AN [+], CASS >3). The primary outcome was a composite of the incidence of death from any cause, new major cardiovascular or cerebrovascular event, or development of severe rena...
Source: Neurology Clinical Practice - March 27, 2023 Category: Neurology Authors: Kwon, P. M., Lawrence, S., Figueroa, A., Robinson-Papp, J. Tags: Autonomic diseases, HIV, Peripheral neuropathy, Cardiac; see Cerebrovascular Disease/Cardiac, Cohort studies Research Article Source Type: research
Contextualizing Adverse Childhood Experiences in Patients With Parkinson Disease: The Beginnings of a Complicated Area of Neurologic Research
Adverse childhood experiences (ACEs) are traumatic events associated with negative health behaviors and outcomes in adulthood. The pivotal studies identifying the relationship between childhood adversity and health outcomes were conducted in the late 90s and found that having high ACEs (defined as 4 or more forms of childhood adversity) was associated with an increased risk of cardiovascular disease, lung disease, and mental health disorders, along with others.1 Having 6 or more ACEs was associated with a shortened lifespan, which was more concerning.2 (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - March 22, 2023 Category: Neurology Authors: Mendizabal, A. Tags: All Health Services Research, All Clinical Neurology, Parkinson's disease/Parkinsonism, Structural and social determinants of health Editorial Source Type: research
Hospital EEG Capability and Associations With Interhospital Transfer in Status Epilepticus
We examined annual change in the proportion of hospitals that were EEG capable during the study period, compared characteristics of hospitals that were EEG capable with those that were not, and fit multivariable logistic regression models to determine whether hospital EEG capability was associated with likelihood of interhospital transfer.
Results
Among 4,550 hospitals in 2018, 1,241 (27.3%) were EEG capable. Of these, 1,188 hospitals (95.7%) were in urban settings. From 2012 to 2018, the proportion of hospitals that were EEG capable increased in urban settings (30.5%–41.1%, Mann-Kendall [M-K] test p < 0.001) and...
Source: Neurology Clinical Practice - March 16, 2023 Category: Neurology Authors: Suen, C. G., Wood, A. J., Burke, J. F., Betjemann, J. P., Guterman, E. L. Tags: All Health Services Research, Status epilepticus, EEG, Epilepsy monitoring, Video/ EEG use in epilepsy Research Article Source Type: research
Neighborhood Social Determinants of Health in Patients Seen in Neurology Movement Disorders Clinics
Discussion
Neighborhood-linked SDH vary among different MDs. These findings have implications for public health interventions aimed at improving the care of people affected by MDs. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - March 16, 2023 Category: Neurology Authors: Onishchenko, R., Clarke, P. J., Marshall, C., Wyant, K. J., Kotagal, V. Tags: All Movement Disorders, Parkinson's disease/Parkinsonism, Health disparities, Structural and social determinants of health Research Article Source Type: research
Racial and Ethnic Disparities in Parkinson Disease: A Call to Action
In this report, we summarize findings from our comprehensive white paper for the Michael J. Fox Foundation that reviews the current state of knowledge on racial and ethnic disparities in PD care in the following areas: epidemiology, etiology, phenotype and diagnosis, treatment, and research. We also identify knowledge gaps and necessary policy changes to ensure equitable, high-value care for all persons with PD. These strategies are designed to help identify and reduce health disparities among persons with PD and may serve as a model for other neurologic diseases. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - March 16, 2023 Category: Neurology Authors: Aamodt, W. W., Willis, A. W., Dahodwala, N. Tags: Parkinson's disease/Parkinsonism, Inclusion, Diversity, Equity, Anti-racism, and Social Justice (IDEAS), Advocacy Commentary Source Type: research
