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Neurology. Clinical Practice

Pouya Tahsili-Fahadan, Alexis N Simpkins, Richard Leigh, José G Merino
No abstract text is available yet for this article.
October 2016: Neurology. Clinical Practice
Albert A Davis, Brad Racette
PURPOSE OF REVIEW: While the distinctive motor symptoms of Parkinson disease (PD) have been described for centuries, cognitive impairment has only recently been recognized as a central feature. Studies have yielded clues to the etiology and natural history of cognitive impairment in PD, but much remains unclear and effective therapies are needed. RECENT FINDINGS: Longitudinal cohort studies demonstrate that almost all patients with PD will develop dementia if they live long enough...
October 2016: Neurology. Clinical Practice
Christopher D Streib, Linda M Hartman, Bradley J Molyneaux
BACKGROUND: Decompressive craniectomy (DC) is an aggressive life-saving surgical intervention for patients with malignant cerebral infarction (MCI). However, DC remains inconsistently and infrequently utilized, primarily due to enduring concern that increased survival occurs only at the cost of poor functional outcome. Our aim was to clarify the role of DC performed within 48 hours (early DC) for patients with MCI, including patients aged >60 years. METHODS: We performed a meta-analysis of all available randomized controlled trials comparing early DC to best medical care for MCI...
October 2016: Neurology. Clinical Practice
Claire M O'Connor, Lindy Clemson, Michael Hornberger, Cristian E Leyton, John R Hodges, Olivier Piguet, Eneida Mioshi
BACKGROUND: The relationship between behavioral changes and functional decline in frontotemporal dementia (FTD) is not well understood. METHODS: Thirty-nine patients (21 behavioral variant FTD [bvFTD], 18 semantic variant primary progressive aphasia [svPPA]) were followed up longitudinally (2-4 years follow-up). Functional (Disability Assessment for Dementia) and behavioral (Cambridge Behavioural Inventory Revised) assessments were included for between-group (pairwise comparisons, mixed model analysis) and within-group analyses (bivariate correlations)...
October 2016: Neurology. Clinical Practice
Adham Jammoul, Luay Shayya, Karin Mente, Jianbo Li, Alexander Rae-Grant, Yuebing Li
BACKGROUND: Antibodies against voltage-gated potassium channel (VGKC)-complex are implicated in the pathogenesis of acquired neuromyotonia, limbic encephalitis, faciobrachial dystonic seizure, and Morvan syndrome. Outside these entities, the clinical value of VGKC-complex antibodies remains unclear. METHODS: We conducted a single-center review of patients positive for VGKC-complex antibodies over an 8-year period. RESULTS: Among 114 patients positive for VGKC-complex antibody, 11 (9...
October 2016: Neurology. Clinical Practice
Amber Salter, Tuula Tyry, Guoqiao Wang, Robert J Fox, Gary Cutter, Ruth Ann Marrie
BACKGROUND: In multiple sclerosis (MS), comorbidities have been associated with disability progression and an increased risk of mortality. We investigated the association between comorbidities and mortality in MS after accounting for disability and health behaviors. METHODS: We followed North American Research Committee on Multiple Sclerosis (NARCOMS) Registry participants who completed the Fall 2006 survey on comorbidities until death (reported or matched in the National Death Index) or date of last follow-up in 2014...
October 2016: Neurology. Clinical Practice
Sara K Rostanski, Olajide Williams, Joshua I Stillman, Randolph S Marshall, Joshua Z Willey
BACKGROUND: Acute stroke is a time-sensitive condition in which rapid diagnosis must be made in order for thrombolytic treatment to be administered. A certain proportion of patients who receive thrombolysis will be found on further evaluation to have a diagnosis other than stroke, so-called "stroke mimics." Little is known about the role of language discordance in the emergency department diagnosis of acute ischemic stroke. METHODS: This is a retrospective analysis of all acute ischemic stroke patients who received IV tissue plasminogen activator (tPA) in our emergency department between July 2011 and December 2015...
October 2016: Neurology. Clinical Practice
Le H Hua, Jeffrey A Cohen
PURPOSE OF REVIEW: Medication prices are a major contributor to the high cost of care for multiple sclerosis (MS). The patents for some of the initial injectable therapies for relapsing MS recently expired, permitting development, regulatory approval, and marketing of generic alternatives with the potential for lower prices and cost savings to payers and patients. RECENT FINDINGS: A generic version of glatiramer acetate 20 mg administered by daily subcutaneous injection recently received regulatory approval in the United States...
August 2016: Neurology. Clinical Practice
Nilam J Soni, Ricardo Franco-Sadud, Daniel Schnobrich, Ria Dancel, David M Tierney, Gerard Salame, Marcos I Restrepo, Paul McHardy
PURPOSE OF REVIEW: To review the literature and describe techniques to use ultrasound to guide performance of lumbar puncture (LP). RECENT FINDINGS: Ultrasound evaluation of the lumbar spine has been shown in randomized trials to improve LP success rates while reducing the number of attempts and the number of traumatic taps. SUMMARY: Ultrasound mapping of the lumbar spine reveals anatomical information that is not obtainable by physical examination, including depth of the ligamentum flavum, width of the interspinous spaces, and spinal bone abnormalities, including scoliosis...
August 2016: Neurology. Clinical Practice
Carlo Tornatore, J Theodore Phillips, Omar Khan, Aaron E Miller, Mark Hughes
PURPOSE OF REVIEW: To assess current practice patterns of US neurologists in patients with radiologically isolated syndrome (RIS), clinically isolated syndrome (CIS), and relapsing-remitting multiple sclerosis (RRMS) using case-based Web surveys. RECENT FINDINGS: We identified a total of 47 points of consensus (≥75% agreement) with regard to diagnosis, treatment, and monitoring of RIS, CIS, and RRMS. Current US treatment consensus patterns emphasize (1) MRI in multiple sclerosis (MS) diagnosis and subsequent treatment decisions, (2) treatment of early disease, (3) aggressive initial treatment of highly active MS, and (4) close patient monitoring for clinical response and adverse effects of disease-modifying drugs...
August 2016: Neurology. Clinical Practice
Khara M Sauro, Jayna Holroyd-Leduc, Samuel Wiebe, Hude Quan, Lara Cooke, J Helen Cross, Gary W Mathern, Heather Armson, Julie Stromer, Nathalie Jetté
BACKGROUND: Guidelines recommend that surgery be considered in patients with drug-resistant epilepsy, yet delays to epilepsy surgery still exist. A Web-based, evidence-informed clinical decision tool ( was developed to help physicians determine which patients are appropriate for an epilepsy surgery evaluation. We evaluated the usability and feasibility of the tool with the intended end users in order to improve implementation into practice. METHODS: Usability testing was conducted with relevant end users...
August 2016: Neurology. Clinical Practice
Andrew Liu, Kathleen Suozzi, David Y Hwang, Jeremy J Moeller, Rossitza Lazova, Daniel DiCapua
No abstract text is available yet for this article.
June 2016: Neurology. Clinical Practice
Paul Jewell, Olaf Ansorge, Wilhelm Kuker, Sarosh R Irani, Giovanna Zamboni
No abstract text is available yet for this article.
June 2016: Neurology. Clinical Practice
Jan Dirk Blom
PURPOSE OF REVIEW: To summarize the literature on Alice in Wonderland syndrome (AIWS), a disorder characterized by distortions of visual perception, the body schema, and the experience of time. RECENT FINDINGS: On the basis of 169 published case descriptions, the etiology of AIWS is divided into 8 main groups, with neurologic disorders affecting mostly adults and elderly patients and encephalitides affecting mostly patients aged ≤18 years. Symptoms of AIWS are also experienced in the general population, with up to 30% of adolescents reporting nonclinical symptoms...
June 2016: Neurology. Clinical Practice
Jayne R Wilkinson, Meredith Spindler, Stephanie M Wood, Steven C Marcus, Daniel Weintraub, James F Morley, Margaret G Stineman, John E Duda
BACKGROUND: Parkinson disease (PD) is a complex neurodegenerative disorder that benefits from specialty care. Telehealth is an innovative resource that can enhance access to this care within a patient-centered framework. Research suggests that telehealth can lead to increased patient satisfaction, equal or better clinical outcomes, and cost savings, but these outcomes have not been well-studied in PD. METHODS: We conducted a dual active-arm 12-month randomized controlled trial to assess patient satisfaction, clinical outcomes, travel burden, and health care utilization in PD using video telehealth for follow-up care with specialty providers...
June 2016: Neurology. Clinical Practice
Roy E Strowd, Deanna Saylor, Rachel Marie E Salas, Roland Thorpe, Tiana E Cruz, Charlene E Gamaldo
BACKGROUND: Professionalism is integral to medical training and practice. Recent studies suggest generational differences in perceptions of professionalism, which have not been adequately explored in academic neurology. METHODS: A cross-sectional study was performed to describe perceptions of professionalism among representative physicians across the academic training spectrum of neurology. A self-report questionnaire adapted from a published instrument was distributed to students, residents, fellows, and faculty in neurology at a single institution...
June 2016: Neurology. Clinical Practice
Robert J Fox, Andrew Chan, Ralf Gold, J Theodore Phillips, Krzysztof Selmaj, Ih Chang, Mark Novas, Jitesh Rana, Jing L Marantz
BACKGROUND: Delayed-release dimethyl fumarate (DMF), indicated for the treatment of patients with relapsing-remitting multiple sclerosis (MS), is a disease-modifying therapy with potential immunomodulatory and neuroprotective effects. In clinical trials, DMF was associated with reduced white blood cell and absolute lymphocyte counts. Current US prescribing information recommends obtaining a complete blood count, including absolute lymphocyte count (ALC), before initiating and during DMF treatment...
June 2016: Neurology. Clinical Practice
Isabel Boersma, Jacqueline Jones, Julie Carter, David Bekelman, Janis Miyasaki, Jean Kutner, Benzi Kluger
BACKGROUND: A growing body of literature suggests that patients with Parkinson disease (PD) have many unmet needs under current models of care that may be addressed through palliative care approaches. A first step in improving care for patients with PD through palliative care principles is to better understand patient perspectives on their perceived needs and care preferences. METHODS: A total of 30 in-depth individual interviews and 4 focus groups were held to elicit the perspectives of patients with PD on unmet palliative care needs and preferences for addressing these needs...
June 2016: Neurology. Clinical Practice
Richard L Barbano
No abstract text is available yet for this article.
June 2016: Neurology. Clinical Practice
Leonard L Sokol, Alberto J Espay
No abstract text is available yet for this article.
April 2016: Neurology. Clinical Practice
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