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With the exponential growth of literature on coronavirus disease 2019 (COVID-19), we aimed to identify and characterize the 100 most cited COVID-19–related articles in neurology and neurosurgery. In March 2021, we performed a title-specific search of the Scopus database using ("neurology" or "neurologic" or "neurosurgery" or "neurosurgical") and "COVID" as our search query term without date restrictions. The top 100 most cited English-language articles were obtained and reviewed. Our search yielded 9648 articles published from December 2019 to March 2021. Bibliometric analysis of the top 100 articles found that the most cited article had a citation count of 1741 and was the first to report on the detailed neurologic manifestations of the disease; Neurology had the most number of publications; the majority of the primary authors were neurologists, but 35% were from nonneuroscience specialties; the United States, Italy, the United Kingdom, China, and Germany were the top contributors, with a combined total of 77%; most of the publications were correspondence or editorial articles; and most articles discussed the neurologic manifestations and complications of patients with COVID-19. This study identified the top 100 most cited neurologic or neurosurgical COVID-19–related articles published to date. This list can be used to identify high-impact studies that will help health care practitioners in clinical decision making and researchers in navigating key areas of study and guiding future research. [ABSTRACT FROM AUTHOR]

Patients with neurologic diseases have complex medical needs and may benefit from the addition of clinical pharmacists in their care. This study aimed to describe integration and benefit of clinical pharmacists in neuroimmunology and neuromuscular clinics at an academic medical center. This retrospective chart review evaluated patients initiated on a neurology medication for a neuroimmunology or neuromuscular disease state before and after pharmacist integration in neurology clinics. The primary outcome measured access to an initially prescribed neuroimmunology or neuromuscular medication within 90 days of prescription. Secondary outcomes included access to an initially prescribed or alternative neurology medication owing to insurance requirements within 90 days, time from initial prescription to start, and description of pharmacist involvement. There were 101 patients in the pregroup and 101 patients in the postgroup. The percentage of patients with confirmed initially prescribed medication access at 90 days increased in the postgroup compared with the pregroup (87.1% vs. 72.5%, respectively, P = 0.014). For secondary outcomes, the percentage of patients who started on an initially prescribed or alternative neuroimmunology or neuromuscular medication within 90 days also increased in the postgroup compared with the pregroup (90.0% vs. 73.3%, respectively, P = 0.004). Additional pharmacist involvement occurred in 64 patients (63.4%) in the postgroup and included prior authorization approval assistance, drug information support, and medication liaison interventions, with an average of 4.7 pharmacist interventions at each pharmacy-led encounter. The addition of pharmacists into neuroimmunology and neuromuscular clinics improved operational access to medications for neuroimmunology and neuromuscular conditions. In addition, pharmacists were able to assist with multiple areas of patient care including medication education, monitoring, and serving as a medication liaison. This study supports continuing to offer clinical pharmacy services in neuroimmunology and neuromuscular departments and may support the addition of clinical pharmacists into neurology services at other institutions. [ABSTRACT FROM AUTHOR]

1. Evaluate the state of advance care planning procedure codes in neurological disease. 2. Investigate healthcare and palliative outcomes associated with use of advance care planning codes. Neuropalliative care emphasizes the need to reduce suffering and improve quality of life for the 1 billion people living with neurological disease worldwide. Advance care planning (ACP) procedure codes (CPT 99497 and 99498) have been established to reimburse meaningful care-goal discussions, but these codes are underutilized in neurological patients. Using the TrinetX database, real-world electronic health data was collected from over 800,000 individuals across 92 institutions with one of four neurological diseases: Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis (ALS), and ischemic stroke. The findings were similar across these illnesses. ACP procedure codes were documented in 2.5% of patients, commonly at 2-years disease duration. Twenty percent of individuals had multiple ACP discussions noted. Furthermore, except in ALS, individuals who were white were 3% more likely to have the ACP codes documented than nonwhite individuals (p<0.015). After matching for demographic and health variables, usage of the ACP codes was associated with fewer hospitalizations and emergency visits and more palliative services (p<0.05). Multiple instances of ACP codes are further associated with more palliative encounters (p<0.05). Despite medical progress in neurology, many neurological diseases remain incurable. ACP procedure codes may represent meaningful conversations that help avoid burdensome care and increase symptom-focused management. Based on the positive associations identified in our study, we encourage more providers to have these conversations and document appropriately for reimbursement. Future work should investigate on a more granular scale how these codes are used in clinical practice to identify aspects of the care-delivery system that are most associated with healthcare and palliative outcomes. [ABSTRACT FROM AUTHOR]

The World Health Assembly (WHA) approved the Intersectoral Global Action Plan (IGAP) in 2022. This ambitious project, formally called the Intersectoral Global Action Plan for Epilepsy and Other Neurological Disorders, is a 10-year plan to enhance neurology implementation worldwide and to raise the status of brain health and neurology services for patients with neurological diseases. The IGAP has 5 important components: relation with policy makers, therapy, prophylaxis, research, and public health. The implementation of IGAP is a challenge, not only for the specialty of neurology but for the whole neurological community, encompassing patients, carers, healthcare providers, and the public. The lack of a unified definition of neurology and the great variety of health systems, as well as the dependency on socioeconomic status, will necessitate custom-made solutions in all regions. [ABSTRACT FROM AUTHOR]

Given widespread use of glucocorticoid therapy in neurologic disease, understanding glucocorticoid pharmacology and risk is paramount for the practicing neurologist. While dosing and tapering regimens vary depending on the neurological disease and indication being treated, there are important general principles of glucocorticoid prescribing and monitoring that can guide clinical decision-making. Glucocorticoid-related toxicities can occur across multiple organ systems, including hypertension; dyslipidemia; weight gain; hyperglycemia; osteoporosis and avascular necrosis; myopathy; gastrointestinal bleeding; infection; and neuropsychiatric effects with sleep, mood disturbance and cognition. This narrative review provides a practical framework for safe and responsible prescribing of this therapeutic class of medications, including appreciation of immunosuppressive consequences, risk mitigation strategies, dosing and tapering, and recognition of adrenal insufficiency and glucocorticoid withdrawal. • Glucocorticoids have widespread anti-inflammatory and non-inflammatory effects. • Glucocorticoids carry risk of toxicities with opportunities for risk mitigation. • Surveillance is needed to minimize risk of steroid-associated adrenal suppression. • Glucocorticoid taper benefits from stable and predictable dose reduction over time. [ABSTRACT FROM AUTHOR]