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
Consensus Statement on Visual Rehabilitation in Mild Traumatic Brain Injury
Optometric visual rehabilitation therapy has been used for a variety of visual disorders. Descriptively named entities such as posttrauma visual syndrome, visual midline shift syndrome, and vertical heterophoria syndrome are frequently diagnosed by neuro-optometrists and/or behavioral optometrists in patients after stroke or head injury or in the setting of dizziness and/or headache. The scientific underpinnings of these diagnoses and treatments are weak, and published clinical studies comprise case reports and case series without comparison to control populations. Neuro-ophthalmologists are frequently questioned by patien...
Source: Neurology Clinical Practice - December 13, 2022 Category: Neurology Authors: Subramanian, P. S., Barton, J. J. S., Ranalli, P., Smith, C., Francis, C. E., Frishberg, B. Tags: Commentary Source Type: research
Single-Center Description of Therapeutic Anticoagulation Practices and Outcomes in Large Hemispheric Infarctions
Discussion
Although radiographic HT is common among patients with LHI, it does not always portend symptomatic clinical deterioration. Further research regarding AC timing and safety is necessary. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - December 13, 2022 Category: Neurology Authors: Breit, H., Sterenstein, A., Abburi, N., Song, S., John, S., Da Silva, I., Koffman, L. Tags: Research Article Source Type: research
Improving Early Recognition of Creutzfeldt-Jakob Disease Mimics
Discussion
Immune-mediated, vascular, granulomatous, and neurodegenerative diseases may mimic CJD at presentation and should be considered in patients with early motor dysfunction and abnormal CSF studies. The detection of atypical features—particularly elevations in CSF leukocytes and protein—should prompt evaluation for mimics and consideration of empiric treatment while waiting for the results of more specific tests. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - December 13, 2022 Category: Neurology Authors: Lazar, E. B., Porter, A. L., Prusinski, C. C., Dunham, S. R., Lopez-Chiriboga, A. S., Hammami, M. B., Dubey, D., Day, G. S. Tags: Research Article Source Type: research
Criminality in Huntington Disease
Discussion
The presence of criminality was not infrequent in our cohort, but rarely did this result in criminal charges and rarely did these charges result in arrests or incarcerations. Discussions surrounding driving safety and management of physical aggression toward caregivers should be part of regular outpatient visits with patients with HD. Ultimately, it is unknown whether criminality is a common feature of HD, and assessments need to be developed to determine its true prevalence. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - December 13, 2022 Category: Neurology Authors: Olvera, C., Stebbins, G. T., Romero, V. P., Hall, D. A. Tags: Research Article Source Type: research
Health Care Utilization in the Last Year of Life in Parkinson Disease and Other Neurodegenerative Movement Disorders
Discussion
There are high rates of in-hospital death and acute care utilization in the year before death among those with neurodegenerative movement disorders. Most did not access specialist palliative or neurologic care in the last year of life. Outpatient palliative care and home care services were associated with increased odds of dying at home. Our results indicate the need for further research into the causes, costs, and potential modifiers to inform public health planning. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - December 13, 2022 Category: Neurology Authors: McKenzie, E. D., Bruno, V. A., Fong, A., Cai, P., Earp, M., Camicioli, R. M., de Kock, I., Buttenschoen, D., Sinnarajah, A., Miyasaki, J. Tags: Research Article Source Type: research
Neurologists and Palliative Care: Are We Doing Enough?
With an aging population, the prevalence of neurodegenerative disorders is increasing.1,2 The natural history of neurodegenerative diseases is one of increasing disability, loss of function, immobility, and eventual demise. As McKenzie et al.3 show in this issue of Neurology® Clinical Practice, end-stage neurologic diseases including Parkinson disease are accompanied by increasing inpatient health care utilization culminating often with prolonged intensive care stays and in-hospital death. As the role of palliative care has expanded over time from its original application in patients with terminal cancer to include per...
Source: Neurology Clinical Practice - December 13, 2022 Category: Neurology Authors: Ney, J. P. Tags: Editorial Source Type: research
