Chronic Inflammatory Demyelinating Polyradiculoneuropathy: Five New Things
Purpose of Review The purpose of this review is to give an update on chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Recent findings There are several recent developments in CIDP, the major one being the 2021 second revision of the European Academy of Neurology/Peripheral Nerve Society guideline on diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy. Other updates address therapy in CIDP, antibodies, serum neurofilament light chain, chronic immune sensory polyradiculopathy (CISP) and CIDP mimics. Summary CIDP criteria continue to be refined and some disorders are now exc...
Source: Neurology Clinical Practice - June 7, 2022 Category: Neurology Authors: Karam, C. Tags: Chronic inflammatory demyelinating polyneuropathy Five New Things Source Type: research
Cognitive-Motor Dissociation Following Pediatric Brain Injury: What About the Children?
Discussion These converging lines of evidence lead us to conclude that both participants had preserved cognitive function dissociated from their motor output. Throughout the 5+ years since injury, communication attempts and therapy had remained uninformed by such objective evidence of their cognitive abilities. Proper diagnosis of CMD is an ethical imperative. Children with covert cognition reflect a vulnerable and isolated population; the methods outlined here provide a first step in identifying such persons to advance efforts to alleviate their condition. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 7, 2022 Category: Neurology Authors: Kim, N., O'Sullivan, J., Olafson, E., Caliendo, E., Nowak, S., Voss, H. U., Lowder, R., Watson, W. D., Ivanidze, J., Fins, J. J., Schiff, N. D., Hill, N. J., Shah, S. A. Tags: fMRI, PET, EEG; see Epilepsy/Seizures, Evoked Potentials/Auditory Research Source Type: research
Using Semiology to Classify Epileptic Seizures vs Psychogenic Nonepileptic Seizures: A Meta-analysis
Discussion While all signs require an interpretation in the overall clinical context, the presence of ictal eye closure and asynchronous limb movements are reliable discriminative signs for PNES. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 7, 2022 Category: Neurology Authors: Muthusamy, S., Seneviratne, U., Ding, C., Phan, T. G. Tags: All Epilepsy/Seizures, Epilepsy semiology, Video/ EEG use in epilepsy, Nonepileptic seizures Research Source Type: research
Disparities in Telehealth Care in Multiple Sclerosis
Discussion Older age, lower socioeconomic status, and disease-related impairments are associated with less access to and use of telehealth services in people with MS. Barriers to telehealth should be addressed to avoid aggravating health care disparities when using digital medicine. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 7, 2022 Category: Neurology Authors: Marrie, R. A., Kosowan, L., Cutter, G., Fox, R., Salter, A. Tags: Inclusion, Diversity, Equity, Anti-racism, and Social Justice (IDEAS), Health disparities, Multiple sclerosis Research Source Type: research
Two-Year Profile of Preventable Errors in Hospital-Based Neurology
Discussion Systems-based interventions may reduce both clinical and systems-based errors, and protocol changes are effective when feasible. Given the important goal of optimizing care for every patient, quality leaders should conduct continuous audits of preventable errors and quality improvement systems in their clinical areas. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 7, 2022 Category: Neurology Authors: Marks, A., Takahashi, C., Anand, P., Lau, K. H. V. Tags: Outcome research, Harm/ risk (analysis), Medical care, Patient safety, Methods of education Source Type: research
Electrodiagnostic Characteristics Suggestive of Muscle-Specific Kinase Myasthenia Gravis
This study compares EDX features of MuSK + MG with acetylcholine receptor (AChR) antibody–positive MG (AChR + MG) to discern whether any unique EDX pattern exists that can aid in clinical diagnosis. Methods From January 1, 2010, through December 31, 2020, all patients with MuSK + MG at our institution were identified and randomly matched to an AChR + MG cohort in a 1:2 ratio based on sex, age at onset, and subsequently Myasthenia Gravis Foundation of America (MGFA) clinical severity for a case-control study. Each patient's clinical profile, treatment, and EDX testing were summarized and analyzed. Results Twenty-two...
Source: Neurology Clinical Practice - June 7, 2022 Category: Neurology Authors: Skolka, M., Lamb, C. J., Rubin, D. I., Klein, C. J., Laughlin, R. S. Tags: Myasthenia, All clinical neurophysiology, EMG Research Source Type: research
Neurology Access Clinic: A Model to Improve Access to Neurologic Care in an Academic Medical Center
Discussion Our findings suggest that introducing an access clinic as service rotation for neurology faculty is both effective in offering enhanced access for patients to neurologic care and for patient satisfaction. Future studies may test this model in other centers and should address the effect on provider satisfaction. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 7, 2022 Category: Neurology Authors: Yarbrough, A. J., Johnson, L., Vats, A., Jaffee, M. S., Busl, K. M. Tags: All Health Services Research, Models of care Source Type: research
Triggers for Referral to Specialized Palliative Care in Advanced Neurologic and Neurosurgical Conditions: A Systematic Review
Discussion There is a growing body of research that outlines evidence-based referral triggers for neuropalliative care. The ambiguity of nomenclature surrounding referral triggers in the current literature and field of neuropalliative care was a limitation to this study. We suggest that condition-specific triggers are likely to be the most effective for identifying the appropriate patients and timing for referral to specialist palliative care. (PROSPERO registration number: CRD42020135791, crd.york.ac.uk/prospero) (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 7, 2022 Category: Neurology Authors: McConvey, K., Kazazian, K., Iansavichene, A. E., Jenkins, M. E., Gofton, T. E. Tags: All Clinical Neurology, Palliative care Research Source Type: research
Inclusion of Historically Oppressed Genders in Neurologic Practice Research
In this issue of Neurology® Clinical Practice, Qureshi et al.1 present a case of a transgender man of childbearing age with a reported body mass index of 37 who presents with idiopathic intracranial hypertension (IIH). The authors conclude that exogenous testosterone as part of a gender-affirming hormone regimen may be a potential mechanism for his diagnosis of IIH, based on prior evidence that disorders in androgen metabolism may influence CSF production.2 The authors additionally report multiple similar case reports in the literature of transmasculine patients with IIH. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 7, 2022 Category: Neurology Authors: Lerario, M., Galis, A. Tags: Health care reform, Underserved populations, Inclusion, Diversity, Equity, Anti-racism, and Social Justice (IDEAS), Gender, LGBTQI Editorial Source Type: research
Acute Ascending Necrotizing Myelitis After COVID-19 Infection: A Clinicopathologic Report
We described the clinical presentation, disease course, diagnostic workup, therapeutic measures, and pathologic findings of ANM associated with COVID-19 infection. Results A 31-year-old previously healthy woman developed a longitudinally extensive lower thoracic myelopathy 3 weeks after COVID-19 infection. The thoracic spinal cord lesion extended to cervical level in 1 week and to the lower medullary level in 2 more weeks. Thoracic laminectomy at T5-T6 level and cord biopsy revealed necrobiotic changes without viral particles or microglial nodules. The clinical deficit stabilized after immunomodulatory and eculizumab ther...
Source: Neurology Clinical Practice - June 7, 2022 Category: Neurology Authors: Guada, L., Cabrero, F. R., Baldwin, N. L., Levi, A. D., Gultekin, S. H., Verma, A. Tags: COVID-19, Transverse myelitis Clinical/Scientific Note Source Type: research
Unusual Post-COVID-19 Presentation With Tetraventricular Hydrocephalus: A Case Report
Discussion Fourth ventricular outlet obstruction is a rare cause of tetraventricular HCP. In most cases, it is associated with a history of inflammatory conditions or hemorrhage. In our case, a history of recent COVID-19 infection and normal imaging before COVID-19 make COVID-19 the most probable explanation for HCP. We suggest considering COVID-19 infection in the differential diagnosis of HCP of unclear etiology. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 7, 2022 Category: Neurology Authors: Saini, C., Zaid, G. K., Gachechiladze, L., Krishnan, R. Tags: Hydrocephalus, MRI, Post-infectious, Clinical neurology history, COVID-19 Clinical/Scientific Note Source Type: research
Cerebral White Matter Injury in a Newborn Infant With COVID-19: A Case Report
Discussion Neurologic presentation of SARS-CoV-2 in newborns seems to be rare and is not fully known. SARS-CoV-2 infection should be considered in newborns with seizures and white matter abnormalities. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 7, 2022 Category: Neurology Authors: Alves, L., Alcantara, T., Hazin, A., Lucato, L., Ferraz de Magalhaes, J. J., Alves, J., Meneses, J. Tags: MRI, Neonatal, COVID-19 Clinical/Scientific Note Source Type: research
SARS-CoV-2 Infection and Vaccination Outcomes in Multiple Sclerosis
The objectives of this study were to determine the incidence of new neurologic symptoms or symptom recrudescence among PwMS who received the SARS-CoV-2 vaccine, characterize outcomes after SARS-CoV-2 infection, and assess MS-specific determinants of vaccine hesitancy. Methods Online surveys that assessed incidence and severity of SARS-CoV-2 infection, vaccination status/type, reasons for vaccine deferral, and postvaccination symptoms were administered to PwMS. Medical charts were reviewed for consenting respondents. Associations between infection, postvaccination outcomes, and clinical characteristics were compared using ...
Source: Neurology Clinical Practice - June 7, 2022 Category: Neurology Authors: Brunn, J. A., Dunietz, G. L., Romeo, A. R., Braley, T. J. Tags: COVID-19, Multiple sclerosis Research Source Type: research
Neuroimaging for Pediatric Non-First-Time Seizures in the Emergency Department
Discussion Patients with a NIS who have abnormal neuroimaging associated with an ACM present with unique risk factors. Prospectively validating these factors may allow for a prediction tool for NIS in EDs where reduced exposure to ionizing radiation, sedation, and resource utilization are critically important. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 7, 2022 Category: Neurology Authors: Mazzio, E., Mistry, R. D., Rosenthal, S., Ser, E., Jewell, J., Martin, J., Messer, R., Straley, M., Leonard, J., Press, C. A. Tags: CT, MRI, Clinical neurology history, Clinical neurology examination, All Epilepsy/Seizures Research Source Type: research
Essential Tremor: Five New Things
Purpose of the Review To highlight five new things in the research and clinical aspects of essential tremor (ET). Recent Findings The introduction of a new definition of ET and a new category "ET plus" were the major themes of the recent consensus statement. This new change demands a change in the approach to the clinical diagnosis of ET and related diseases. From the pathogenesis standpoint, the cerebellar neurodegenerative model seems to have abundant evidence in its favor compared with the olivary model, which has largely fallen out of favor. From the standpoint of therapeutics, magnetic resonance–guided focused ...
Source: Neurology Clinical Practice - April 12, 2022 Category: Neurology Authors: Lenka, A., Pandey, S. Tags: Tremor Five New Things Source Type: research