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Fetal cerebral ventriculomegaly is one of the most common fetal neurological disorders identified prenatally by neuroimaging. The challenges in the evolving landscape of conditions like fetal cerebral ventriculomegaly involve accurate diagnosis and how best to provide prenatal counseling regarding prognosis as well as postnatal management and care of the infant. The purpose of this narrative review is to discuss the literature on fetal ventriculomegaly, including postnatal management and neurodevelopmental outcome, and to provide practice recommendations for pediatric neurologists. [ABSTRACT FROM AUTHOR]

Part III of this contribution continues to celebrate the many contributions that Jewish physicians have made to advance the specialty of dermatology, as reflected by eponyms that honor their names. Part I covered the years before 1933, a highly productive period of creativity by Jewish dermatologists, especially in Germany and Austria. The lives of 17 Jewish physicians and their eponyms were described in Part I. Part II focused on the years of 1933 to 1945, when the Nazis rose to power in Europe, and how their anti-Semitic genocidal policies affected leading Jewish dermatologists caught within the Third Reich. Fourteen Jewish physicians and their eponyms are discussed in Part II. Part III continues the remembrance of the Holocaust era by looking at the careers and eponyms of an additional 13 Jewish physicians who contributed to dermatology during the period of 1933 to 1945. Two of these 13 physicians, pathologist Ludwig Pick (1868-1944) and neurologist Arthur Simons (1877-1942), perished in the Holocaust. They are remembered by the following eponyms of interest to dermatologists: Lubarsch-Pick syndrome, Niemann-Pick disease, and Barraquer-Simons syndrome. Four of the 13 Jewish physicians escaped the Nazis: Felix Pinkus (1868-1947), Herman Pinkus (1905-1985), Arnault Tzanck (1886-1954), and Erich Urbach (1893-1946). Eponyms that honor their names include nitidus Pinkus, fibroepithelioma of Pinkus, Tzanck test, Urbach-Wiethe disease, Urbach-Koningstein technique, Oppenheim-Urbach disease, and extracellular cholesterinosis of Karl-Urbach. The other seven Jewish physicians lived outside the reach of the Nazis, in either Canada, the United States, or Israel. Their eponyms are discussed in this contribution. Part III also discusses eponyms that honor seven contemporary Jewish dermatologists who practiced dermatology after 1945 and who continue the nearly 200 years of Jewish contribution to the development of the specialty. They are A. Bernard Ackerman (1936-2008), Irwin M. Braverman, Sarah Brenner, Israel Chanarin, Maurice L. Dorfman, Dan Lipsker, and Ronni Wolf. Their eponyms are Ackerman syndrome, Braverman sign, Brenner sign, Chanarin-Dorfman syndrome, Lipsker criteria of the Schnitzler syndrome, and Wolf's isotopic response. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the effects of a nurse-led cognitive behavioral intervention for parents of children with epilepsy (CWE). The study recruited 238 CWE from the neurology ward of Xiangya Hospital from March 2019 to August 2022. According to the interventions after discharge, the children and their parents were randomly divided into 117 parent-child dyads in the intervention group and 121 parent-child dyads in the control group. The seizure severity and treatment compliance in CWE as well as the parents' psychological states and satisfaction with the care provided by nurses were compared before and after intervention. The follow-up six months after discharge showed that the seizure frequency among CWE in the intervention group was significantly less than the controls (P = 0.048). Compared with the controls, the intervention group also reported fewer symptoms of anxiety and depression, better sleep quality, and more positive attitudes toward epilepsy, as well as higher nursing satisfaction (P < 0.001). The correlation analysis indicated the correlation of CWE's seizure severity was correlated with the compliance, parents' psychological states, and parents' satisfaction with the care provided by nurses. The adoption of the nurse-led cognitive behavioral intervention on parents of CWE can improve the parents' mental health status and their satisfaction with the nurses, which can have a positive association with the seizure severity of CWE. In light of this information, this nursing intervention may be a new method for the long-term disease management of CWE. [ABSTRACT FROM AUTHOR]

• Are there disparities in gender, skin colour, education, academic productivity, and career progression among neurologists? • There was predominance of men at consultant level, with a university affiliation, and with a full professor position. • All 24 female full professors had white skin colour. • Darker-coloured neurologists were less likely to have a PhD, be consultants, and it took them longer to become consultants. • Disparities among consultant neurologists in the UK need to be addressed in the future. Equitable representation is key for successful clinical and research work. Inequalities in gender, skin colour, and education have been found among professionals in many medical, surgical and academic fields, but have not been examined yet in the current UK neurologists' workforce. This cross-sectional study examined whether there are disparities in gender, perceived skin colour, education, academic productivity, and career progression among UK neurologists. The names of consultant neurologists working in the UK anytime between December 2021 and March 2022 were found via an online search. Online data were collected regarding education, research activity, academic productivity, impact and progression. A total of 1010 consultant neurologists were found to be working in the UK. There was predominance of men at consultant level, with a university affiliation, and with a full professor position. All 24 female full professors had white skin colour. There were no skin colour or gender disparities in currently being affiliated with a top university, obtaining a Master's degree, or duration between medical degree obtainment and becoming full professors. However, less black or brown neurologists had obtained a PhD, were consultants, and it took them a longer time from medical school graduation until becoming consultants. Less females were currently affiliated with a university and had obtained their medical degree from a top university. There were also skin colour and gender disparities in bibliometrics. In conclusion, this study revealed that there are gender, skin colour, education, academic productivity, and career progression gaps among UK consultant neurologists, which need to be addressed. [ABSTRACT FROM AUTHOR]

• A review was undertaken of an Australia-wide ambulatory video-EEG monitoring service. • Patients were in view of camera for 94.90% of events, and 84.89% of studies had all events on camera. • 84.42% of events from wakefulness were reported, compared to 54.27% from sleep. Recording electrographic and behavioral information during epileptic and other paroxysmal events is important during video electroencephalography (EEG) monitoring. This study was undertaken to measure the event capture rate of an home service operating across Australia using a shoulder-worn EEG device and telescopic pole-mounted camera. Neurologist reports were accessed retrospectively. Studies with confirmed events were identified and assessed for event capture by recording modality, whether events were reported or discovered, and physiological state. 6,265 studies were identified, of which 2,788 (44.50%) had events. A total of 15,691 events were captured, of which 77.89% were reported. The EEG amplifier was active for 99.83% of events. The patient was in view of the camera for 94.90% of events. 84.89% of studies had all events on camera, and 2.65% had zero events on camera (mean = 93.66%, median = 100.00%). 84.42% of events from wakefulness were reported, compared to 54.27% from sleep. Event capture was similar to previously reported rates from home studies, with higher capture rates on video. Most patients have all events captured on camera. Home monitoring is capable of high rates of event capture, and the use of wide-angle cameras allows for all events to be captured in the majority of studies. [ABSTRACT FROM AUTHOR]

1. Participants will be able to identify goals of care conversation domains. 2. Participants will be able to understand the components of a high quality goals of care conversation. While observing interactions between neurologists and hospitalized patients suffering stroke, only 1-in-3 patients had an observed goals of care conversations (GOCC) between the neurologist and the patient and/or their surrogate medical decision maker at any point during hospitalization. The results of these observations indicate a need to increase the prevalence and content quality of GOCC for patients hospitalized after stroke. Goals of Care Conversations (GOCC) are crucial for determining patient's preferences, values, and goals of medical care. To determine the prevalence and content of GOCC between neurologists and hospitalized patients suffering stroke. Neurologists were observed every day for eight weeks during routine hospital rounds. A standardized checklist was used to determine domains and content of GOCC between neurologists and patients and/or their support person. Conversation encounters were categorized into the following domains: symptoms, diagnosis, prognosis, treatment plan, patients' preferences, values, and goals (preferences), quality of life (QOL), and establishing goals of medical care (establishing goals). Conversations in the domains of patient's preferences, QOL, and establishing goals were considered GOCC. Descriptive data was analyzed to determine prevalence of GOCC, conversation content, and conversation details including how, when, where, and with whom the conversation took place. Thirty-one stroke patients were observed during n=109 encounters with neurologists. Patients were primarily male (68%), with a median age of 60 years old. Approximately half of patients were White (48%), and half were Black (48%). A total of 11 patients (35%) had at least one observed GOCC encounter. Among patients with a GOCC, there were 21 total GOCC encounters. The GOCC encounters included 14 (13%) about patient preferences, 13 (12%) regarding establishing goals, and 7 discussed QOL (6%). During the 109 encounters, less than half (40%) of patients and/or their support persons asked any question about their care. Neurology residents were present during 79 encounters, and attendings during 57. Only 1/3 of stroke patients had an observed GOCC during their hospitalization. When GOCC occurred, they were primarily about patient preferences, and establishing a treatment plan. QOL was rarely discussed. The results of these observations indicate a need to increase the prevalence and content quality of GOCC for patients hospitalized after stroke. Communication / Models of Palliative Care Delivery [ABSTRACT FROM AUTHOR]

1. Classify the common abortive and prophylactic medication choices to treat pediatric PSH. 2. Recognize the variation in pharmacologic management between pediatric specialties for treating pediatric PSH. There are currently no studies that describe practice patterns among clinicians to manage pediatric paroxysmal sympathetic hyperactivity (PSH), frequently referred to as dysautonomia or "storming." We performed a national survey with 295 respondents that showed significant heterogeneity in which specialties were primarily responsible in managing PSH, as well as significant variability in medication choices between specialties. Pediatric paroxysmal sympathetic hyperactivity (PSH), frequently referred to as dysautonomia and "storming," is a common source of discomfort among children with severe neurological impairment. Despite more than 20 classes of medications being described in the literature to treat PSH, there are currently no studies that broadly describe utilization patterns among pediatric clinicians and recommendations rely on expert opinion. To describe current trends in pharmacologic management of PSH among pediatric physicians practicing in North America. From March through August 2023, attending physicians were invited to complete a cross-sectional online survey conducted via Qualtrics. We explored medication preferences and examined which specialties were primarily responsible for managing PSH at their institution. Descriptive statistics were calculated; subgroup analyses were conducted using Chi-squared and Fisher's exact tests. Of 295 respondents, 33% were palliative care physicians, 23% were pediatric neurologists, 18% were complex care specialists, and 17% were physiatrists. The majority (76%) of respondents felt very/somewhat comfortable managing pediatric PSH. Subspecialties primarily responsible for managing inpatient PSH varied significantly: physiatry (32%), neurology (26%), critical care medicine (15%), palliative care (4%), and general pediatrics (3%). The most frequently used abortive medications were GABA-A agonists (e.g., lorazepam) (85.7%) and alpha-2 agonists (e.g., clonidine) (78.6%). The most used maintenance medications were alpha-2 agonists (89.6%) and gabapentinoids (88.6%). For both abortive (p< 0.01) and maintenance (p< 0.05) treatment, use of opioids, alpha-2 agonists, and dopamine agonists varied significantly when comparing palliative care, neurology, complex care, and physiatry. Significant heterogeneity in pharmacologic management of pediatric PSH exists, especially across pediatric subspecialties. Future work comparing efficacy of PSH management strategies could be helpful in improving consistency of optimal management. Pharmacotherapeutics / PharmacopalliationScientific Research [ABSTRACT FROM AUTHOR]

Les vascularites systémiques primitives, principalement des petits et moyens vaisseaux, s'associent de façon fréquente à la survenue de neuropathies périphériques. Lorsque la maladie est connue, l'apparition d'une neuropathie doit faire évoquer une atteinte spécifique, ce d'autant plus qu'associée à d'autres atteintes systémiques. À l'inverse, quand la neuropathie est inaugurale, une collaboration étroite entre neurologues et internistes est nécessaire pour aboutir au diagnostic. Une enquête électro-clinique standardisée précisant la topographie, l'évolutivité et le mécanisme de l'atteinte nerveuse permet le diagnostic positif de la neuropathie. Plusieurs éléments permettent d'orienter le diagnostic étiologique, et d'éliminer le principal diagnostic différentiel : les vascularites nerveuses limitées au nerf périphérique. On retient notamment l'existence de manifestations systémiques associés (néphropathie glomérulaire ou vasculaire, pneumopathie interstitielle, hémorragie intra-alvéolaire, atteinte ORL, etc.), de marqueurs biologiques discutés en fonction de la neuropathie (ANCA, cryoglobulinémie, facteur rhumatoïde) et d'examens invasifs permettant une analyse histologique (biopsie neuromusculaire). Primary systemic vasculitides, mainly of the small and medium-sized vessels, are frequently associated with peripheral neuropathies. When the disease is already known, the appearance of a neuropathy should suggest a specific injury, especially when associated with other systemic manifestations. Conversely, when neuropathy is inaugural, close collaboration between neurologists and internists is necessary to reach a diagnosis. A standardized electro-clinical investigation specifying the topography, the evolution and the mechanism of the nerve damage enables the positive diagnosis of the neuropathy. Several elements orient the etiological diagnosis and allow to eliminate the main differential diagnosis: non systemic vasculitic neuropathy. The existence of associated systemic manifestations (glomerular or vascular nephropathy, interstitial lung disease, intra-alveolar hemorrhage, ENT involvement...), biological markers (ANCA, cryoglobulinemia, rheumatoid factor), and invasive examinations allowing histological analysis (neuromuscular biopsy) are all useful tools for. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess the extent and drivers of telehealth use variation across clinicians within the same pediatric subspecialties. METHODS: In this mixed methods study, 8 pediatric medical groups in California shared data for eleven subspecialties. We calculated the proportion of total visits delivered via telehealth by medical group for each subspecialty and identified the 8 most common International Classification of Diseases 10 diagnoses for telehealth and in-person visits in endocrinology and neurology. We conducted semi-structured interviews with 32 pediatric endocrinologists and neurologists and applied a positive deviance approach comparing high versus low utilizers to identify factors that influenced their level of telehealth use. RESULTS: In 2019, medical groups that submitted quantitative data conducted 1.8 million visits with 549,306 unique pediatric patients. For 3 subspecialties, there was relatively little variation in telehealth use across medical groups: urology (mean: 16.5%, range: 9%-23%), orthopedics (mean: 7.2%, range: 2% -14%), and cardiology (mean: 11.2%, range: 2%-24%). The remaining subspecialties, including neurology (mean: 58.6%, range: 8%-93%) and endocrinology (mean: 49.5%, range: 24%-92%), exhibited higher levels of variation. For both neurology and endocrinology, the top diagnoses treated in-person were similar to those treated via telehealth. There was limited consensus on which clinical conditions were appropriate for telehealth. High telehealth utilizers were more comfortable conducting telehealth visits for new patients and often worked in practices with innovations to support telehealth. CONCLUSIONS: Clinicians perceive that telehealth may be appropriate for a range of clinical conditions when the right supports are available. [ABSTRACT FROM AUTHOR]

Background: There has been a growing impetus for developing pediatric neurocritical care (PNCC) programs to improve care delivery for children with critical neurological conditions. We sought to develop a unique PNCC program using the concept of Community of Practice (CoP).Methods: This is a process improvement project in an academic Children's Hospital. Using CoP framework (domain, community, practice), we created a domain of PNCC with a stated vision and formal organizational structure, a core community of intensivists and neurologists interested in PNCC, and a standardized practice approach by establishing core competencies for PNCC and implementing practice guidelines.Results: We evaluated the program through the Four-Frame Model of Organizational Theory and Behavior (structural, human resource, political, symbolic) and by the Neurocritical Care Society's (NCS's) standards for a Level I Neurocritical Care Unit (Neuro-ICU). Structural frame included opening a pediatric Neuro-ICU, identifying PNCC leaders across specialties, and developing a multidisciplinary care delivery model. Human resource frame included forming physician and nurse groups with a primary role in PNCC and ongoing education through workshops, lecture series, and certification. Politically, program implementation was tailored to each department gaining institution-wide support for program initiatives. Symbolically, the PNCC program highlighted the vision to advance knowledge and best practices. Our program met 232 of 252 (92%) proposed NCS standards.Conclusions: The CoP as the foundation for program development has enabled us to achieve the majority of standards proposed by NCS for a Level I Neuro-ICU. The generalizability of these frameworks may facilitate the development of a PNCC program for other institutions. [ABSTRACT FROM AUTHOR]

Although care of Parkinsonism (PKM) is assumed to be optimally provided by movement disorder neurologists within an interdisciplinary clinic model, there is a paucity of published data to support this. To investigate the impact of movement disorder neurologist care of individuals with Parkinsonism (PKM). A retrospective exposure design was adopted using administrative data. Incident PKM individuals were identified in billing claims. A nine-year exposure period to movement disorder neurologist, general neurologist and non-neurologist care was calculated based on the billing codes. Regression models were used to test the association of provider exposure on time to death and long-term care (LTC) admission. Linear models were used to test varying provider exposure and hospital admissions, hospital days and emergency department visits. 1914 incident individuals were identified. There was no difference in PKM mortality, emergency visits, hospital admissions, or hospital days between providers, however exposure to general neurology and non-neurology care was associated with a significantly higher risk of admission to LTC compared to movement disorder neurologist care (HR 1.43; 95% CI 1.09–1.87 for general neurology (p-value = 0.0089); HR 1.61; 95% CI 1.25–2.05 for non-neurology (p-value = 0.0002), respectively. Movement disorder neurologist care is associated with a lower risk of admission to LTC over general neurologist care in individuals with PKM. • It is not yet proven what model of care is best to manage Parkinson Disease. • We studied models of care in a cohort of 1914 incident cases of Parkinsonism over 9 years. • Movement disorder neurologist care is associated with a lower risk of admission to long term care. • Movement disorder neurologist is associated with a reduction in hospital admission. • Evidence supports that Parkinson Disease is best managed by Movement disorder neurologists. [ABSTRACT FROM AUTHOR]

Telephone appointments are now widely used in seizure treatment, but there is little understanding of how they compare to face-to-face appointments. Studies from other fields suggest that comparisons can be done on three levels: 1) Abstract level: duration of appointment. 2) Structural level: distribution of talk. 3) Detailed level: aspects of communication. This study aims to compare seizure clinic face-to-face and telephone appointments based on their duration, distribution of talk, and the number of questions asked by patients/companions. Statistical comparison between recordings and transcripts of 34 telephone appointments (recorded in 2021) and 56 face-to-face appointments (recorded in 2013). There was no significant difference between the duration of face-to-face (median: 16.5 min) and telephone appointments (median: 16.2 min). There was no significant difference in the ratio of neurologist to patient/companion talk (face-to-face: 55% vs. 45%, telephone: 54% vs. 46%). Patients/companions asked significantly more questions per minute in face-to-face (median: 0.17) than telephone appointments (median: 0.06, p < 0.05). At a broad level, seizure clinic face-to-face and telephone appointments are similar. Examining the details of the interaction, however, reveals important differences in questioning. Practitioners could take steps to facilitate patient questioning in telephone appointments. • Face-to-face and teleconsultations were of comparable duration. • The ratio of doctor to patient talk was comparable between modalities. • Patients asked significantly fewer questions in teleconsultations. • These findings were not explained by the presence of a companion. • Practitioners could take steps to encourage patient questions in teleconsultations. [ABSTRACT FROM AUTHOR]

Background: In addition to physical health, pandemics affect mental health. The aim was to reveal problems encountered during the coronavirus disease 2019 (COVID-19) pandemic by pediatric neurologists and pediatric neurology residents in Turkey.Methods: Participants were sent a survey form using Google Forms between November 05, 2020, and December 07, 2020. The form included questions about demographic information, changes to services offered, effects of the COVID-19 pandemic on patient follow-up/treatment and doctor decision-making, the Depression-Anxiety-Stress Scale 21, and the Impact of Events scale for posttraumatic stress disorder.Results: A total of 232 pediatric neurologists and residents (mean age: 40.67 ± 7.8 years) participated. Of these 182 participants (78.4%) stated the pandemic had affected decisions during diagnosis and treatment management. A total of 222 participants completed the Depression-Anxiety-Stress Scale 21 and Impact of Events scale. Of these, points at levels that were "severe and very severe" were present for 42 participants (18.9%) for depression, 29 participants for anxiety (13%), and 31 participants for stress (14%). Impact of Events scale points were high at "severe" levels for 122 participants (55%). All scores were higher for those with individuals at risk in terms of COVID-19 in their family compared with those without individuals at risk in the family (P < 0.05).Conclusions: As we emerge from the destruction caused by COVID-19, it will be beneficial not only for our professional practice but also in terms of our individual health to learn lessons that will assist in managing the next pandemic waiting in our future. [ABSTRACT FROM AUTHOR]

Background: The current practice of child neurology in Latin America has been impacted by the waves of sociopolitical unrest that in the last decades have swept the region.Methods: We searched the available literature referring to the situation of child neurology in Latin America and conditions that specifically impact the region.Results: In lower-middle-income countries, the number of child neurologists is inadequate. Child neurologists working in large public hospitals can only afford to do so on a part-time basis as these institutions are chronically underfunded. Several circumstances are particularly relevant to Latin America: Spanish is the main language spoken, something that limits the opportunity to keep local child neurologists up to date. The structure of health care systems in Latin America varies significantly. Some countries have fragmented systems with inadequate capacity to offer equitable access to medical care. Latin America has been impacted by epidemics of arthropod-borne viruses: zika, chikungunya, and dengue. It stands to reason that the COVID-19 pandemic will affect the distribution of resources for chronic neurological conditions.Conclusions: The virtual platforms such as Zoom, expanded during the COVID-19 pandemic, are useful not only to improve access to care through telemedicine but also for educational purposes. Collaborative efforts to support educational courses and symposia in Spanish are ongoing. It is necessary to set short- and long-term priorities to improve child neurology care in the region. Immediate priorities should focus on improving the diagnosis of neurological conditions, making emphasis on locally available resources. [ABSTRACT FROM AUTHOR]

Delayed cerebral ischemia (DCI) contributes to poor outcomes after subarachnoid hemorrhage (SAH). The pathophysiology of DCI is not fully understood, which has hindered the adoption of a uniform definition. Furthermore, a reliable diagnostic test and an effective evidence-based treatment are lacking. This could lead to variations in care. A web-based survey on the variations in the definition, diagnosis, and treatment of DCI was designed and sent to 314 intensivists, neurologists, and neurosurgeons of all 9 hospitals in the Netherlands who care for patients with SAH. The responders were categorized into physicians responsible for the coordination of SAH care and those who were not. For questions on the definition and diagnosis, only the responses from the coordinating physicians were evaluated. For the treatment questions, all the responses were evaluated. The response rate was 34% (106 of 314). All 9 hospitals were represented. Of the responses, 27 did not provide answers for the definition, diagnosis, or treatment questions; 79 responses were used for analysis. Signs of vasospasm were required by 21 of the 47 coordinating physicians (44%) when considering DCI. Of the 47 coordinating physicians, 24 (51%) did not use a diagnostic test results for a positive diagnosis of DCI. When patients were discharged within 21 days, 33 of the 73 responders (45%) did not provide a prescription for nimodipine continuation. Finally, all but one hospital had treated DCI with hypertension induction. We found large variations in the definition, diagnosis, and treatment of DCI in the Netherlands. In the absence of evidence-based treatment, standardization of management seems warranted in an effort to optimize DCI care. [ABSTRACT FROM AUTHOR]

Genetic advances over the past decade have enhanced our understanding of the genetic landscape of childhood epilepsy. However a major challenge for clinicians ha been understanding the rationale and systematic approach towards interpretation of the clinical significance of variant(s) detected in their patients. As the clinical paradigm evolves from gene panels to whole exome or whole genome testing including rapid genome sequencing, the number of patients tested and variants identified per patient will only increase. Each step in the process of variant interpretation has limitations and there is no single criterion which enables the clinician to draw reliable conclusions on a causal relationship between the variant and disease without robust clinical phenotyping. Although many automated online analysis software tools are available, these carry a risk of misinterpretation. This guideline provides a pragmatic, real-world approach to variant interpretation for the child neurologist. The focus will be on ascertaining aspects such as variant frequency, subtype, inheritance pattern, structural and functional consequence with regard to genotype-phenotype correlations, while refraining from mere interpretation of the classification provided in a genetic test report. It will not replace the expert advice of colleagues in clinical genetics, however as genomic investigations become a first-line test for epilepsy, it is vital that neurologists and epileptologists are equipped to navigate this landscape. • Monogram on real world genetic test interpretation in the epilepsy clinic. • Necessity of robust genotype-phenotype correlations in childhood epilepsy. • Clinical approach to variants of uncertain significance. [ABSTRACT FROM AUTHOR]

Multiple system atrophy (MSA) is a neurodegenerative disease with presentations including parkinsonism, autonomic disturbances, gait impairment and mood disorders. The progressive nature of MSA results in a significant deterioration in quality of life for patients. To investigate the needs of people with MSA (PwMSA) in the United Kingdom (UK) and the support provided to them. A survey of members of the UK's MSA Trust including PwMSA and former carers explored questions on the physical, emotional, personal and financial impact of MSA and on support received. There were 284 valid responses from PwMSA and 371 responses from former carers. Difficulties with movement were universally experienced by PwMSA. The majority of former carers reported these as difficult or very difficult to manage (90 %), followed by autonomic problems (85 %) and breathing, speech or swallowing problems (81 %). PwMSA also reported fatigue (96 %), mood disorders (80 %) and social isolation (82 %). 41 % of former carers felt that the emotional needs of PwMSA had not been met. Many also reported inadequately covered financial needs (48 %). Equipment used most commonly included mobility equipment (90 %). The majority received support from neurologists (95 %) and GPs (92 %), but few from palliative care or mental health professionals. Satisfaction was highest for support from palliative services (95 %) and specialist nurses (91 %). This survey demonstrates the high burden of MSA across various aspects of life for PwMSA. It suggests that whilst there is good provision of neurology services and physical equipment, there is a need to improve support for their emotional and social needs. • The most common problems reported were difficulties movingsymptoms and breathing, speech or swallowing problems. • They also frequent experience fatigue, mood disorders and social isolation but their emotional needs are often not met. • Many people with multiple system atrophy have inadequately met financial needs. • Few people with multiple system atrophy receive support from palliative care or mental health professionals. • Satisfaction for support from palliative care and specialist nurses is high. [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]

Evaluate adherence, discontinuation rates, and reasons for non-adherence and discontinuation of prescription CBD during the 12-months post-initiation period at an integrated care center. This was a prospective study of patients prescribed CBD by a neurology clinic provider with initial prescription fulfillment through the center's specialty pharmacy from January 2019 through April 2020. Baseline demographics and reasons for non-adherence and/or discontinuation were collected from the electronic health record and pharmacy claims history was used to calculate adherence using proportion of days covered (PDC). Patients were included in the PDC analysis if they had at least 3 fills during the study period. Non-adherence was defined as a PDC < 0.8. Descriptive statistics were used to summarize data with categorical variables represented as frequencies and percentages and continuous variables as medians and interquartile ranges (IQRs). We included 136 patients with a median age of 14 years (IQR 9 - 21). Most patients were white (n = 115, 85%), with a diagnosis of intractable epilepsy (n = 100, 74%). Among the 128 patients with 3 or more fills, the median PDC was 0.99 (IQR 0.95 – 1.00) with non-adherence seen in 6% (n = 8) of patients. The most common reason for non-adherence was side effects (n = 2, 25%). Prescription CBD was discontinued by 23% (n = 31) of patients with a median time to discontinuation of 117 days (IQR 68 – 216). The most common reason for discontinuation was major side effects (n = 12, 39%). The most common side effects leading to discontinuation were agitation/irritability (n = 4), mood changes (n = 4), aggressive behavior (n = 3), and increased seizure frequency (n = 3). Adherence to prescription CBD at an integrated care center was high with approximately 94% of patients considered adherent. Providers and pharmacists may improve adherence and discontinuation rates by educating patients on the timeline of response, potential side effects, and potential for dose adjustments. • Approximately 94% of patients are adherent to prescription cannabidiol (CBD). • Prescription CBD was discontinued by 23% of patients within 12-months of initiation. • Providers may improve adherence and discontinuation via education and dose changes. [ABSTRACT FROM AUTHOR]

• EEG-based ML techniques for seizure prediction achieved promising results. • Various factors can influence the performance of EEG-based ML algorithms. • ML-based algorithms provide considerable opportunities for clinicians in the field. • Prediction model including patient clinical characteristics can be further developed. • With cooperation of related fields, the area can be advanced by novel ML based techniques. The unpredictability of epileptic seizures is one of the most problematic aspects of the field of epilepsy. Methods or devices capable of detecting seizures minutes before they occur may help prevent injury or even death and significantly improve the quality of life. Machine learning (ML) is an emerging technology that can markedly enhance algorithm performance by interpreting data. ML has gained increasing attention from medical researchers in recent years. Its epilepsy applications range from the localization of the epileptic region, predicting the medical or surgical outcome of epilepsy, and automated electroencephalography (EEG) analysis to seizure prediction. While ML has good prospects with regard to detecting epileptic seizures via EEG signals, many clinicians are still unfamiliar with this field. This work briefly summarizes the history and recent significant progress made in this field and clarifies the essential components of the automatic seizure detection system using ML methodologies for clinicians. This review also proposes how neurologists can actively contribute to ensure improvements in seizure prediction using EEG-based ML. [ABSTRACT FROM AUTHOR]

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]

A shorter door-to-puncture time is an independent predictor of good clinical outcomes in patients with acute ischemic stroke (AIS) who undergo mechanical thrombectomy (MT). We recently initiated a protocol for direct care from neurointerventionalists (NIs) in the emergency department (ED) rather than from non-NI neurologists for patients with AIS. Our aim was to investigate whether NIs, as the first point-of-care physicians for stroke in the ED, could shorten door-to-puncture time compared to non-NI neurologists. From January 2020 to December 2020, 50 patients with AIS underwent MT at our hospital. Patients were divided into 2 groups based on the type of physician who provided initial care for stroke in the ED: (a) NI group (n = 20) and (b) non-NI group (n = 30). The door-to-puncture time was retrospectively analyzed. The NI group had a significantly shorter door-to-puncture time than the non-NI group (135.2 ± 50.0 minutes vs. 167.2 ± 54.3 minutes, P = 0.040). A door-to-puncture time of ≤120 minutes was more frequently achieved in the NI group than in the non-NI group (55.0% vs. 23.3%, P = 0.022). Multivariable logistic regression analysis revealed that a door-to-puncture time of ≤120 minutes was independently associated with the NI group (adjusted odds ratio 4.098, 95% confidence interval 1.085–15.479, P = 0.037). Our study showed that NIs, as the first point-of-care stroke physicians in the ED, were associated with shorter door-to-puncture times. We suggest that NIs should be at the forefront of care for patients with AIS in the acute setting by performing triage and deciding on and performing MT. [ABSTRACT FROM AUTHOR]

Neurological disorders are the leading cause of disability and the second leading cause of death globally. To challenge this enormous disease burden, scientists are pursuing innovative solutions to maintain and improve the quality of neurological care. Despite the availability of many effective evidence-based practices, many patients with neurological disorders cannot access these (or receive them inefficiently after a long delay) and may be exposed to unnecessary, expensive, and potentially harmful treatments. To promote the systematic uptake of evidence-based practices into the real world, a new scientific study of methods has been developed: implementation science. In implementation science research, transdisciplinary research teams systematically (using theory, model, and framework) assess local barriers to facilitate the adoption of evidence-based practices and examine potential solutions using implementation strategies (interventions that help adoption of intended practices) targeting multiple levels in the health care system, including patient, provider, clinic, facility, organization, or broader community and policy environment. The success of these strategies (implementation outcomes) is measured by the extent and quality of the implementation. Implementation studies can be either observational or interventional but are distinct from traditional efficacy or effectiveness studies. Traditional neuroscience research and clinical trials, conducted in controlled settings, focus on discovering new insights with little consideration of translating those insights into the everyday practice of a resource-constrained and dynamic health care system. Thus, neurologists should become familiar with implementation science to reduce the knowledge-practice gap, maximize health care value, and improve management of brain disorders affecting public health. [ABSTRACT FROM AUTHOR]

To prospectively evaluate the effectiveness and safety of radiosurgical thalamotomy in patients with Essential Tremor (ET). Patients underwent stereotactic radiation VIM thalamotomy by a dedicated Cobalt 60 intracranial radiosurgery platform in a fixed headframe. 130 Gy was prescribed to the 100% isodose point with single 4mm collimator. Effectiveness was evaluated using validated tremor rating scale: upper limb CRST Part B ratings (CRST) in comparison to baseline. To be eligible minimal CRST score of 2 in writing or drawing was required. Writing and drawing score assessments were conducted by a single movement disorder neurologist in a blinded fashion. Mean writing and drawing scores were statistically compared with paired t-test. A total of 213 cases (203 patients) were enrolled in the study, 7 cases (and individual patients) withdrew prior to treatment. The total number of thalamotomies performed was 206. Ten patients had right and left thalamotomies on study. Eleven patients underwent a contralateral thalamotomy but their initial thalamotomy was not a case in this study. 30 patients withdrew or were lost to follow-up, 2 patients were withdrawn due to not meeting medication criteria after treatment, 12 patients were withdrawn not meeting CRST rating criteria. Two patients were lost to follow-up immediately following the procedure (one of whom was a patient who underwent right and left staged procedures – no follow-up was obtained after the second procedure). 177 cases completed 6-month follow-up; 169 cases completed 1 year follow-up; 113 cases completed 2-year follow-up. For 189 total evaluable cases pre-treatment, drawing score mean was 2.86 +/- 0.84, pre-treatment writing score mean was 2.96 +/- 0.86. WRITING At one year: 143 cases (writing side targeted) mean writing score 1.28 +/-1.11 P<.01. 77% of cases improved by 1 point or greater. At two years: 102 cases 1.48+/-1.11, P<.01. 78% of cases improved by 1 point or greater. DRAWING At one year: 169 cases mean drawing score 1.42 +/-0.97, P<.01. 71% of cases improved by 1 point or greater. At two years: 113 cases mean drawing score 1.49+/-0.98, P<.01. 71% of cases improved by 1 point or greater. Cumulative side effects at 6 months and 1 year were seen in 17 of 175 of patients. 12 mild, 3 moderate and 2 severe. Mild side effects included numbness of the fingers, lip or hand and mild dysarthria. Severe side effects were 1 thalamic hemorrhage resulting in contralateral weakness. 1 patient developed foot drop and slurring of speech. Cumulative 2-year side effects were 15 mild, 3 moderate and 3 severe (1 additional thalamic hemorrhage). Stereotactic radiosurgical thalamotomy provided a significant reduction in tremor at 1 and 2 years. The treatment is an effective noninvasive treatment option worthy of consideration in many patients. The treatment has a low but non-zero risk of significant SEs. [ABSTRACT FROM AUTHOR]

Neurocritical diseases and conditions are common causes of long-term disability and mortality. Early recognition and management of neurocritically ill patients is a significant challenge for neurosurgeons, neurologists, and neurointensivists. Although cerebral angiography, magnetic resonance imaging, computed tomography, and radionuclide imaging are useful in neuromonitoring and neuroimaging, they have several important limitations: they are not readily available, cannot be used for a continuous assessment of cerebral function, and frequently require patient transport to the radiological department. Near-infrared spectroscopy (NIRS) is an inexpensive, portable, noninvasive method that does not require advanced expertise and can be used at the bedside for critically ill patients without moving them to the radiology department. NIRS can detect and monitor multiple critical parameters, including cerebral oximetry, intracranial pressure, temperature, and cerebral blood flow. NIRS can be valuable for a wide variety of neurocritical diseases and conditions, such as ischemic and hemorrhagic strokes, severe traumatic brain injury, brain tumors, and perioperative neurosurgery. Although NIRS has been studied extensively in multiple neurocritical conditions, more evidence on its application is needed. [ABSTRACT FROM AUTHOR]

Neurological disorders are one of the reasons for admission in pediatric emergency departments (PEDs). We aimed to evaluate the frequency of neurological disorders seen in a large tertiary PED. We conducted a one-year retrospective study that included 1471 medical records. Inclusion was based on the main complaint recorded by nurses at triage. We also retrieved the final diagnoses and the investigations performed in the PED. About 3.4% of the yearly admissions was based on a neurologic complaint on arrival. The final diagnosis was of a neurologic disorder in 1237 children, 2% of which were admitted to the pediatric intensive care unit. An opinion from a child neurologist was requested for 33% of the children. Seizures were the most frequent reason for admission, followed by headaches. A previous visit to the PED in the past six months was a frequent finding (40%), and about one third of the patients with a neurologic diagnosis (except headaches) was already being followed by a child neurologist. Neurological disorders are frequent in our PED and are mainly represented by seizures and headaches. Appropriate training in epileptology might be helpful for healthcare professional working in PEDs. • Neurological disorders account for 3,4% of the total admission in a large tertiary PED in Europe. • Seizures and headache are the most frequent neurological diagnoses. • An earlier visit is common in children seen for a neurological complaint. • Child neurologists opinion was requested for roughly one third of these children. [ABSTRACT FROM AUTHOR]

Migraine is a common and invalidating disorder worldwide. Patients of all ages experience the disorder as very impairing regarding their personal and occupational lives. The current approach in migraine therapy is multimodal including lifestyle management, psychoeducation and, if available, psychotherapeutic interventions, and pharmacotherapy. The lack of non-pharmacological and non-invasive treatment options call for new and innovative therapeutic approaches. Peripheral neurostimulation is a relatively new method in migraine management offering a painless and non-pharmacological way of targeting specific mechanisms involved in migraine. This review summarizes 15 recent randomized clinical trials to provide an overview of non-invasive peripheral neurostimulation methods currently available for the treatment of migraine. Efficacy, tolerability, and safety of the different interventions and their feasibility in the pediatric setting are evaluated. Vagal nerve stimulation (VNS), remote electrical neuromodulation (REN) and supraorbital nerve stimulation (SNS) are considered effective in treating acute migraine attacks, the latter being more pronounced in migraine without aura. Regarding migraine prevention, occipital nerve stimulation (ONS) and supraorbital nerve stimulation (SNS) demonstrated efficacy, whereas repetitive neuromuscular magnetic stimulation (rNMS) may represent a further effective option in episodic migraine. REN and rNMS were found to be well-accepted with fewer patients discontinuing treatment than those receiving direct cranial nerve stimulation. In summary, peripheral neurostimulation represents a promising option to complement the multimodal therapy concept for pediatric migraine. In particular, rNMS opens a new field for research and treatment fitting the requirements of "non-invasiveness" for children. Given the reported efficacy, safety, and feasibility, the therapy decision should be made on an individual level. • tSNS, tVNS and REN are effective treatment of acute migraine. • tONS and tSNS are effective applications for migraine prevention. • REN and rNMS are particularly safe and well-accepted. • Peripheral neurostimulation can complement the therapy for pediatric migraine. • Individual choices required due to efficacy, safety, and feasibility considerations. [ABSTRACT FROM AUTHOR]

Surgical treatment of spontaneous cerebrospinal fluid (CSF) leak is now performed by ENT surgeons, endonasal endoscopy being preferred to craniotomy as less invasive. However, it is often the symptom of underlying idiopathic intracranial hypertension, which lies outside the traditional sphere of ENT competence. Surgery is a necessary step, but should not obscure the need to treat the underlying pathology. This treatment is complex, and requires multidisciplinary team-work between otorhinolaryngologist, ophthalmologist, neurologist, neurosurgeon, radiologist, dietician, endocrinologist and psychotherapist. The present update details this multidisciplinary management to which the ENT surgeons must be attentive before and after spontaneous CSF leak repair. [ABSTRACT FROM AUTHOR]

Francis Xavier Dercum (1856-1931) was a renowned clinician, teacher, and scientist. Although he is widely known as a prominent neurologist and remembered for his treatment of then-President Woodrow Wilson, he also had many contributions to the field of medicine. Specific to dermatology, he provided the first observations and descriptions of adiposis dolorosa, which laid the groundwork for further examination and research. He dedicated his life as a scholar to teaching others and furthering the field of medicine. [ABSTRACT FROM AUTHOR]

Perampanel is the latest anti-seizure medication introduced in the Philippines in 2015. This was initially approved as an adjunctive treatment for focal seizures and those with secondary generalization among individuals 12 years old and above. By March 2020, it has been approved also for generalized seizures and in children 4 years and above. The general objective of this research is to describe the clinical experience of Filipino child neurologists on the use of perampanel in children. This is a cross-sectional descriptive study that surveyed child neurologists with review of medical records of children who have received perampanel as either an adjunctive therapy or monotherapy for epilepsy. There were 65 patients included in the study aged 1 to 18 years with a mean age of 10.0 ± 5.2 years and a median of 10 years. Follow-up duration were between 2 weeks to more than a year. Perampanel was started in 98.5% as an add-on treatment between 5 months and 18 years of age. The responder rate is 69.2% (45/65), seizure-free rate is 29.2% (19/65), seizure-aggravation rate is 9.2% (6/65), and perampanel retention rate is 83.1% (54/65). Treatment emergent adverse events were noted in 53.8% of the children with somnolence (20.0%), gait problems (12.3%), weight gain (10.8%) and dizziness (9.2%) as the most common events experienced. Dizziness was experienced significantly more among children 12 to 18 years of age. Perampanel is seen to be effective and relatively safe to use among Filipino children. [ABSTRACT FROM AUTHOR]

Objectives: The COVID-19 pandemic enforced an almost complete switch from face-to-face clinical work to tele-neurology. This study explores neurologists' perceptions of telephone and videophone remote consultations.Methods: Semi-structured interviews were conducted with neurologists and a GP with a specialist interest (n = 22). Interviews were conducted remotely via Zoom®, audio-recorded, transcribed verbatim and analysed using the principles of thematic analysis.Results: Four main themes emerged: 'unknown unknowns (risks/uncertainties)', 'better service', 'challenges', and 'beyond the pandemic'. Thematic saturation was achieved by interview 19. Participants highlighted a number of benefits of remote consultations but over 80% also complained of a reduction in work satisfaction.Conclusion: The sudden introduction of tele-neurology is unlikely to be fully reversed when pandemic-related restrictions have been lifted. However, this study confirms tele-neurology cannot completely replace face-to-face consultations. Some patient groups and consultation types require direct contact. Moreover, significant administrative and infrastructural investment will be required to develop the full potential of tele-neurology.Practice Implications: Tele-medicine is capable of improving access and efficiency of specialist neurology services, but limited by lack of non-verbal communication and technical problems. It could enhance service provision with sufficient infrastructural and administrative investment, but may reduce neurologists' job statisfaction. [ABSTRACT FROM AUTHOR]

Dr. Lester Baker adopted my family during my internship at Children's Hospital of Philadelphia (CHOP), and with a firm hand he helped me to accept my limitations in the laboratory and guided me to a more fitting clinical academic career. The final mentor of my early career arrived later that year when Dr. Peter Berman, the Chief of Neurology, called me into his office. Caring for patients extends beyond the chief complaint The role of the child neurologist is more than counting seizures or addressing tic severity. [Extracted from the article]

Background: The past decades have seen a transformational shift in the understanding and treatment for neurological diseases affecting infants and children. These advances have been driven in part by the pediatric neurology physician-scientist workforce and its efforts. However, pediatric neurology research faces substantial challenges from internal and external forces including work-life balance demands, COVID-19 pandemic effects, and research funding. Understanding the impact of these challenges on the perceptions, planning, and careers of pediatric neurology physician-scientists is needed to guide the research mission.Methods: Our objective was to survey the research challenges, goals, and priorities of pediatric neurologists. In 2020 we conducted a cross-sectional, 28-question survey emailed to 1,775 members of the Child Neurology Society.Results: One hundred fifty-one individuals responded to the survey. Most respondents were grant investigators (52%) and conducted clinical research (69%). Research areas included epilepsy (23%), neurodevelopmental and autism (16%), neurocritical care and stroke (11%), neurogenetics and neurometabolics (9%), neonatal neurology (8%), and others. The most common funding source was the National Institutes of Health (37%). Shared major research concerns were funding, utilization of remote technology, overcoming disparities, natural history and multicenter studies, global neurology, and diversification of the research portfolio. Commitment to continuing and increasing research efforts was evident.Conclusions: Our survey demonstrates obstacles for physician-scientist researchers in pediatric neurology, but it also shows optimism about continued opportunity. Creative approaches to address challenges will benefit the research mission, maximize the current and future pool of researchers, and help improve the lives of children with neurological disorders. [ABSTRACT FROM AUTHOR]

L'akathisie, c'est-à-dire l'impossibilité qu'éprouve mentalement et physiquement un malade à rester immobile, à l'origine d'un impératif irrépressible de mouvements, est un symptôme clinique décrit par un médecin tchèque, Ladislas Haškovec (1866–1944), dans un article publié par La Revue Neurologique en 1901. Après une brève biographie de ce neurologue polyglotte, nous donnons les définitions actuelles de ce trouble. Les deux premiers cas cliniques sont ensuite confrontés aux observations publiées dans la première moitié du siècle dernier, afin de montrer comment l'origine psychique de type anxiophobique initialement retenue est devenue une origine neurologique organique, notamment au cours de l'épidémie d'encéphalite léthargique de von Economo. L'introduction de la thérapeutique antipsychotique par les neuroleptiques a multiplié le nombre de cas au point de laisser penser que cet effet iatrogène est l'unique cause de l'akathisie. Les différentes interprétations cliniques et physiopathologiques données à cet effet collatéral d'une thérapeutique indispensable montrent combien les spéculations théoriques sont démenties par les constatations auprès des malades. On peut espérer que l'échelle de Barnes, conçue pour quantifier et suivre l'évolution de l'akathisie, permettra de perfectionner la prise en charge. Enfin, une revue des écrits médicaux, depuis ceux du XVIIe siècle, permet d'aborder au mieux la parenté clinique entre l'akathisie et le syndrome des jambes sans repos. Akathisia, or a patient's mental and physical inability to stay still, results in an irrepressible need to move. This clinical symptom was described by a Czech physician, Ladislas Haškovec (1866–1944), in an article published by La Revue Neurologique in 1901. After a brief biography of this polyglot neurologist, we will give the current definitions of this condition. We will then compare the first two clinical cases with the observations published in the first half of the last century, to show how the originally favoured psychic cause, related to anxiety and phobias, evolved into an organic neurological cause, notably during the epidemic of encephalitis lethargica, described by von Economo. The introduction of antipsychotic treatment by neuroleptics greatly increased the number of cases, suggesting that this iatrogenic effect is the only cause of akathisia. The various clinical and pathophysiological interpretations of this collateral effect of an indispensable therapy show how theoretical speculations are refuted by direct observations of patients. There is reason to hope that the Barnes scale, designed to quantify and monitor the progression of akathisia, will improve treatment. We will conclude with a review of medical writings, starting in the 17th century, to better appreciate the clinical relation between akathisia and restless legs syndrome. [ABSTRACT FROM AUTHOR]