Burden Of Neurological Disorders Research Articles

The impact of reminiscent music therapy and robot-assisted rehabilitation on older stroke patients: a protocol for a randomized controlled trial.

Stroke is the main disease that causes the burden of neurological disease, leading to upper limb dysfunction and affecting their self-care abilities. Robot-assisted rehabilitation therapy has been gradually used in the rehabilitation of upper limb function after stroke. However, it would be beneficial to explore auxiliary interventions such as reminiscent music therapy, a combination of music and reminiscent, to relieve negative emotions and post-stroke fatigue and improve rehabilitation outcomes. This protocol aims to evaluate the effectiveness of reminiscent music therapy combined with robot-assisted rehabilitation in older stroke patients. This trial is a single-blind, three-arm randomized controlled trial. Older stroke patients with upper limb dysfunction will be recruited. Participants will be randomly assigned to receive usual rehabilitation treatment and care, usual rehabilitation treatment and care plus robot-assisted rehabilitation and reminiscent music therapy, or usual rehabilitation treatment and care plus robot-assisted rehabilitation. Robot-assisted rehabilitation will be conducted by rehabilitation doctors five times per week for 3 weeks. In experimental group 1, a reminiscent song list will be played for patients. The primary outcome is activities of daily living. All outcomes will be evaluated at baseline and in the week immediately post-intervention. We are conducting the first randomized controlled trial on the effects of reminiscent music therapy combined with robot-assisted rehabilitation in older stroke patients. It is expected that this study, if proven effective in improving the activities of daily living in older stroke patients with upper limb dysfunction, will provide evidence-based rehabilitation strategies for medical staff.Clinical Trial Registration: ChiCTR2200063738.

Neurology Training and Medical Education in Resource-Limited Settings: Building and Growing the First Neurology Residency Program in East Africa.

The burden of neurological disease disproportionately affects low- and middle-income countries, where the lowest number of neurologists are located. Building local training opportunities in resource-limited settings is a foundational step to enhancing the neurological workforce and improving access to neurological care in these regions. In this article, we describe the development and growth of the first neurology residency program in East Africa, which was established in 2006 at Zewditu Memorial Hospital and the Tikur Anbessa Specialized Hospital, Addis Ababa University, Ethiopia. We highlight the impact of the program on clinical care, research, collaborations between neurologists across Ethiopia, and ways to build educational opportunities and mentorship while faced with limited resources. The main challenges in starting the residency program included lack of faculty with neurological expertise, lack of a precedent for subspecialty training in our setting, as well as limited resources and space. The formation of sustainable international collaborations with clinicians at established institutions in high-income countries and neurological societies has been a major source of support in developing the initial infrastructure, curriculum and educational content, knowledge assessments, and mentored research projects. Local partnerships with related medical specialties, including internal medicine, critical care, neurological surgery, and psychiatry, were also instrumental in creating training opportunities. As the program continues to evolve, many challenges remain, including limited diagnostics, lack of access to advanced treatment modalities, lack of fellowship training opportunities in various neurological subspecialties, and insufficient training and experience in scientific writing. Despite these challenges, the residency program has persevered and its creation resulted in many positive changes: since its inception in 2006, we graduated 80 neurologists and the number of practicing neurologists in Ethiopia has increased from 5 to 78, our institution has evolved into a national referral center for neurology, graduates have published 61 articles in the past 3 years and contributed to international neurology research, and alumni of the program have grown the Association of Ethiopian Neurologists. Future directions include development of fellowship opportunities, creation of international rotations, and implementation of teleneurology to further strengthen neurological care across Ethiopia.

Building Equitable Neuroscience Research Collaborations in Resource-limited Settings.

The burden of noncommunicable neurological disorders, such as stroke, dementia, and headache disorders, are on the rise in low- to middle-income countries (LMICs), while neuroinfectious diseases remain a major concern. The development of neuroscience research aimed at defining the burden of neurological diseases across the lifespan, as well as optimizing diagnosis and treatment strategies, is fundamental to improving neurological health in resource-limited settings. One of the key factors to advancing neuroscience research in LMICs is the establishment of effective collaborations based on responsible and trustworthy partnerships between local scientists in LMICs and international collaborators. LMIC researchers face many logistical, institutional, and individual level challenges as they embark on their neuroscience research journey. Despite these challenges, there are opportunities for improving LMIC investigator-led research that should focus on human and institutional infrastructure development. With regard to human capacity building, potential areas for offering support include enhancing research methodology training, offering instruction in manuscript and grant-writing, institutionalizing mentorship programs, and providing opportunities to conduct funded, mentored research to disseminate in high-impact journals. The foundational elements required for implementing and optimizing neuroscience research within an institution include an institutional review board, mentorship programs, data management, research administration, and laboratory facilities. This institutional capacity varies significantly across and within countries, and many rely on collaborations with better-resourced institutions to initiate research. Successful equitable collaborations ensure the engagement of all local and international stakeholders, as well as implementation of a self-sustaining long-term program. Building research capacity in LMICs is an essential endeavor that requires ongoing commitment to training independent scientists. As research capacity increases, LMIC institutions and governments should consider developing competitive research grant programs to support innovative studies led by local researchers, foster regional collaborations, and hence create a sustainable and independent neuroscience research environment.

Neurologijos srityje vartojamų vaistinių preparatų klinikinių tyrimų tendencijos Lietuvoje ir Europoje

Background. As the global burden of neurological diseases has been increasing, clinical trials have become more important. Yet, no systematic analysis of clinical trials of neurological medicinal products has been done in Europe and, specifically, in Lithuania. The aim of this study is to evaluate the tendencies of characteristics and registration dynamics of clinical trials of neurological medicines in Europe and Lithuania.Materials and methods. Analysis of data from the clinical trials register of the European Union drug regulatory authorities (EudraCT) has been performed. Applications of clinical trials of neurological medicines included in the register during the period between 2012–2021 have been reviewed. The following aspects have been evaluated: the phase of the trial, the sponsor status, the neurological condition (indication), the expected sample size of the trial, the trial design, and the number of member countries.Results. 2,242 clinical trials of neurological medicines have been registered in Europe during the period of 2012–2021, and they comprised 6.49% of all clinical trials registered in Europe. The annual registration rates did not change significantly during the period of 2012–2021 (R² = 0.039; p = 0.606). The majority of the trials (72.18%) were sponsored by commercial pharmaceutical companies. Most trials (31.73%) were registered as phase I trials. The majority of the trials (363 (17.20%)) were clinical trials for Alzheimer’s disease and other dementias. During the period of 2012–2021, there was a significant decrease in the annual registration rate of clinical trials for Alzheimer’s disease and other dementias (R² = 0.751, p = 0.001) and an increase of clinical trials for myoneural junction and muscle diseases and motor neuron disease (R² = 0.582, p = 0.010 and R² = 0.635, p = 0.006, accordingly). Commercial trials had a higher planned number of subjects (p = 0.014). Multiple member states participated in commercial trials more frequently (p < 0.001). Fifty-five clinical trials of neurological medicines were registered in Lithuania during the period of 2012–2021, and they comprised 8.08% of all clinical trials registered in Lithuania. The annual registration rate has decreased significantly (R² = 0.401, p = 0.049). Almost all trials in Lithuania (53 out of 55) were sponsored by commercial companies. The majority of trials (23 (42%)) were trials for demyelinating diseases of the CNS.Conclusions. The annual registration rates of trials of neurological medicines remain stable in Europe while decreasing in Lithuania. Commercial clinical trials have more participants, and are more commonly conducted in multiple member states.

Advancing genetic testing for neurological disorders in Tanzania: importance, challenges, and strategies for implementation.

This manuscript discusses the critical need for advancing genetic testing capabilities for neurological disorders (NDs) in Tanzania, emphasizing the importance, challenges, and strategies for implementation. Neurological disorders, often caused by a complex interplay of genetic and environmental factors, disproportionately affect low and middle-income countries like Tanzania. Patients with neurogenetic diagnoses in Tanzania face substantial obstacles, including lack of trust in medical professionals, stigmatization, and limited access to proper care. The manuscript underscores the infancy of genetic testing implementation for NDs in Tanzania, citing challenges such as high costs, limited availability, and the absence of routine testing in diagnostic procedures. The paper recommends establishing well-characterized cohorts, conducting a nationwide emergency census survey, and enhancing diagnostic services and healthcare financing. The paper stresses on the importance of collaboration, research, public awareness, and advocacy to address the challenges posed by NDs in Tanzania. The manuscript proposes a comprehensive plan, including training and capacity building in molecular diagnosis and bioinformatics, to establish genetic testing capabilities and reduce the burden of NDs in the country. Overall, the manuscript calls for a collaborative effort involving government support, stakeholder engagement, and international partnerships to advance genetic testing and improve healthcare outcomes for individuals with neurological disorders in Tanzania.

Interdisciplinary fetal-neonatal neurology training applies neural exposome perspectives to neurology principles and practice.

An interdisciplinary fetal-neonatal neurology (FNN) program over the first 1,000 days teaches perspectives of the neural exposome that are applicable across the life span. This curriculum strengthens neonatal neurocritical care, pediatric, and adult neurology training objectives. Teaching at maternal-pediatric hospital centers optimally merges reproductive, pregnancy, and pediatric approaches to healthcare. Phenotype-genotype expressions of health or disease pathways represent a dynamic neural exposome over developmental time. The science of uncertainty applied to FNN training re-enforces the importance of shared clinical decisions that minimize bias and reduce cognitive errors. Trainees select mentoring committee participants that will maximize their learning experiences. Standardized questions and oral presentations monitor educational progress. Master or doctoral defense preparation and competitive research funding can be goals for specific individuals. FNN principles applied to practice offer an understanding of gene-environment interactions that recognizes the effects of reproductive health on the maternal-placental-fetal triad, neonate, child, and adult. Pre-conception and prenatal adversities potentially diminish life-course brain health. Endogenous and exogenous toxic stressor interplay (TSI) alters the neural exposome through maladaptive developmental neuroplasticity. Developmental disorders and epilepsy are primarily expressed during the first 1,000 days. Communicable and noncommunicable illnesses continue to interact with the neural exposome to express diverse neurologic disorders across the lifespan, particularly during the critical/sensitive time periods of adolescence and reproductive senescence. Anomalous or destructive fetal neuropathologic lesions change clinical expressions across this developmental-aging continuum. An integrated understanding of reproductive, pregnancy, placental, neonatal, childhood, and adult exposome effects offers a life-course perspective of the neural exposome. Exosome research promises improved disease monitoring and drug delivery starting during pregnancy. Developmental origins of health and disease principles applied to FNN practice anticipate neurologic diagnoses with interventions that can benefit successive generations. Addressing health care disparities in the Global South and high-income country medical deserts require constructive dialogue among stakeholders to achieve medical equity. Population health policies require a brain capital strategy that reduces the global burden of neurologic diseases by applying FNN principles and practice. This integrative neurologic care approach will prolong survival with an improved quality of life for persons across the lifespan confronted with neurological disorders.

A strategic neurological research agenda for Europe: Towards clinically relevant and patient-centred neurological research priorities.

Neurological disorders constitute a significant portion of the global disease burden, affecting >30% of the world's population. This prevalence poses a substantial threat to global health in the foreseeable future. A lack of awareness regarding this high burden of neurological diseases has led to their underrecognition, underappreciation, and insufficient funding. Establishing a strategic and comprehensive research agenda for brain-related studies is a crucial step towards aligning research objectives among all pertinent stakeholders and fostering greater societal awareness. A scoping literature review was undertaken by a working group from the European Academy of Neurology (EAN) to identify any existing research agendas relevant to neurology. Additionally, a specialized survey was conducted among all EAN scientific panels, including neurologists and patients, inquiring about their perspectives on the current research priorities and gaps in neurology. The review revealed the absence of a unified, overarching brain research agenda. Existing research agendas predominantly focus on specialized topics within neurology, resulting in an imbalance in the number of agendas across subspecialties. The survey indicated a prioritization of neurological disorders and research gaps. Building upon the findings from the review and survey, key components for a strategic and comprehensive neurological research agenda in Europe were delineated. This research agenda serves as a valuable prioritization tool for neuroscientific researchers, as well as for clinicians, donors, and funding agencies in the field of neurology. It offers essential guidance for creating a roadmap for research and clinical advancement, ultimately leading to heightened awareness and reduced burden of neurological disorders.

Ambient air pollution and the dynamic transitions of stroke and dementia: a population-based cohort study

Stroke and dementia are the leading causes of neurological disease burden. Detrimental effects of air pollution on both conditions are increasingly recognised, while the impacts on the dynamic transitions have not yet been explored, and whether critical time intervals exist is unknown. This prospective study was conducted based on the UK Biobank. Annual average air pollution concentrations at baseline year 2010 estimated by land-use regression models were used as a proxy for long-term air pollution exposure. Associations between multiple air pollutants (PM2.5, PM2.5-10, and NO2) indicated by air pollution score and the dynamic transitions of stroke and dementia were estimated, and the impacts during critical time intervals were explored. The date cutoff of this study was February 29,2020. During a median follow-up of 10.9 years in 413,372 participants, 6484, 3813, and 376 participants developed incident stroke, dementia, and comorbidity of stroke and dementia. For the overall transition from stroke to comorbid dementia, the hazard ratio (HR) for each interquartile range (IQR) increase in air pollution score was 1.38 (95% CI, 1.15, 1.65), and the risks were limited to two time intervals (within 1 year and over 5 years after stroke). As for the transition from dementia to comorbid stroke, increased risk was only observed during 2-3 years after dementia. Our findings suggested that air pollution played an important role in the dynamic transition of stroke and dementia even at concentrations below the current criteria. The findings provided new evidence for alleviating the disease burden of neurological disorders related to air pollution during critical time intervals. The State Scholarship Fund of China Scholarship Council.

Role of incompatible food and regimen in neurological disorders

Introduction: The burden of neurological disorders has gradually increased over last 30 years. Neurological disorders are becoming a leading cause of disability and mortality in worldwide population. Patients presenting with common neurological symptoms like headache, anxiety, behavioural changes, fatigue, unexplained pain, erectile dysfunction, have been increasing, most of which can be attributed to unhealthy lifestyle and dietary practices. Ayurveda is one of the oldest systems of medicine, evolved over 3 millennia through constant devotedness of its preachers & learners. Viruddha Ahara is mentioned to cause various metabolic disorders and may even lead to neurological diseases. Food-food interaction is a serious issue requiring much attention. Hence it is of importance to ascertain role of Viruddha Ahara in the manifestation of different neurological disorders. Aim: To study role of incompatible food and regimen in neurological disorders. Material and Methods: This is a conceptual study for which various Ayurveda texts, Modern texts and published Articles are referred. Discussion: Although food combinations in present era are different in nature, principles remain the same and it is required to identify such food incompatibilities that can cause neurological disorders based on basic Ayurvedic principles. Conclusions will be made on basis of mentioned concepts.

Soriano award lecture: The epidemiology and burden of neurological disorders

Soriano award lecture: The epidemiology and burden of neurological disorders

Characterization and economic burden of neurological diseases from 2018 to 2019 in the City of Cartagena, Colombia

Characterization and economic burden of neurological diseases from 2018 to 2019 in the City of Cartagena, Colombia

Incidence and prevalence of neurological disorders in the United Arab Emirates: a systematic review

Background/ObjectivesThe United Arab Emirates (UAE) is a rapidly developing country. With the increase in average life-expectancy, high rates of consanguinity, and the adoption of a Western lifestyle, the burden of neurological disorders is expected to increase over the next few decades. Despite the importance of neurological disorders, there has not been a systematic review of published studies on the epidemiology of neurological disorders in the UAE.MethodsWe searched for studies of incidence and/or prevalence of neurological disorders in the UAE published in English in MEDLINE, Google Scholar, Embase, and Scopus databases with no date restrictions up until 01 October 2023. Two authors independently assessed abstracts and full texts of possibly relevant papers, followed by data extraction from studies satisfying the eligibility criteria.ResultsEight articles (N = 2067 patients) were included, half reported incidence and prevalence of multiple sclerosis, with an average crude prevalence 56/100,000 and related demyelinating disorders. Others were related to headache, meningitis, cerebral venous thrombosis, and brain tumours.ConclusionThere is a distinct lack of data on the epidemiology of different neurological diseases in the UAE. Large population-based studies, ideally longitudinal, are required to provide accurate and reliable estimates of the incidence and prevalence of neurological disorders to help inform healthcare capacity planning.

Epilepsy in cardiofaciocutaneous syndrome: Clinical burden and response to anti-seizure medication.

Treatment-resistant epilepsy is among the most serious complications of cardiofaciocutaneous syndrome (CFCS), a rare disorder caused by germline variants in the RAS-MAPK signaling pathway. This study analyzed the clinical characteristics of epilepsy and response to anti-seizure medications (ASMs) in a multinational CFCS cohort. A caregiver survey provided data regarding seizure history, use of ASMs and other treatment approaches, adverse effects, caregiver perception of treatment response, and neurological disease burden impact among individuals with CFCS. Results from 138 survey responses were quantitatively analyzed in conjunction with molecular genetic results and neurological records. The disease burden impact of CFCS was higher among individuals with epilepsy (n = 74/138), especially those with more severe seizure presentation. Oxcarbazepine, a sodium-channel blocker, had the best seizure control profile with relatively infrequent adverse effects. The most commonly prescribed ASM, levetiracetam, demonstrated comparatively poor seizure control. ASM efficacy was generally similar for individuals with BRAF and MAP2K1 gene variants. The high proportion of patients with CFCS who experienced poor seizure control despite use of multiple ASMs highlights a substantial unmet treatment need. Prospective study of ASM efficacy and clinical trials of therapies to attenuate RAS-MAPK signaling may improve avenues for clinical management.

A review of neurological health disparities in Peru.

Peru is a historically unique and culturally diverse Latin American country. As a low-to-middle-income country (LMIC), Peru faces health implications from the spread of communicable diseases as well as a growing rate of noncommunicable diseases, both of which have been worsened by the recent COVID-19 pandemic's impact on the national health system. Over the past two decades, the country has aimed to improve health access for its population through various efforts described in this review. Despite this, there are notable neurological health disparities that exist today. This narrative review investigates such disparities through the leading neurological contributors to the national burden of disease in the country, including migraine headaches, cerebrovascular disease, and dementia. Public health disparities that contribute to other major neurological diseases in the country, including epilepsy, neurocysticercosis, Chagas disease, multiple sclerosis, traumatic brain injury, traumatic and non-traumatic spinal cord injuries are also investigated. We also explore potential solutions for overcoming the various neurological health disparities covered in this review that may be applied through public policies, as well as in similar LMICs in Latin America. By overcoming such disparities, the country may be able to successfully address the major contributors of neurological disease burden and create a healthcare environment that can sustainably and equitably improve health outcomes for Peruvian people.

Determinants of Inequities in Neurologic Disease, Health, and Well-being: The NINDS Social Determinants of Health Framework.

A National Institute of Neurological Disorders and Stroke working group developed the Determinants of Inequities in Neurological Disease, Health, and Well-being framework. Our goal was to guide and inspire a new generation of neurologic research that pushes the field to design and test new approaches in pursuit of health equity, population health, and social justice. We seek to expand the lens of those looking to reduce or eliminate racial, socioeconomic status, and other inequities in neurologic disease, health, and well-being to improve our collective ability to create research, programs, and policies that lead to larger, more impactful, and more sustainable change in neurologic disease patterns. In this context, we outline a framework that includes and highlights "upstream" factors in the hopes of enhancing the focus of research, programmatic, and policy efforts to reduce and eliminate inequities in neurologic health and well-being. We explicitly discuss racism and other structural factors to clarify that social determinants are not natural and unchangeable. Populations with a disproportionate burden of neurologic disease are not inherently deficient, despite what some approaches to framing health inequities imply. The framework is presented linearly, but the pathways linking the determinants of neurologic disease, health, and well-being are far more complex than those demonstrated by the arrows included in the figure. The framework highlights the different levels and scale of causation, including the structural and intermediary social determinants and their impact on neurologic health. We offer this framework to refine efforts to contextualize the interpretation of neurologic research findings and suggest new avenues for their application. We illustrate how behavioral and biological factors occur in a social and economic context, factors that have been understudied as points of intervention to reduce inequities in neurologic disease. Considering social and structural determinants of health provides promising new opportunities to achieve neurologic health equity, reach social justice, and improve our science. Extending our work in this fashion is not simply about health equity or social justice but to fundamentally improve the quality of neurologic research by enhancing underlying theory and improving study design and implementation.

Perception of neurology among undergraduate medical students – what can be done to counter neurophobia during clinical studies?

Background and purposeWith a global increase in the burden of neurological diseases, the aversion towards neurology (neurophobia) may challenge the sufficient provision of new specialists in this field. We investigated the possible determinants of neurophobia among medical students and its influence on the intent to pursue neurology residency.MethodsFrom September 2021 to March 2022, an online questionnaire was distributed to medical students in Lithuania. It included questions about knowledge, confidence, interest, and teaching quality of various medical specialties (including neurology), as well as the willingness to choose neurology for residency.ResultsEight hundred fifty-two students responded to the survey (77.2% female) – they rated neurology as significantly more difficult than other medical areas and lacked confidence in assessing patients with neurological problems (p < 0.001). However, neurology was selected as one of the most interesting subjects and was reportedly well-taught. The prevalence of neurophobia among respondents was 58.9%. Most of them (207, 87.7%) indicated that neurology professors positively affected their outlook towards this medical specialty – such experience was associated with lower odds of neurophobia (odds ratio (OR) = 0.383, 95% confidence interval (CI) = 0.223 to 0.658). Being less neurophobic (OR = 1.785, 95% CI = 1.152 to 2.767) and having conducted neurology research (OR = 2.072, 95% CI = 1.145 to 3.747) increased the odds of a student being willing to pursue a career in neurology.ConclusionNeurophobia was frequent among students in Lithuania and was inversely related to the positive influence by neurology professors. Together with previous research experience in the field, low levels of neurophobia were associated with the inclination to enter neurology residency.

The impact of cognitive impairment resulting from traumatic brain injury on health-related quality of life (HRQOL) in Pakistan.

Madam, Millions of people are affected by traumatic brain injury (TB) across the world each year. Road traffic accidents (RTAs) are among the top contributors of mild to severe TBI cases, and in developing countries like Pakistan, low literacy rates and lack of awareness regarding traffic rules have further aggravated the situation.(1) Many survivors of RTAs never return to their normal life and are made to live with persistent disabilities. The limitation of knowledge regarding post-TBI cognitive impairment has been noted, and it further adds a barrier to necessary actions. It's evident that following mild to moderate TBI, the patients are prone to cognitive impairment and its associated adverse effects.(2) A recent 2019 study by Gorgoraptis et al. reported that cognitive impairment adversely effects health-related quality of life (HRQOL) following TBI.(3) In Pakistan’s already struggling healthcare system, there are a few emergency trauma centres with neurocritical care units in it. Another study indicates that TBI patients are not assessed by an experienced doctor most of the time, with poor reporting of the clinical findings and hence missing out on an important finding in such patients. (4) Computed Tomography (CT) scans for critical patients are available only in large centres and patient load, and cost of investigation can hinder to its timely availability for most TBI patients. Post TBI cognitive impairment can cause a significant burden on the healthcare system leading to other social implications as well. The patients are discharged once they get stabilized with no proper follow-up plans which can lead to other avoidable cognitive impairments like dementia, psychiatric problems, and behavioural changes. In TBI cases, risk assessment and more advanced investigations like MRI can be provided to the patients who suspected of any finding missed on a CT scan. Furthermore, TBI guidelines need to be reviewed and planned accordingly. A psychiatric team must assess patient’s mental status changes during the stay and if needed proper therapy must be initiated. Neuropsychological rehabilitation plays a pivotal role in cognitive impairments and can help decrease the burden of neurological diseases (5) and improves HRQOL of patients. Hence, a unified and interdisciplinary approach towards patients with traumatic brain injury is required so that not only can mortality be reduced but also to better the quality of life in survivors.

Fetal Neurology Practice Survey (P10-9.001)

<h3>Objective:</h3> To study the fetal neurology care delivery across centers in the US. <h3>Background:</h3> Fetal neurology is a rapidly evolving subspecialty that centers on the diagnosis and treatment of neurologic conditions of the developing brain. Innovations in fetal diagnostic tools and therapies have resulted in an increased need for specialized training. Prenatal diagnostic input with postnatal continuity of care can better address sequelae including developmental, behavioral, epileptic and mental health disorders. Despite the growing need for fetal neurology services, little is known about the current practice. <h3>Design/Methods:</h3> The Fetal Neurology Consortium (representatives from 9 sites across the US) distributed a survey characterizing fetal neurologic care delivery to practicing child neurologists using a Redcap database posted to the Child Neurology Society member website in November 2021 and March 2022. The results were summarized using descriptive statistics. <h3>Results:</h3> Representatives from 43 US institutions responded. Most centers had a fetal diagnostic center (n=38/43, 88%), with about half using a fetal neurology registry. Most performed fetal ultrasound and MRI on site. The annual fetal consultations ranged between &lt;20 for 40% to &gt;100 for 17%. About 50% of respondents were subspecialty trained. Earliest gestational age of fetal MRI was 16–19 weeks in 30% and 20–23 weeks in 30%. 25% of respondents participated in interdisciplinary consultations. Majority of the respondents followed neurodevelopment clinically. 91% were interested in participating in a collaborative national registry. The top-five priorities ranked by respondents were clinical guidelines, long-term follow-up data, imaging, practice improvement and prenatal counseling technique. <h3>Conclusions:</h3> This survey highlights heterogeneity in fetal neurology practice, lack of standardization, and high demand for practice guidelines and education. Interdisciplinary collaborations will be crucial for relevant curriculum and program development, including increasing attention to healthcare disparities. This synergy among different disciplines will improve outcomes and may reduce the burden of neurological diseases with fetal origins across the lifespan. <b>Disclosure:</b> Dr. Tarui has nothing to disclose. Dr. Venkatesan has nothing to disclose. Dr. Gano has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Clifford Law Offices. The institution of Dr. Gano has received research support from Cerebral Palsy Alliance Research Foundation. Dr. Lemmon has received research support from NINDS. Dr. Lemmon has received research support from BAND foundation. Dr. Lemmon has received research support from Doris Duke Charitable Foundation. The institution of Dr. Mulkey has received research support from Thrasher Research Fund. The institution of Dr. Mulkey has received research support from Centers of Disease Control. The institution of Dr. Mulkey has received research support from National Institutes of Health. The institution of Dr. Pardo has received research support from UCB Biosciences. The institution of Dr. Pardo has received research support from The Patrick G. and Shirley W. Ryan Foundation . The institution of Dr. Pardo has received research support from NINDS- Stroke Trials Network. The institution of Dr. Pardo has received research support from NINDS-I-ACQUIRE. The institution of Dr. Pardo has received research support from NINDS- VIPS-II. Dr. Emrick has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Arkema. The institution of Dr. Emrick has received research support from Lysogene. The institution of Dr. Emrick has received research support from PTC. The institution of Dr. Emrick has received research support from Roche. The institution of Dr. Emrick has received research support from NIH. Dr. Scher has nothing to disclose. Dr. Agarwal has nothing to disclose.

Are Neurologists Aware of the Neurology-Specific Hospice Criteria? (P8-6.004)

<h3>Objective:</h3> Are Neurologists Aware of Neurology-Specific Hospice Criteria? <h3>Background:</h3> The aging population has led to an increasing neurological disease burden. Neurology-specific criteria for hospice exist but awareness and utilization rates are not well-known. We surveyed neurology trainees and faculty at a single academic medical center regarding their awareness and familiarity with neurology-specific hospice criteria. <h3>Design/Methods:</h3> An anonymous online survey was sent to PGY 2–4 neurology residents and faculty at the Department of Neurology across Los Angeles County + University of Southern California Medical Center and Keck Medical Center. The questionnaire asked if the provider was aware of any neurology-specific hospice criteria (yes/no) for major neurological conditions. They were also asked how often they discussed eligibility for hospice when indicated (5-point Likert scale; Never, Rarely, Sometimes, Often, Always) and how familiar they were with any staging/performance scales for hospice (not at all, slightly, somewhat, moderately, extremely). Proportions of answers were recorded. <h3>Results:</h3> 22 out of 65 (33.8%) providers responded to the survey. 63.6% were faculty. 40.9% were aware of any neurology-specific hospice criteria. Top 5 conditions that providers thought had hospice criteria used by Centers for Medicare &amp; Medicaid Services were Amyotrophic Lateral Sclerosis (86.4%), Alzheimer’s Dementia (68.2%), Parkinson’s Disease (63.6%), Stroke (45.5%), and Muscular Dystrophy (45.5%). 22.7% of providers often or always initiated discussion on hospice when indicated. 9.1% were moderately or extremely familiar while 68.2% were not at all familiar with any staging or performance scales for hospice. <h3>Conclusions:</h3> Less than half of Neurology trainees and faculty were aware of any neurology-specific hospice criteria while less than one tenth were at most moderately familiar with any staging or performance scales for hospice. A larger study is needed to determine the familiarity and utilization hospice screening tools. Dedicated educational tools for neurologists can be useful. <b>Disclosure:</b> Dr. Oh has nothing to disclose. Dr. Stuart has nothing to disclose. Dr. Matta has nothing to disclose. Dr. Liang has nothing to disclose. The institution of Dr. Sung has received research support from NIH. Dr. Hui has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sunovion. Dr. Hui has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sunovion. The institution of Dr. Hui has received research support from Roche. The institution of Dr. Hui has received research support from Abbvie. Dr. Hui has received personal compensation in the range of $500-$4,999 for serving as a Roundtable speaker with Medscape .

Neurologic Disease Burden in Asia is Both Growing and Changing: But More Data Are Needed.

Neurologic Disease Burden in Asia is Both Growing and Changing: But More Data Are Needed.