Canadian Neurological Sciences Federation Research Articles

Advances in Cerebral Small Vessel Disease: Sandra E. Black Lecture to the Canadian Neurological Sciences Federation.

Cerebral small vessel diseases (CSVDs) are among the most common age-related pathologies of the brain. Arteriolosclerosis and cerebral amyloid angiopathy (CAA) are the most common CSVDs. In addition to causing stroke and dementia, CSVDs can have diverse covert radiological manifestations on computed tomography and magnetic resonance imaging including lacunes, T2-weighted white matter hyperintensities, increased density of visible perivascular spaces, microbleeds and cortical superficial siderosis. Because they cannot be visualized directly, research on the pathophysiology of CSVD has been difficult. However, advances in quantitative imaging methods, including physiological imaging such as measurement of cerebrovascular reactivity and increased vascular permeability, are beginning to allow investigation of the early effects of CSVD in living people. Furthermore, genomics, metabolomics and proteomics have the potential to illuminate previously unrecognized pathways to CSVD that could be important targets for new clinical trials.

A brain-based definition of death and criteria for its determination after arrest of circulation or neurologic function in Canada: a 2023 clinical practice guideline

This 2023 Clinical Practice Guideline provides the biomedical definition of death based on permanent cessation of brain function that applies to all persons, as well as recommendations for death determination by circulatory criteria for potential organ donors and death determination by neurologic criteria for all mechanically ventilated patients regardless of organ donation potential. This Guideline is endorsed by the Canadian Critical Care Society, the Canadian Medical Association, the Canadian Association of Critical Care Nurses, Canadian Anesthesiologists’ Society, the Canadian Neurological Sciences Federation (representing the Canadian Neurological Society, Canadian Neurosurgical Society, Canadian Society of Clinical Neurophysiologists, Canadian Association of Child Neurology, Canadian Society of Neuroradiology, and Canadian Stroke Consortium), Canadian Blood Services, the Canadian Donation and Transplantation Research Program, the Canadian Association of Emergency Physicians, the Nurse Practitioners Association of Canada, and the Canadian Cardiovascular Critical Care Society.

The state of pediatric tuberous sclerosis complex epilepsy care: Results from a national survey.

Epilepsy associated with tuberous sclerosis complex (TSC) can be challenging to treat and is associated with significant disease burden. Our objective was to better understand the state of epilepsy care of TSC amongst pediatric neurologists in Canada, identify gaps in care and determine whether access to a dedicated TSC clinic has an impact on epilepsy management. A survey was developed after a literature review and discussion amongst two pediatric epileptologists and one nurse practitioner with expertise in TSC about the state of epilepsy care of TSC patients in Canada. Canadian pediatric neurologists were asked to participate in sharing their experiences via an anonymous web-based survey through the Canadian League Against Epilepsy (CLAE) and the Canadian Neurological Sciences Federation (CNSF). Fifty-seven responses were received. Access to a dedicated TSC clinic was reported by 25% (n=14). Sixty percent (n=34) reported performing serial EEG monitoring in infants with TSC and 57% (n=33) started prophylactic antiseizure therapy when EEG abnormalities were detected, regardless of whether there was access to a TSC clinic (P=.06 and P=.29, respectively). While 52% (n=29) did not feel comfortable prescribing mTORi for epilepsy, 65% (n=36) indicated they would consider it with additional training. Epilepsy surgery was offered in 93% (n=13) of centers with a dedicated TSC clinic but only 45% of centers without a TSC clinic (n=19) (P=.002). Our findings demonstrate the variability in neurological care of pediatric patients with TSC as it pertains to epilepsy management. There is a need for the establishment of epilepsy practice guidelines and a national network to support clinical practice, research, and education.

P.087 The landscape of paediatric tuberous sclerosis complex (TSC) neurological care in canada: results from a national survey

Background: Tuberous Sclerosis Complex (TSC) is a genetic disease that affects multiple body systems with the neurological manifestations causing the greatest disease burden. The objective of this study was to understand the scope of neurological TSC care delivery across Canada. Methods: A survey was developed after literature review and discussion amongst two Paediatric Epileptologists and one Nurse Practitioner with expertise in TSC. Canadian Paediatric Neurologists participated via an anonymous web-based survey through the Canadian League Against Epilepsy (CLAE) and Canadian Neurological Sciences Federation (CNSF). Results: Fifty-eight responses were received. A dedicated TSC clinic was reported by 24% (n=14). Sixty percent (n= 35) reported preforming serial screening EEG monitoring in infants and 58% (n= 34) started prophylactic therapy when EEG abnormalities occurred. Vigabatrin was used in 37% (n=21). For management of drug-resistant epilepsy, surgery was reported as the preferred therapeutic option in 57% (n=32) of respondents. Barriers to treatment identified were a lack of multi-disciplinary care, unfamiliarity with new therapies and insufficient resources. Conclusions: Our findings demonstrate the variability in neurological care delivery of patients with TSC. With few dedicated TSC clinics, there is a need for the establishment of a national network to support clinical practice, research and education.

P.009 Canadian Survey of the neurological care provided to women living with epilepsy: preliminary results

Background: In Canada, approximately 300,000 women with epilepsy (WWE) are of childbearing potential. Given the unique aspects of providing care for WWE, our objective was to gather demographic and practice characteristics of health care professionals providing care for WWE to identify potential gaps. Methods: We developed a questionnaire to understand the demographic and practice characteristics of professionals providing care for WWE. We invited all French and English practitioners (physicians, physician assistants and nurse practitioners), recruited through the Canadian League Against Epilepsy (CLAE), Canadian Neurological Sciences Federation (CNSF) and Canadian Epilepsy nursing Group (CENG), to complete our online questionnaire. Results: Preliminary data show 43% were between 32-40 years of age and 76% were medical doctors. Sixty-three percent had been in practice for less than 20 years; 81% considered themselves epilepsy specialists and 66% devoted their practice entirely to epilepsy patients and 78% practiced exclusively in academic centers. Conclusions: Our data shows providers involved in the care of women with epilepsy in Canada are predominantly academic experts in epilepsy. Potential gaps in care include mid-late career physicians, non-specialized health care practitioners, and community-based practices, as less likely to provide care for WWE. This snapshot may provide future insights to the unmet needs of WWE Canada.

P.172 Work-up and management of asymptomatic extracranial traumatic vertebral artery injury

Background: Extracranial traumatic vertebral artery injury (eTVAI) is common following non-penetrating head and neck trauma. Most cases are initially asymptomatic with an increased risk for stroke. Consensus is lacking regarding screening, treatment, and follow-up of asymptomatic patients with eTVAI. Our objective was to investigate national practice patterns reflecting these domains. Methods: An electronic survey was distributed via the Canadian Neurological Sciences Federation and Canadian Spine Society. Two case-based scenarios featured asymptomatic patients with eTVAI. Case 1: non-displaced cervical lateral mass fracture; angiography stratified by luminal diameter reduction. Case 2: complex C2 fracture; angiography featuring pseudoaneurysm dissection. Analysis: descriptive statistics. Results: Response Rate: 108 of 182 participants (59%), representing 20 academic institutions.Case 1: 78% of respondents would screen using CTA (97%), immediately (88%). Most respondents (97%) would initiate treatment, using aspirin (89%) for 3-6 months (46%).Case 2: 73% of respondents would screen using CTA (96%), immediately (88%). The majority of respondents (94%) would initiate treatment, using aspirin (50%) for 3-6 months (35%). Thirty-six percent of respondents would utilize endovascular therapy.In both cases, the majority of respondents would follow-up clinically or radiographically every 1-3 months, respectively. Conclusions: This study highlights consensus in Canadian practice patterns for the workup and management of asymptomatic eTVAI.

P.143 How well can neuroradiologists localize clinical signs?

Background: A basic understanding of localization for a given set of focal neurological deficits is essential for accurate acquisition and interpretation of neuroimaging. Relying on often-limited clinical information, neuroradiologists must choose the most appropriate imaging modality and tailor a study to best identify the culprit lesion to allow for accurate interpretation. Methods: A multiple-choice quiz was designed including clinical vignettes localizing to lesions within the central (CNS) and peripheral nervous systems (PNS). The quiz was pilot-tested and refined before distribution as an electronic survey to practicing neuroradiologists and fellows within newsletters from the American Society for Neuroradiology and Canadian Neurological Sciences Federation. Results: The quiz was begun by 45 neuroradiologists and completed in its entirety by 22. Most respondents were working at urban academic/teaching hospitals(81%) in the USA(42%). The majority (90%) report no clinical neurology rotation during their training. Respondents identified a high proportion (88%) of correct answers in questions about brainstem localizations. Fewer correct answers were selected in questions describing seizure semiology (44%) or flaccid weakness (59%). Conclusions: The small size of our study limits interpretation and generalizability of the findings. Identification of a potential gap in neuroradiology education relating to localization of more complex CNS and PNS presentations merits further exploration.

A Survey of Cerebrospinal Fluid Total Protein Upper Limits in Canada: Time for an Update?

The antiquated standard reference range of 0.15-0.45 g/L for cerebrospinal fluid total protein (CSF-TP) is well entrenched in medical literature and laboratory operating procedures across the world. We conducted a web-based survey with a response rate of 34.9% through the listserv of the Canadian Neurological Sciences Federation. Additional laboratory reference data were collated by telephone interview of hospital laboratory technologists across Canada. A total of 142 site responses were obtained: 64.1% from academic/tertiary hospitals and 35.9% from community hospitals. A strong majority (80.4%) of both types of institutions reported using a CSF-TP upper reference limit of 0.45 g/L or less. As a rule, no age adjustments were implemented in CSF-TP-level interpretation. Recent well-powered laboratory reference studies have documented CSF-TP upper reference limits that are above 0.6 g/L starting at age 50, with incremental limits partitioned by subsequent decades of age. The conventional 0.45 g/L limit could lead to false positive results. Our survey suggests there is a need to consider a wide adoption of data-driven, rather than historical, reference values.

P.031 A qualitative study of patient perspectives regarding the role of the neurologist in advanced Multiple Sclerosis

Background: With few evidence-based disease-modifying therapies being available for patients with progressive multiple sclerosis (PMS), how can neurologists best care for their patients? Little is known about the perspectives of patients with respect to the role they would like their neurologist to play in their care. We hereby report an update to our abstract presented at the Canadian Neurological Sciences Federation’s annual congress in 2016. Methods: Patients with PMS having an Expanded Disability Status Scale (EDSS) score of 6 or more were invited to participate. Semi-structured interviews were conducted with patients and their caregivers, and written questionnaires were completed by all participants. Collected data was subjected to thematic coding. Results: We have now interviewed a total of 18 patients (compared to 10 in 2016) and have reached thematic saturation. The majority of patients identified the neurologist as a useful figure in their care. Three main reasons were identified: (1) The neurologist provides information about new research and therapies (2) The neurologist educates patients about their disease and available services (3) The neurologist is viewed as an important supportive figure. Conclusions: Despite a lack of disease-modifying treatments for progressive multiple sclerosis, patients with PMS view the neurologist as an essential provider of care.

Canadian Neurological Sciences Federation 2018 Congress June 24 – 27 Halifax Convention Centre, Halifax, Nova Scotia

Canadian Neurological Sciences Federation 2018 Congress June 24 – 27 Halifax Convention Centre, Halifax, Nova Scotia

Canadian Association of Neuropathologists L’Association Canadienne des Neuropathologistes

The Canadian Association of Neuropathologists (CANP) held their 57th annual meeting at the Inn at the Forks Hotel in Winnipeg, Manitoba from October 12th-14th, 2017, under the leadership of Dr. Marc Del Bigio, CANP president, who also handled the local arrangements. The annual banquet was held at the Assiniboine Park Conservancy where the polar bears captivated the crowd of Neuropathologists.The academic program of 14 scientific abstracts and 11 unknown cases were compiled by the CANP Secretary-Treasurer Dr. Julia Keith into 4 sessions; Infectious/Immune Mediated and Epilepsy Neuropathology, Tumour Neuropathology, Developmental Neuropathology and Neurodegenerative/Neuromuscular Neuropathology. The program also included a guided interactive forum on Quality Assurance and Professional Affairs for Neuropathologists led by Dr Del Bigio.The digital pathology images from the 11 unknown cases are available for viewing online (www.canp.ca) thanks to the CANP webmaster, Dr. Jason Karamchandani. All submitted abstracts were peer reviewed by the CANP Abstract Review committee comprised of Drs. Marie-Christine Guiot, David Munoz, and Harvey Sarnat.The Presidential Symposium explored the theme of Pediatric Head Injuries and Forensic Neuropathology. Dr. Michael J. Ellis (Section of Neurosurgery, University of Manitoba) delivered an invited lecture entitled Current Concepts in Pediatric Concussion. The Dr. Gordon Mathieson invited member lecturer was Dr. David Ramsay (Western University) who spoke on the subject of Observations on Selected Neuropathological Aspects of Suspected Inflicted Head and Spinal Injury in Young Children. The Dr. David Robertson invited lecture was delivered by Dr. Paul Kadar (Department of Pediatrics, Hospital for Sick Children, University of Toronto) Child Maltreatment/Abusive Head Trauma in a “Pre-” and “Post-Goudge” World. The Dr. Jerzy Olszewski guest lecturer was Dr. Waney Squier (Oxford University, UK) who explained the Impact of Legal Changes in the UK on Brain Retention, Evolving Opinions and Controversies about “Shaken Baby Syndrome”. The symposium concluded with a panel discussion and group Question and Answer session with the symposium speakers.The resident awards committee was comprised of Drs. Sidney Croul and Sherry Krawitz. The Mary Tom Award for best clinical science paper was awarded to Dr. Randy van Ommeren (supervisor Dr. Patrick Shannon) for his presentation of Unknown Case #8 and the Morrison H. Finlayson Award went to Dr. Andrew Gao (supervisor Dr. Lili Hazrati) for his presentation Abstract #14 The Role of ATP and P2X Purinoreceptor 7 in the Pathogenesis of Cerebral Tau.The following abstracts were presented at the 2017 Canadian Association of Neuropathologists (CANP) 57th Annual Meeting in October. The material presented contains the abstracts submitted as part of the 2017 Canadian Association of Neuropathologists (CANP) 57th Annual Meeting, as part of the standard processes of The Canadian Journal of Neurological Sciences, and may contain promotional content that does not represent the views or policies of the journal or publisher. The content and the views expressed therein are those of the presenting entity and not the Editors of The Canadian Journal of Neurological Sciences, the Canadian Neurological Sciences Federation, or Cambridge University Press. Authors have not provided standard disclosure forms as part of their submission, although these would have been evident at the time of the meeting.

A Canadian perspective on anterior cervical discectomies: practice patterns and preferences.

The purpose of this study is to elucidate the current practice patterns of Canadian neurosurgeons with regards to anterior cervical discectomy (ACD). A one-page questionnaire was sent out using SurveyMonkey to all neurosurgeon members of the Canadian Neurological Sciences Federation (CNSF). End points were surgeon preference for ACD surgical method, graft source, the length of collar usage and the recommended time before returning to work. Response rate was 74.0%. Of the responders, 75.0% performed single level ACD and 18.3% had completed spine fellowships. The majority (68.2%) chose ACD with fusion and plating (ACDFP) as their preferred method with allograft being the most popular choice of fusion material (44.3%). Most of the respondents did not prescribe collars (60.9%) and when they did, hard collar was prescribed most often (76.9%) and AspenTM collar was the most popular choice (67.7%). The majority of surgeons chose 'other' as their response for length of time for collar use (40.0%) while allowing them to take their collars off at night (78.1%). Most of the surgeons recommended physiotherapy post-operatively (58.1%) and time to physiotherapy was 6-8 weeks. Recommended back to work time was 6 weeks for 44.9% of respondents. In the cross analysis, surgeons who performed ACDF were more likely to prescribe collars (50%, P=0.01) versus surgeons who performed ACDFP (21.7%, P=0.01). Our survey is an up to date description of current practice patterns for ACD amongst Canadian neurosurgeons.

P.076 Quantitative EEG in Canada: a national technologist survey

Background: Burgeoning EEG demand has largely gone unmet with insufficient supply of manpower and equipment. Quantitative EEG (QEEG) may help compress large volumes of data for expedited review. We sought to determine the current use of QEEG in Canada through a national EEG technologist survey. Methods: A 10-item questionnaire was administered to participants at the 2016 meeting of the Canadian Association of Electroneurophysiology Technologists, which occurred in parallel with the Canadian Neurological Sciences Federation meeting. Results: A response rate of 63% (14/22) represented 12 institutions (11 adult, 6 paediatric) over six provinces with 73% of the national population. Only academic institutions (9/12) used QEEG, representing five provinces with 70% of the national population. Most institutions generated QEEG either real-time or retrospectively in the critical care and epilepsy monitoring units for long-term monitoring and automated seizure detection. The most used trends were spectrographic, seizure detection, and artifact detection. Montage use, QEEG duration, and timebase settings were highly variable. Conclusions: QEEG is in surprisingly frequent use across Canada. There is no consensus on optimal QEEG use, which mirrors uncertainty in the literature. The relative ubiquity of QEEG in Canada offers promise for collaborative multicentre research into unlocking the full potential of QEEG in enhancing patient care.

Canadian Neurological Sciences Federation 2017 Congress June 20 – 23 Victoria Conference Centre, Victoria, BC

An abstract is not available for this content so a preview has been provided. As you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

The state of everyday quantitative EEG use in Canada: A national technologist survey

PurposeThis study sought to determine the state of quantitative EEG (QEEG) use in Canada, as QEEG may provide a partial solution to the issue of escalating EEG demand against insufficient health care resources. MethodsA 10-item survey questionnaire was administered to participants at the annual meeting of the Canadian Association of Electroneurophysiology Technologists, which was held in parallel with the annual meeting of the Canadian Neurological Sciences Federation. ResultsAt least 70% of the Canadian population has QEEG access through academic medical institutions with applicability to adults and children. QEEG was clinically used 50% in real-time and 50% retrospectively in the critical care and epilepsy monitoring units for long-term monitoring and automated seizure detection. QEEG trend use, montage use, and duration were variable. ConclusionTo cope with insufficient health care resources, QEEG is in surprisingly frequent clinical use across Canada. There is no consensus on optimal QEEG trends and montages. The relative ubiquity of QEEG affords an excellent opportunity for research as increasing EEG demand outpaces dwindling health care resources into the foreseeable future.

What is the Future of Pediatric Neurology in Canada? Resident and Faculty Perceptions of Training and Workforce Issues.

Pediatric neurology trainee numbers have grown considerably in Canada; recent research, however, has shown that the number of pediatric neurology graduates is outpacing the need for future pediatric neurologists. The purpose of this study was to seek the opinion of pediatric neurology program directors and trainees regarding possible solutions for this issue. Two focus groups were convened during the Canadian Neurological Sciences Federation annual congress in June 2012; one consisted of current and former program directors, and the other of current pediatric neurology trainees. Groups were asked for their perceptions regarding child neurology manpower issues in Canada as well as possible solutions. Focus groups were audio-recorded and transcribed for analysis. Theme-based qualitative analysis was used to analyze the transcripts. Major themes emerging from both focus groups included the emphasis on community pediatric neurology as a viable option for trainees, including the need for community mentors; recognizing the needs of underserviced areas; and establishing academic positions for community preceptors. The need for career mentoring and support structures during residency training was another major theme which arose. Program directors and trainees also gave examples of ways to reduce the current oversupply of trainees in Canada, including limiting the number of trainees entering programs, as well as creating a long-term vision of child neurology in Canada. A nationwide dialogue to discuss the supply and demand of manpower in academic and community pediatric neurology is essential. Career guidance options for pediatric neurology trainees across the country merit further strengthening.

49th Annual Congress of the Canadian Neurological Sciences Federation

49th Annual Congress of the Canadian Neurological Sciences Federation

48th Annual Congress of the Canadian Neurological Sciences Federation

An abstract is not available for this content so a preview has been provided. As you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

47th Annual Congress of the Canadian Neurological Sciences Federation

47th Annual Congress of the Canadian Neurological Sciences Federation

46th Annual Congress of the Canadian Neurological Sciences Federation

An abstract is not available for this content so a preview has been provided. As you have access to this content, a full PDF is available via the ‘Save PDF’ action button.