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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
Kiran M Kanth, Guillermo E Solorzano, Myla D Goldman
No abstract text is available yet for this article.
April 2016: Neurology. Clinical Practice
Melissa J Armstrong, Lisa M Shulman, Joseph Vandigo, C Daniel Mullins
Neurology is inherently patient-centered given that clinical uncertainty is common, forcing physicians, patients, and families to partner on treatment approach. An increasing emphasis on patient-centered care, patient engagement, and shared decision-making (SDM) in health care provides neurologists with an opportunity to reassess current clinical approaches to decision-making. Such assessment is not simply theoretical but has clear practice implications, with patients indicating a desire for SDM and calls for reimbursement to be tied to demonstration of SDM in practice...
April 2016: Neurology. Clinical Practice
Dennis N Bourdette, Daniel M Hartung, Ruth H Whitham
The US Food and Drug Administration has registered 13 multiple sclerosis (MS) disease-modifying therapies (DMTs). The medications are not interchangeable as they vary in route of administration, efficacy, and safety profile. Selecting the appropriate MS DMT for individual patients requires shared decision-making between patients and neurologists. To reduce costs, insurance companies acting through pharmacy benefit companies restrict access to MS DMTs through tiered coverage and other regulations. We discuss how policies established by insurance companies that limit access to MS DMTs interfere with the process of shared decision-making and harm patients...
April 2016: Neurology. Clinical Practice
Brent L Fogel, Saty Satya-Murti, Bruce H Cohen
PURPOSE OF REVIEW: The landscape of genetic diagnostic testing has changed dramatically with the introduction of next-generation clinical exome sequencing (CES), which provides an unbiased analysis of all protein-coding sequences in the roughly 21,000 genes in the human genome. Use of this testing, however, is currently limited in clinical neurologic practice by the lack of a framework for appropriate use and payer coverage. RECENT FINDINGS: CES can be cost-effective due to its high diagnostic yield in comparison to other genetic tests in current use and should be utilized as a routine diagnostic test in patients with heterogeneous neurologic phenotypes facing a broad genetic differential diagnosis...
April 2016: Neurology. Clinical Practice
Shadi Yaghi, Joshua Z Willey, Pooja Khatri
BACKGROUND: Two-thirds of patients with stroke have mild deficits. The optimal triaging of these patients remains unclear. It is crucial to stratify patients based on who needs inpatient vs outpatient evaluation in a cost-effective manner. METHODS: We reviewed the current literature (randomized trials, retrospective studies, case series, and case reports) on minor ischemic stroke and extrapolated evidence-based opinions and future directions on the management of minor ischemic stroke...
April 2016: Neurology. Clinical Practice
Roberto Erro, Francesco Brigo, Eugen Trinka, Giulia Turri, Mark J Edwards, Michele Tinazzi
PURPOSE OF REVIEW: Neurologic symptoms due to a psychogenic cause are frequently seen in clinical practice. Psychogenic nonepileptic seizures (PNES) and psychogenic movement disorders (PMD) are among the most common psychogenic neurologic disorders. PNES and PMD are usually investigated and managed separately by different neurology subspecialists. We review the main epidemiologic and clinical features of both PNES and PMD, aiming to highlight their similarities and differences and to see whether a common framework for these disorders exists...
April 2016: Neurology. Clinical Practice
Ruth Ann Marrie, John Fisk, Helen Tremlett, Christina Wolfson, Sharon Warren, James Blanchard, Scott B Patten
BACKGROUND: Although the adverse effects of vascular comorbidities are increasingly recognized in multiple sclerosis (MS), the epidemiology of these conditions remains poorly understood. METHODS: Using population-based administrative data, we identified 44,452 Canadians with MS and 220,849 age-, sex- and geographically matched controls. We applied validated definitions to estimate the incidence of diabetes, hypertension, hyperlipidemia, and ischemic heart disease (IHD) from 1995 to 2005...
April 2016: Neurology. Clinical Practice
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