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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]

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]

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]

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]

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]

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]

Background: To assess and compare resident and practicing child neurologists' attitudes regarding recruitment and residency training in child neurology.Methods: A joint task force of the American Academy of Pediatrics and the Child Neurology Society conducted an electronic survey of child neurology residents (n = 305), practicing child neurologists (n = 1290), and neurodevelopmental disabilities specialists (n = 30) in 2015. Descriptive and multivariate analyses were performed.Results: Response rates were 32% for residents (n = 97; 36% male; 65% Caucasian) and 40% for practitioners (n = 523; 63% male; 80% Caucasian; 30% lifetime certification). Regarding recruitment, 70% (n = 372) attributed difficulties recruiting medical students to insufficient early exposure. Although 68% (n = 364) reported that their medical school required a neurology clerkship, just 28% (n = 152) reported a child neurology component. Regarding residency curriculum, respondents supported increased training emphasis for genetics, neurodevelopmental disabilities, and multiple other subspecialty areas. Major changes in board certification requirements were supported, with 73% (n = 363) favoring reduced adult neurology training (strongest predictors: fewer years since medical school P = 0.003; and among practicing child neurologists, working more half-day clinics per week P = 0.005). Furthermore, 58% (n = 289) favored an option to reduce total training to 4 years, with 1 year of general pediatrics. Eighty-two percent (n = 448) would definitely or probably choose child neurology again.Conclusions: These findings provide support for recruitment efforts emphasizing early exposure of medical students to child neurology. Increased subspecialty exposure and an option for major changes in board certification requirements are favored by a significant number of respondents. [ABSTRACT FROM AUTHOR]

Background: Tics and Tourette syndrome are common problems evaluated by both the general pediatrician and pediatric neurologist. The common comorbidities of tics are well known, but the severe neurological complications are rare and may not be appreciated.Methods: This is a retrospective case series and literature review.Results: We present here four adolescents with Tourette syndrome who had severe neurological complications secondary to motor tics. We provide the history, neurological examination, and radiological findings in addition to a review of previously reported cases of vascular and cervical cord complications associated with violent motor tics.Conclusions: We highlight the importance of recognizing the presenting signs of these complications early and the need to vigorously treat violent motor tics to prevent significant neurological complications. [ABSTRACT FROM AUTHOR]

Background: Medical child abuse occurs when a child receives unnecessary and harmful, or potentially harmful, medical care at the instigation of a caretaker through exaggeration, falsification, or induction of symptoms of illness in a child. Neurological manifestations are common with this type of maltreatment.Objectives: We sought to review common reported neurological manifestations that may alert the clinician to consider medical child abuse. In addition, the possible sequelae of this form of child maltreatment is discussed, as well as practice recommendations for establishing the diagnosis and stopping the abuse once it is identified.Methods: A review of the medical literature was conducted regarding the reported neurological presentations of this entity.Results: Neurological manifestations of medical child abuse include false reports of apparent life-threatening events and seizures and reports of induction of symptoms from poisoning. Failure to correlate objective findings with subjective complaints may lead to unnecessary and potentially harmful testing or treatment. This form of child maltreatment puts a child at significant risk of long-term morbidity and mortality.Conclusions: A wide variety of neurological manifestations have been reported in cases of medical child abuse. It is important for the practicing neurologist to include medical child abuse on the differential diagnosis. [ABSTRACT FROM AUTHOR]

Introduction Movement disorder specialists can achieve a high level of accuracy when clinically diagnosing parkinsonism syndromes. However, data about the diagnostic accuracy among general neurologists is limited. Objectives This study investigated the recent diagnostic accuracy of parkinsonism syndromes by general neurologists. Methods A retrospective examination of 1362 post-mortem cases diagnosed in the years 2000-2012 by neuropathologists was performed. Out of these cases, we identified 111 patients who received a clinical parkinsonism diagnosis during life and 122 patients who received a neuropathological diagnosis of a parkinsonism syndrome post-mortem including 11 incidental cases. Results Fifty-eight (75.3%) of the 77 patients who had received clinical Parkinson's disease (PD) diagnoses were confirmed after the neuropathological examination. The sensitivity of the clinical diagnosis for idiopathic Parkinson's disease (PD) was 89.2% and the specificity was 57.8%. The corresponding numbers for progressive supranuclear palsy (PSP) were 52.9% and 100%, and for multiple system atrophy (MSA) were 64.3% and 99.0%, respectively. Conclusions Parkinson's disease is heavily overdiagnosed by general neurologists, whereas parkinsonism plus syndromes are underdiagnosed. Despite improvements in the diagnostic methods during recent decades and the development of diagnostic clinical criteria for parkinsonian syndromes, the diagnostic accuracy of Parkinson's disease remains relatively low, and 1/4 of diagnoses are incorrect. [ABSTRACT FROM AUTHOR]

Neurology is one of Africa's central and noble specialties due to the frequency of its related diseases. Through this study we: −1-described the status of neurologists in Africa in terms of numbers,-2-listed the reasons and discussed how to increase their number, and how to get the most benefit of them in healthcare coverage. The distribution and number of neurologists in the African continent was acquired from many participants in different African countries using a survey sent between March 2020 and August 2020 by email. Further, data from the World health organization on the number of neurologists was added for the countries, from which we didn't receive answers by the survey. Surveys' answers were received from representatives of 50 (92%) of the 54 African nations. Authors suggest a ranking into four levels according to the number of neurologists per nation. Level A [more than 201 neurologists per country] included 2 nations. Level B [31 to 200 neurologists per country] included six nations. Level C [1 to 30 neurologists per country] including the majority of African countries (36 nations). Level D includes 10 nations without any neurologists. The need for reliable and competent neurologists with a sufficient number is considered as a crucial element to enhance the care of neurological diseases in Africa. For this, all African countries should establish new centers of excellence in neurology, by developing good south-south collaboration with supports from governmental and non-governmental institutions. • The number of neurologist is low in Africa compared to other regions. • African nations were divided into four levels according to the number of neurologists per nation. • Our study showed an expanding number of the African neurologists in the last 15 years. • Teleneurology plays an effective tool to encourage, assist, and establish training programs for African physicians. [ABSTRACT FROM AUTHOR]

Objectives: Functional neurological symptoms (FNS) were considered as a psychiatric disorder at the beginning of the 20th century (conversion disorder). Psychiatrists performed diagnosis and treatment throughout most of the past century in the Netherlands, but in the latest decades patients were usually firstly referred to neurologists. The aim of this study was to investigate the opinions of today's neurologists, psychiatrists and rehabilitation physicians in the Netherlands, regarding pathogenesis, diagnosis and treatment of FNS. Design: An electronic questionnaire was sent to all neurologists registered with the Dutch Society for Neurology and to the members of the Department for Consultation-liaison and General Hospital Psychiatry. Results: 343 of 780 neurologists, 64 of 197 psychiatrists and 47 of 750 rehabilitation physicians completed the questionnaire. 60% of neurologists and 67% of psychiatrists considered disordered brain functioning together with psychogenic factors responsible for FNS. 29% of neurologists and 88% of psychiatrists felt a psychiatrist was needed for diagnosis. 55% of neurologists and 88% of psychiatrists preferred combined treatment consisting of explaining FNS to patients, psychotherapy and physiotherapy provided by a therapist trained in FNS. 15% of neurologists preferred only physiotherapy. Conclusion: Most neurologists and psychiatrists did not consider FNS as a mere psychiatric disorder, but counted disordered brain functioning together with psychogenic factors responsible for FNS. Subsequently, according to the majority of neurologists and psychiatrists FNS should not be solely diagnosed and treated by psychiatrists. These results can help to formulate treatment strategies. [ABSTRACT FROM AUTHOR]

The majority of neurological disorders exist in low- and middle-income countries, but these nations have the fewest neurologists and neurological training opportunities worldwide. The objective of this study was to assess the effectiveness, relevance, and feasibility of a five-day neurocritical care course delivered online to African healthcare workers and to understand participants' prior neurological and neurocritical care training experiences. We offered the Neurocritical Care Society's Emergency Neurological Life Support (ENLS) course covering 14 neurocritical conditions via Zoom to 403 African healthcare workers over a 4-day period. An additional day was devoted to management of neurological emergencies in resource-limited settings. Participants completed pre- and post-course surveys to assess the effectiveness, relevance, and feasibility of the overall course to their settings. 318 participants (46% female; 56% residents; 24% neurologists; 9.0 ± 6.7 years practicing medicine) from 11 African countries completed the pre-course self-assessment, and 232 completed the post-course self-assessment. 97% reported prior experience caring for patients with neurological emergencies but only 35% reported prior neurology training and 9% prior neurocritical care training. Pre-course and post-course comfort levels showed statistically significant improvements (p < 0.001) across all fourteen neurocritical topics. 95% of participants found the course relevant to their current practice setting, 94% agreed the Zoom online platform was easy to use, and 93% reported it facilitated their learning. Suggestions for course improvement included addition of non-critical neurological conditions and inclusion of locally available diagnostics and treatment modalities. Study results suggest virtual platforms may offer a way to improve neurology training in areas with reduced neurological workforce. • A virtual neurocritical care course for African healthcare workers was effective. • Course could be improved by including locally available diagnostics and treatment. • Most participants regularly cared for patients with neurological emergencies. • Few participants had formal training in neurology or neurocritical care. • Virtual platforms could improve training in areas with few neurologists. [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]

Abstract: The peripartum period entails the next prenatal interval when novel neuroprotective strategies will be designed and tested. Research development will lead to novel evaluations for maternal-fetal pairs who require inpatient treatment and possible delivery for worsening or acute neurologic problems. Future studies should critically compare serial fetal surveillance assessments with postnatal clinical findings to detect and treat more accurately fetal/neonatal brain disorders that begin or worsen during the peripartum period. Clinical management decisions require an interdisciplinary treatment approach. Protocols may begin before and during parturition, and continue through neonatal resuscitation and early postnatal periods into infancy. Appropriate choices of preventive, rescue, and repair neuroprotective interventions must consider both the timing and etiologies of encephalopathies in the context of maternal, fetal, placental, and neonatal diseases. [Copyright &y& Elsevier]

Abstract: In Parkinson’s disease (PD), wearing-off can be difficult to detect as it is very variable and may affect motor and non-motor symptoms. The Wearing-Off Questionnaire, WOQ-32 (Stacy et al., 2005), was introduced to help identify wearing-off and proved to be very efficient. Two short versions of the questionnaire (WOQ-19 or QUICK and WOQ-9) were later developed to decrease the respondent burden without loss of efficacy in terms of sensitivity. The objective of the present study was to check the ability of a new 10-item QUICK version, Q10, to identify patients with wearing-off. Q10 items were selected from the QUICK validation study data set through statistical analysis and it was then tested on a sample of 162 PD patients, 64.8% with wearing-off. Sensitivity, specificity, and accuracy were 96%, 63%, and 85% respectively with one positive response and 90%, 70%, and 83% respectively with two positive responses. The correlation with the gold standard (neurologist diagnosis of wearing-off) was substantial (kappa = 0.62–0.64). Comparison with the QUICK and WOQ-9 shows that the Q10 can be a new tool for detection of wearing-off with satisfactory properties and a good balance between brevity and performance. [Copyright &y& Elsevier]

Abstract: Objective: Consultations with patients with functional symptoms can be challenging. This study describes some of the interactional and linguistic resources doctors use when they deliver the diagnosis of a functional disorder and recommend psychological treatment to patients presenting with medically unexplained neurological symptoms. Methods: Twenty out-patient consultations between three experienced neurologists and patients with non-epileptic seizures (NES, N=17) or other functional neurological symptoms (FNS, n=3) were recorded and analysed using Conversation Analysis (CA). Encounters were split into activity sequences (1: history-taking; 2: discussion of examination and test results; 3: diagnosis; 4: aetiology; 5: treatment recommendations). The doctors'' formulation effort (FE) in each activity sequence was graded (1: little, 2: some, 3: marked FE). Results: The doctors'' communication behaviour was characterised by FE and accounting activities. FE increased during the course of the encounters and was most marked when doctors discussed the aetiology of symptoms and made psychological treatment recommendations. However, FE was evident even at the beginning of the encounters, and when patients fully aligned with the doctor. Conclusion: This study provides interactional evidence why doctors may experience these consultations as challenging. While FE and accounting activities were sometimes linked to objective interactional problems (patients'' resistance), doctors also seemed to engage in these practices for no clear interactional reasons, suggesting a degree of defensiveness or prior concern about the consultation. The extent of FE and accounting activities may display doctors'' interactional distress but may also reflect a degree of delicacy when doctors explain the diagnoses of NES or FNS. [Copyright &y& Elsevier]

Abstract: There is increasing interest from neurologists to use therapeutic apheresis in autoimmune neurologic diseases due to growing knowledge of pathogenic relevance of autoantibodies. Developments in that field have been summarized in this review focusing on German guidelines and recent results from clinical research. Therapeutic apheresis can offer a therapeutic armamentarium with rapid response for severe acute neurologic symptoms, and a drug-free option for clinical courses being refractory to drug based strategies or complicated by drug side effects. Plasma exchange (PE) as the classical method has become part of current guidelines within basic and escalating immunomodulatory treatments of autoimmune neurologic diseases, and in daily practice gets increasingly replaced by selective immunoadsorption (IA) due to its equivalent efficacy in combination with a superior safety profile. Therapeutic effects of PE and IA in autoantibody mediated diseases can be attributed to 3 major mechanisms: immediate intravascular reduction of (auto-)antibody concentration, pulsed induction of antibody redistribution, and subsequent immunomodulatory changes. 5 treatments over a period of 8-10 days seem to be an appropriate regimen to restore neurologic function in acute flares or relapses of autoimmune neuropathies, e.g. myasthenic crisis, Guillain-Barré-syndrome, and steroid refractory relapse of multiple sclerosis. Especially in MS a better understanding is needed, who are the best candidates for IA. [Copyright &y& Elsevier]

Summary: Seizures are the most common pediatric neurologic disorder. This article describes the guidelines of the French Pediatric Neurology Society, highlighting the importance of a thorough history and examination. Paroxysmal nonepileptic events should be excluded. The role of biological and neuroradiological investigations is discussed. An electroencephalographic recording and advice from a pediatric neurologist are suggested. [Copyright &y& Elsevier]

Summary: Lyme neuroborreliosis (LNB), the neurological manifestation of systemic infection with the complex spirochaete Borrelia burgdorferi, can pose a challenge for practising neurologists. This Review is a summary of clinical presentation, diagnosis, and therapy, as well as of recent advances in our understanding of LNB. Many new insights have been gained through work in experimental models of the disease. An appreciation of the genetic heterogeneity of the causative pathogen has helped clinicians in their understanding of the diverse presentations of LNB. [Copyright &y& Elsevier]

Abstract: One of the major barriers to the provision of quality care for patients with neurological disorders in developing countries is a low ratio of neurologists per inhabitants, the World Health Organization recommends one neurologist per 100,000. In 1998 Honduras had one neurologist per 325,000 inhabitants and all the neurologists were trained outside the country. The Education Committee of the World Federation of Neurology (WFN), in collaboration with the Postgraduate Direction of the National Autonomous University of Honduras, the Honduran Neurological Association, and the Honduran Secretary of Health helped establish the country''s first Neurology Training Program in 1998. This program was established using a problem- and epidemiological-oriented methodology with oversight by an external WFN review board. By 2006 the program has resulted in a 31% increase in the national neurologist ratio per inhabitant, significantly improved the quality of patient care and promoted research in the neurosciences. The Honduras Neurology Training Program has provided a valuable model for other developing countries with similar needs for neurological care. Based on this Honduras experience, members of the Education Committee of the WFN have established guidelines for neurology training programs in developing countries. [Copyright &y& Elsevier]

Abstract: Six hundred and sixteen patients were referred for consultation to the author who served as the neurologist on the 252nd Neurosurgical Team in Kuwait in support of Operation Iraqi Freedom between April and October, 2003. Demographic and military data were collected. The cohort of neurologic patients showed significant differences from the total population of the United States Army contemporarily deployed to Operation Iraqi Freedom. Versus the deployed personnel, the neurologic cohort was older in age (p <0.001), had a greater percentage of females (p <0.00001), had an excessive representation for the military rank of sergeant (p <0.00001), with a deficit of other ranks (junior enlisted and officers), and were more likely to soldiers from the Reserves (p <0.00001) and National Guard (p =0.0021) than from the Regular Army. Seven categories of chief complaints and ten categories of diagnoses constituted some 80% of patients. The incidence of neurologic disease was calculated to be 634 per 100,000 people/year. This information provides valuable information for military neurologists concerning their anticipated duties in future deployments and for non-neurologists by focusing their skills in the evaluation of common neurologic presentations, yet further research is needed to optimize the neurologist''s role in a field environment. [Copyright &y& Elsevier]

Abstract: Patients suffering from amyotrophic lateral sclerosis (ALS) eventually lose their ability to communicate their treatment preferences in later stages of the disease. A living will enables ALS patients to specify their choices concerning life-sustaining treatment in advance. Our premise was that completion of a living will should be preceded by a discussion between patient and physician. We conducted a qualitative study of a sample of 15 neurologists and 15 ALS patients from two neurology centers in Germany. Our aim was to explore how discussions about living wills are undertaken. Data analysis followed grounded theory techniques. Our findings showed that both the patients and the physicians considered living wills to be closely connected to forthcoming death. Physicians waited for respiratory failure to occur before they informed ALS patients about living wills, an information strategy that we called the “wait-and-see-policy”. The patients completed their living will when they had accepted the hopelessness of their disease. They mostly used living will forms and did not see the necessity to set down disease-specific preferences. They intended to wait for symptoms to emerge before they made the decision about whether or not to accept life-sustaining treatment. The patients as well as the physicians pursued a wait-and-see policy towards end-of-life care, thus weakening the purpose of living wills. Our results point to the necessity and importance of an open and honest patient–physician communication which is a prerequisite for the discussion of living wills. [Copyright &y& Elsevier]

Neurological disorders are common in sub-Saharan African, but accurate neuroepidemiologic data are lacking from the region. We assessed a neuroepidemiological screening tool in a rural Ugandan cohort with high HIV prevalence. Participants were recruited from the Rakai Neurology Study in rural Rakai District, Uganda. A nurse administered the tool and a sociodemographic survey. 100 participants returned for validation examinations by a neurologist (validation cohort). The diagnostic utility and validity of the instrument were calculated and characteristics of those with and without neurological disorders compared. The tool was administered to 392 participants, 48% female, 33% people with HIV, average age 35.1 ± 8.5 years. 33% of the study cohort screened positive for neurologic disorders. These participants were older [mean (SD): 38.3 (9.7) vs. 33.5 (7.1) years, p < 0.001], had a lower Karnofsky score [89.8 (8.4) vs. 93.9 (7.5), p < 0.001] and had a lower body mass index [21.8 (3.3) vs. 22.8 (3.7), p = 0.007] than those who screened negative. Amongst the validation cohort, 54% had a neurological abnormality of which 46% were symptomatic. The tool was 57% sensitive and 74% specific for detecting any neurological abnormality and 80% sensitive and 69% specific for symptomatic abnormalities. We found a lower sensitivity and similar specificity for the screening tool compared with two previous studies. The lower validity in this study was likely due in part to the high percentage of asymptomatic neurological abnormalities detected. This screening tool will require further refinement and cultural contextualization before it can be widely implemented across new populations. [ABSTRACT FROM AUTHOR]

Keywords: Functional neurological disorder; Conversion disorder; Dissociative neurological symptom disorder; Psychosomatic medicine EN Functional neurological disorder Conversion disorder Dissociative neurological symptom disorder Psychosomatic medicine N.PAG N.PAG 1 12/28/20 20210101 NES 210101 1 Introduction Previous research into the nature of functional neurological disorders (FND) has found differences in opinion between clinicians and between clinicians and patients [[1]]. Although differences of opinion exist regarding the aetiology of FND, there appears to be consensus around its potential for treatment and whether the symptoms are under any control by the patient. Functional neurological disorder, Conversion disorder, Dissociative neurological symptom disorder, Psychosomatic medicine. [Extracted from the article]

Abstract: We hypothesized that children with Dravet syndrome manifest specific facial features that can be identified by pediatric neurologists and rendered objective by standard photographic measurements. This study comprised two parts. In Part 1, photographs of children with Dravet syndrome were compiled into a booklet with patients and their siblings randomly mixed. The booklet was sent to pediatric neurologists who anonymously identified which children they thought were affected by the syndrome and which were siblings. Although pediatric neurologists generally agreed on whether children were affected or not (20/24 cases; 83%), they were frequently incorrect (12/20; 60%). In Part 2, standard photogrammetric techniques were used to provide 16 facial ratios from digital images. No significant difference in any measurement was evident between children with Dravet syndrome and unaffected siblings (P > 0.05, two-tailed t test). This study did not demonstrate a specific facial phenotype in Dravet syndrome. [Copyright &y& Elsevier]

Abstract: Background: The method for measuring disease severity in essential tremor (ET) is not consistent among neurologists in routine clinical practice. Methods: We have developed a new scale, called Glass scale, which is easy and quick to administer to ET patients with upper limb involvement. Using the scale involves asking the patient one question: “Over the last week, when you were sitting down at the table, how did you drink water from a glass?” Scores: I – I have no difficulties. II – I can drink with one hand, but I have to fill the glass with less liquid to avoid spills. III – I cannot drink with one hand, I need both hands. IV – I cannot drink with my hands, I need a straw. The score is followed by “A” if tremor involves only the upper limbs, and “B” if not. Construct validity of the Glass scale was tested against the Tremor Clinical Rating Scale (TCRS) and the Bain disability scale. A second neurologist blinded to the Glass scale score assessed inter-rater reliability. Results: The Glass scale displayed strong construct validity compared to TCRS (w. kappa = 0.907) and to the Bain scale (w. kappa = 0.868). High inter-rater validity was also observed (w. kappa = 0.937). Conclusion: The Glass scale appears to be a reliable and valid tool to determine tremor severity in ET. The simplicity of the scale makes it appropriate for use in routine clinical practice. [Copyright &y& Elsevier]

Functional neurological disorder (FND) has been considered a contentious topic in neurology literature. The current study findings highlight the need to earnestly address patients' FND symptoms. While it has been advocated that one of the first steps in FND treatment is patient education and their acceptance of the diagnosis, we would add that the very first step toward a successful treatment is believing in your patients' symptoms. [Extracted from the article]