Neurology Research Articles

Artificial Intelligence and Machine Learning (AIML) approaches to empower genomics, drug, and biomarker discovery in ADRD

AbstractBackgroundIn 2021, the NIA launched the Artificial Intelligence and Machine Learning (AIML) Consortium, to develop novel AI and machine learning techniques to tackle pressing questions in Alzheimer’s disease research.MethodDrawing on vast repositories of data from the Alzheimer’s Disease Sequencing Project (ADSP) and other large public biobanks, the 8 awardees funded under this program meet monthly to present their innovations in data analytics in 4 main areas: (1) genome‐guided drug discovery and drug repositioning for AD; (2) discovery of novel genetic and molecular targets for AD therapeutics using whole genome and omics data; and (3) understanding the regulatory code of the genome using deep learning and bioinformatics, and (4) use of electronic health records (EHR) to study treatment outcomes in ADRD. A second branch of AIML activity draws on repositories of neuroimaging data (MRI/FLAIR, DTI, and amyloid‐ and tau‐sensitive PET) to (1) identify ADRD subtypes based on neuroimaging, clinical and neuropsychological data, that differ in terms of their genomic drivers and expected treatment response (for precision medicine and drug trial stratification), (2) perform genetic analysis of endophenotypes derived from brain images (such as longitudinal hippocampal volume changes, atrophy subtype scores, and PET or WMH signatures) for biomarker‐guided gene discovery, and (3) predict neuropathology (TDP‐43, CAA, LBD) from multimodal imaging using AI. The AIML initiative benefits from and helps the ADSP’s Phenotype Harmonization Consortium, as AI methods can also be used to adjust neuroimaging data for site and protocol effects (harmonization).ResultIn this overview of the AIML Consortium, we highlight some recent successes using (1) convolutional neural networks (CNNs), GANs and deep learning for ADRD subtyping and staging; (2) discovery of AD‐relevant motifs and networks in whole genome sequences and functional genomics data; (3) prognostic models of clinical outcomes based on WGS and biomarkers; and (4) novel methods from statistical physics, based on evolutionary action, which model the fitness effect of coding mutations analytically.ConclusionAIML investigators are hosting regular workshops at AAIC and upcoming genomics and clinical neurology conferences to disseminate and teach these approaches to the AD and broader scientific community.

Education Research: Perspectives and Experiences of Clinical Neurology Faculty Regarding the End-of-Rotation Assessment: A Qualitative Study.

End-of-rotation assessments (ERAs) completed by clinical faculty supervising medical students are an important component of medical student performance during clinical rotations. The quality and quantity of the formative and/or summative comments provided by faculty to students on ERAs vary. The goal of this study was to better understand the experiences, limitations, and barriers that may affect faculty at a single institution and its affiliated sites when completing this assessment. A qualitative study design was used, with phenomenology as the qualitative design of inquiry. Clinical faculty at 3 student rotation sites who worked with students and had filled out the electronic assessment form were asked to participate. A virtual platform was used to conduct semistructured interviews. Transcripts of the recorded interviews were reviewed and analyzed to identify emerging and recurrent themes. Eleven faculty members (8 men and 3 women) were interviewed. Most participants felt that the time spent with medical students was limited, compromising the assessment process-particularly at sites where they are assigned to inpatient service for 1 week at a time. Longer intervals between end-of-rotation and completing the assessment limited details in the narrative components. Some participants were hesitant to assign students lower scores and to write negative comments in their assessments. Although constructive comments could be provided verbally, they were not always stipulated as comments on the assessment form. Many were concerned that written comments could negatively affect a student's future career. The participants recognized the importance and benefit of writing comments specific to the individual student. Many opined that providing prewritten examples of suggested comments would result in a generic assessment. The experiences, limitations, and barriers that affected faculty members' ability to assess medical students at the end of the neurology rotation included limited time spent with students, a longer time taken to fill out the assessment form, and reluctance to write negative comments that could potentially affect a student's career. Specific comments about individual students were deemed important. Shorter and more frequent assessments, modifications to faculty schedules, faculty development initiatives, and adoption of a growth mindset are potential ways to overcome barriers faced by faculty.

Expert opinion on diagnosis and management of epilepsy-associated comorbidities.

Apart from seizure freedom, the presence of comorbidities related to neurological, cardiovascular, or psychiatric disorders is the largest determinant of a reduced health-related quality of life in people with epilepsy (PwE). However, comorbidities are often underrecognized and undertreated, and clinical management of comorbid conditions can be challenging. The focus of a comprehensive treatment regimen should maximize seizure control while optimizing clinical management of treatable comorbidities to improve a person's quality of life and overall health. A panel of four European epileptologists with expertise in their respective fields of epilepsy-related comorbidities combined the latest available scientific evidence with clinical expertise and collaborated to provide consensus practical advice to improve the identification and management of comorbidities in PwE. This review provides a critical evaluation for the diagnosis and management of sleep-wake disorders, cardiovascular diseases, cognitive dysfunction, and depression in PwE. Whenever possible, clinical data have been provided. The PubMed database was the main search source for the literature review. The deleterious pathophysiological processes underlying neurological, cardiovascular, or psychiatric comorbidities in PwE interact with the processes responsible for generating seizures to increase cerebral and physiological dysfunction. This can increase the likelihood of developing drug-resistant epilepsy; therefore, early identification of comorbidities and intervention is imperative. The practical evidence-based advice presented in this article may help clinical neurologists and other specialist physicians responsible for the care and management of PwE.

Studies conducted on physical activity and brain: a bibliometric analysis

Purpose: The purpose of the study is to examine physical activity and brain-related studies published in international and peer-reviewed journals using the Bibliometric Analysis Method. Material and Methods: By applying the visualized Bibliometric Analysis Method in the study, it was aimed to examine the general distribution characteristics, study progress, and highlights of existing studies on the effects of physical activity on the brain from 2001 to 2022. Studies that were published in journals containing SSCI, SCI-Expanded and AHCI indices of Web of Science (WoS) were examined within the scope of the study. After the elimination criteria were applied, a total of 6007 studies were included in the Bibliometric Analysis. Results: When the year distributions of the publications were examined, it was found that they were few in number from 1990 to 2000, increased as of 2001, and a significant increase was detected especially in 2019. According to the articles reviewed based on WoS citations, it was found that the fields of neuroscience, clinical neurology and psychiatry came to the forefront. Considering the journal distribution of the examined articles, the PLoS One journal was in the first place. Four main clusters emerged in the common word analysis, which were green, red, blue and yellow. It was obtained that the green cluster occupying the center of the map was the field of sports sciences. The words found in the clusters that emerged from the analysis were physical activity, exercise, cognition, aging, Alzheimer’s disease, depression,dementia, and hippocampus. Conclusion: The study systematically summarizes and analyzes studies conducted on the promotion of physical activity by emphasizing the improvement of cognitive functions. It is expected that the study will provide guidance and reference for future research.

Analysis of publication activity and priority subject areas of research in medicine in the Russian Federation

Introduction. Scientometric analysis is one of the progressive methods and key tools for quantitative and qualitative study of science, identification of priorities and trends of its development. 
 The purpose of the study is a scientometric study of Russia’s report activity in the field of medicine and determination of the priority subject issues of research in this area.
 Material and methods. The study was conducted using SciVal, according to scientometric indicators characterizing the number of publications in various categories and their citation for a three-year period (2019–2021) for the Russian Federation with the reference values for the world.
 Results. The main scientometric indicators (in number and share) characterizing the dynamics in Russia’s publication activity in medical sciences in 2019–2021 are considered and analyzed. A comparative analysis of the TOP five subject areas for 4 scientometric indicators for the world and the Russian Federation is carried out.
 Limitations. The research materials are limited to the results of the data uploading as of a specific date, as well as the selected time period.
 Conclusion. In the field of medicine, Russia is characterized by a steady growth and positive trend in the majority of the selected scientometric indicators. The leading subject areas of the Russian research are general medicine, public health, surgery, oncology, cardiology, immunology and allergology, clinical neurology. The scientometric analysis fully confirms the subject areas of the Russian scientific medical research to fully correspond to both domestic priority areas of medical science development specified in various regulatory documents and the world trends.

Abstract 239: Effects of the COVID‐19 Pandemic on Stroke Treatment in Australia

Introduction In Australia, stroke is one of the leading causes of mortality, death, and disability (Kitsos et al., 2011; Coory et al. 2002). Although Australia has been known to offer excellent stroke treatment and care services in recent years (Deloitte Access Economics, 2020), the rise of the COVID‐19 pandemic caused a reduction in resource availability and delays in stroke treatment. Therefore, we studied the impact that the COVID‐19 pandemic had on stroke treatment in hospitals all over the country. Methods Initially, we conducted secondary research on stroke treatment in Australia. Using this information, we created a survey inquiring more about the COVID‐19 pandemic’s effect on stroke treatment from the physician's perspective. We also focused on inquiring about the disparities in access to stroke care for urban and rural regions in Australia. We compiled a list of clinical and academic neurologists and subsequently distributed the survey to them. We received a total of 4 survey responses from neurologists and additional supplementary information from 2 other neurologists. We also reached out to leaders of stroke support groups to learn more about stroke rehabilitation services and how the pandemic affected them. Furthermore, we conducted one interview with a support group leader from Melbourne, Victoria. Results Based on the survey results and interview, we believe that the main barrier affecting stroke treatment due to the pandemic was reductions in resource availability (including beds, general anesthesia, etc.). In addition, the hospital admission rate of stroke patients decreased during the initial stages of the pandemic in 2020. Some physicians mentioned that this may have been due to patients' fear of receiving care in hospitals that were prioritizing treatment of COVID‐19 rather than stroke. Survey responses indicated that physicians working in urban hospitals observed minor effects on stroke treatment due to the pandemic. However, urban hospitals, benefiting from Australia's advanced stroke treatment, generally managed to withstand these challenges. Although there may be multiple reasons for this, a major reason one of the neurologists mentioned was a lack of politicization regarding public health precautions, which contributed to the initial stages of the pandemic not being as detrimental to Australia as it was in other parts of the world. Conclusion Overall, the pandemic did not have a major effect on stroke treatment in Australia. Compared to before the pandemic, both stroke cases and stroke treatment numbers remained relatively the same. The most prominent effect was the reduction in resources for patients as well as healthcare workers. Patient concern about healthcare availability increased, and the number of patients reporting stroke concerns decreased. However, overall, because of Australia’s advanced treatment services, the COVID‐19 impact on stroke treatment was not significant. Due to the low impact COVID‐19 had on stroke treatment in Australia, we have shifted our interest to studying how stroke treatment in Australia has changed over the last 5 years to better understand changes that predated and currently exist after COVID‐19.

Theoretical Neurobiology of Consciousness Applied to Human Cerebral Organoids.

Organoids and specifically human cerebral organoids (HCOs) are one of the most relevant novelties in the field of biomedical research. Grown either from embryonic or induced pluripotent stem cells, HCOs can be used as in vitro three-dimensional models, mimicking the developmental process and organization of the developing human brain. Based on that, and despite their current limitations, it cannot be assumed that they will never at any stage of development manifest some rudimentary form of consciousness. In the absence of behavioral indicators of consciousness, the theoretical neurobiology of consciousness being applied to unresponsive brain-injured patients can be considered with respect to HCOs. In clinical neurology, it is difficult to discern a capacity for consciousness in unresponsive brain-injured patients who provide no behavioral indicators of consciousness. In such scenarios, a validated neurobiological theory of consciousness, which tells us what the neural mechanisms of consciousness are, could be used to identify a capacity for consciousness. Like the unresponsive patients that provide a diagnostic difficulty for neurologists, HCOs provide no behavioral indicators of consciousness. Therefore, this article discusses how three prominent neurobiological theories of consciousness apply to human cerebral organoids. From the perspective of the Temporal Circuit Hypothesis, the Global Neuronal Workspace Theory, and the Integrated Information Theory, we discuss what neuronal structures and functions might indicate that cerebral organoids have a neurobiological capacity to be conscious.

Neurofilament light chain for classifying the aetiology of alteration of consciousness.

Neurofilament light chain has become a promising biomarker for neuroaxonal injury; however, its diagnostic utility is limited to chronic disorders or specific contexts. Alteration of consciousness is a common clinical problem with diverse aetiologies, many of which require timely diagnoses. We evaluated the value of neurofilament light chain alone, as well as creating diagnostic models, in distinguishing causes of alteration of consciousness. Patients presenting with alteration of consciousness were enrolled. Initial clinical data of each participant were evaluated by a neurologist to give a provisional diagnosis. Each participant subsequently received advanced investigations and follow-up to conclude the final diagnosis. All diagnoses were classified into a structural or non-structural cause of alteration of consciousness. Plasma and cerebrospinal fluid levels of neurofilament light chain were measured. Cerebrospinal fluid neurofilament light chain and other clinical parameters were used to develop logistic regression models. The performance of cerebrospinal fluid neurofilament light chain, the neurologist's provisional diagnosis, and the model to predict the final diagnosis were compared. For the results, among 71 participants enrolled, 67.6% and 32.4% of their final diagnoses were classified as structural and non-structural, respectively. Cerebrospinal fluid neurofilament light chain demonstrated an area under the curve of 0.75 (95% confidence interval 0.63-0.88) which was not significantly different from a neurologist's provisional diagnosis 0.85 (95% confidence interval 0.75-0.94) (P = 0.14). The multivariable regression model using cerebrospinal fluid neurofilament light chain and other basic clinical data achieved an area under the curve of 0.90 (95% confidence interval 0.83-0.98). In conclusion, neurofilament light chain classified causes of alteration of consciousness with moderate accuracy. Nevertheless, including other basic clinical data to construct a model improved the performance to a level that was comparable to clinical neurologists.

A - 68 Brain Health Clinic': a Neuropsychometric Screening & Triage Model.

Cognitive symptoms are frequently not diagnostic for underlying brain damage or disease, but secondary to other treatable medical/psychiatric factors. Neuropsychological evaluation can inform the differential, but is limited by access issues and reduced diagnostic certitude in the setting of unmanaged secondary factors. Development and implementation of a neuropsychometric screening and triage model to address these issues has flexible application across different clinical settings. Literature on cognitive/behavioral/somatic screening methods were reviewed. Measures and associated cut-offs were selected based on open-source availability, clinical domain/condition relevance, intended population, and time to administer/interpret. Consultation with first-line clinicians in general neurology and non-neurology clinics guided refinement. Consultation with Neurologists informed triage guidelines. Recent CPT/CMS guidance on e-consultation billing was reviewed and integrated. A "Brain Health Clinic" model composed of neuropsychometric screening with empirically-derived cut-off scores, along with expert consensus first-line intervention and triage, was piloted with advanced practice providers in a Cognitive Neurology Clinic. E-consultation support was provided by Neuropsychology. Practice findings and refinements are discussed. Adaptations to the model designed for a post-COVID clinic, Concierge Medicine clinic, and Primary Care Practice with integrated Neuropsychologist are reviewed. Upstream extension of neuropsychological expertise via screening and triage with appropriate remote involvement of the neuropsychologist has the potential to resolve cognitive complaints prior to referral, or, optimization of confounding medical/psychiatric factors in those patients eventually escalated for full evaluation. New CPT/CMS billing options make this a viable approach for neuropsychologists across different clinical settings. Empirically-based refinement and assessment of outcomes in the future is indicated.

Etiopathogenic theories of nervous system diseases in Vilnius in the early 19th century: “insanity and epilepsy exacerbate when the moonlight shines”

Neurology as a separate branch of clinical medicine was not yet formed in Europe in the early 19th century. However, in the medical writings of the Vilnius University (VU) authors of that time, the brain was already called the “noblest organ of the human body”, the seat of the soul, the centre of external senses, and the primary beginning of all bodily movements. The aim of the present study is to reveal various etiopathogenic theories of diseases of the nervous system (NS) in Vilnius region, since this knowledge may indicate that there were some beginnings of clinical neurology in the early 19th century in Vilnius. First, we analysed old doctoral dissertations on NS diseases defended at VU in 1803-1832; we then turned to Consessus Caesareae Societatis Medicae Vilnensis (The Protocols of Vilnius Medical Society) and analysed clinical reports recorded in 1806-1842. Our study revealed that although humoralism was the most popular system of medicine, the main causes of NS diseases were believed to be in the solid parts of the human body (influence of solidism theory). It was also assumed that some NS diseases may be inherited or caused by fetal diseases in utero. On the other hand, one of the oldest theories, imaginatio gravidarum, was still prevalent in Vilnius at the time. It was also stated that some NS diseases may be triggered by physical and mechanical causes, concomitant diseases, medications and drinks, strong emotions, or violation of sleep hygiene. “Inflammatory agents” were reported to cause traumatic tetanus as inflammation spread upwards from the nerve endings, tendons, and ligaments to the brain. The authors also described the theory of “poison, specifically acting on the NS” that was transmitted by a rabid animal to a bitten patient. To describe the etiopathogenesis of spinal cord diseases, the concept of “diminishing vital spirits through the loss of bodily matter” was used (it was claimed, e.g., that excessive number of sexual intercourses dried out the spinal cord). In addition, the astrological causes of NS diseases were also believed to be of great importance (“somnambulism, insanity, and epilepsy exacerbate when the moonlight shines”). Finally, cutting off the Polish plait (plica polonica) was considered to be an essential etiological factor of various NS diseases in Vilnius in the early 19th century.

Impact of neck percutaneous interferential current sensory stimulation on swallowing function in patients with Parkinson's disease

Dysphagia is the clinical name for difficulty with swallowing. It can occur with some neurological diseases such as Parkinsonâ–™s disease and, given the rapidly ageing population, the numbers of patients with Parkinsonâ–™s disease and dysphagia is on the rise. Despite being quite commonplace, the complex mechanisms of dysphagia mean that the condition is not well understood. Assistant Professor Masahiro Nakamori is a clinical neurologist investigating the mechanisms of neurological disease, with a focus on neurodegenerative diseases and dysphagia. A current focus is on dysphagia and silent aspiration in people with Parkinsonâ–™s disease. He is based in the Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan. So far, Nakamori has explored several different techniques, including tongue pressure measurement and tongue ultrasonography, which are both used in swallowing evaluation. He is interested in non-invasive techniques that are simple to implement and wants to develop new creative instruments and techniques. In his current research, Nakamori and his collaborators are experimenting with multichannel surface electromyogram to gain a comprehensive understanding of neuromuscular activity. The goal is to develop new techniques and instruments that will help advance clinical neurology and dysphagia research and, of course, benefit patients; improving outcomes and quality of life.

Variations in the treatment of acute peripheral facial paralysis. A nationwide survey

BackgroundAcute peripheral facial paralysis may be diagnosed and treated by different specialists. ObjectiveThe aim of this study was to explore the variability in the treatment of Bell’s palsy (BP) and Ramsay Hunt Syndrome (RHS) among different medical specialties. MethodsAn anonymous nationwide online survey was distributed among the Spanish Societies of Otorhinolaryngology (ORL), Neurology (NRL) and Family and Community Medicine (GP). Results1039 responses were obtained. 98% agreed on using corticosteroids, ORL using higher doses than NRL and GP. Among all, only 13% prescribed antivirals in BP routinely, while 31% prescribed them occasionally. The percentage of specialists not using antivirals for RHS was 5% of ORL, 11% of NRL, and 23% of GP (GP vs. NRL p = 0.001; GP vs. ORL p < 0.0001; NRL vs. ORL p = 0,002). 99% recommended eye care. Exercises as chewing gum or blowing balloons were prescribed by 45% of the participants with statistically significant differences among the three specialties (GP vs. NRL p = 0.021; GP vs. ORL p < 0.0001; NRL vs. ORL p = 0.002). ConclusionThere is general agreement in the use of corticosteroids and recommending eye care as part of the treatment of acute peripheral facial paralysis. Yet, there are discrepancies in corticosteroids dosage, use of antivirals and recommendation of facial exercises among specialties.

Does GPT-4 have neurophobia? Localization and diagnostic accuracy of an artificial intelligence-powered chatbot in clinical vignettes

Background and Objectives: This is an observational study of the performance of an artificial intelligence-powered chatbot tasked with solving unknown neurologic case vignettes. The primary objective of the study is to assess the current capabilities of widely-accessible artificial intelligence within the field of clinical neurology in order to determine how this technology can be deployed in clinical practice, and what insights can be learned from its performance and translated to clinical education. Methods: This observational study tested the accuracy of GPT-4, an artificial intelligence-powered chatbot, at appropriately localizing and generating a differential diagnosis for a series of 29 clinical case vignettes. The cases were from previously published educational material prepared for learners. No cases required more than text input, a current limitation of GPT-4. The primary outcome measures were ranked accuracy of localization and differential diagnosis based on clinical history and exam alone and after ancillary clinical data was provided. Secondary outcome measures included a comparison of accuracy by case difficulty. Results: GPT-4 identified the correct localization less than 50% of the time and performed worse when provided ancillary testing. GPT-4 was more accurate with localization and diagnosis of easier versus harder cases. Diagnostic accuracy was independent of its ability to localize the lesion. Discussion: GPT-4 did not perform as well on neurology clinical vignettes as compared to reported accuracy when provided other medical clinical vignettes. Incorporation of an AI chatbot into the practice of clinical neurology will require neurology-focused teaching.

A bibliometric evaluation of the top 100 cited articles on ocrelizumab.

To analyze the 100 most cited articles (T100) on ocrelizumab using bibliometric methods to determine the current situation and identify research hotspots. Articles with "ocrelizumab" in their title were searched for in the Web of Science (WoS) database, identifying 900 articles. After the exclusion criteria were applied, 183 original articles and reviews were obtained. The T100 were selected from among these articles. Data on these articles (author, source, institution, country, scientific category, citation number, and citation density) were analyzed. The number of articles showed a fluctuating upward trend from 2006 to 2022. The total number of citations for the T100 ranged from two to 923. The average number of citations per article was 45.11. The most articles were published in 2021 (n=31). The "Ocrelizumab versus Placebo in Primary Progressive Multiple Sclerosis" study (T1) was the most cited article among the T100 and had the highest annual average number of citations. T1, T2, and T3 were clinical trials on treating multiple sclerosis. The USA was the most productive and influential research country, with 44 articles. Multiple Sclerosis and Related Disorders was the most productive journal (n=22). Clinical neurology ranked first among the WoS categories (n=70). Hauser Stephen and Kappos Ludwig were the most influential authors, with 10 articles each. Biotechnology company Roche was at the top of the publication list, with 36 articles. This study's results can give researchers an idea about current developments and research collaborations on ocrelizumab. These data can help researchers easily obtain publications that have become classics. We conclude that the clinical and academic communities have shown a growing interest in ocrelizumab for treating primary progressive multiple sclerosis in recent years.

Clinical Neurology in Practice: The Tongue (part 2).

The tongue is an essential organ for the development of certain crucial functions such as swallowing and speech. The examination of the tongue can be very useful in neurology, as the various types of lingual alterations can lead to certain specific diagnoses, the tongue being a kind of 'mirror' of some neurological function. To discuss the elements of clinical examination of the tongue in relation to neurological disorders. After reviewing the different superficial lesions of the tongue, we deal with various movement disorders of the tongue (fasciculations/myokimia, orolingual tremor, choreic movements of the tongue, dystonia of the tongue, lingual myoclonus, and psychogenic movements), disorders of taste and lingual sensitivity and lingual pain. Examination of the tongue should not be limited to studying its motility and trophicity. It is equally important to check the sensory function and understand how to interpret abnormal movements involving the tongue. This study also aimed to demonstrate the importance of nonmotor tongue function in neurological practice.

Augenblickdiagnose in neurology: Revisiting 'diagnosis in the blink of an eye'.

The art of diagnosis in clinical neurology requires attentive listening and careful observation. In certain situations, a fragment of the history or a physical sign may be so distinctive that it allows clinicians to evoke a specific diagnosis. This quick mental process was previously referred to as 'Augenblickdiagnose' ('diagnosis in the blink of an eye') in a seminal paper by Dr. William Campbell in 1998. We aimed to revisit this concept by providing additional clinical vignettes. The authors wrote clinical vignettes using examples from their own clinical practice and performed a non-systematic review of influential neurology textbooks using the words 'pathognomonic' and 'highly suggestive'. Twenty examples from various fields of neurology are presented in a table, stratified by major fields of neurology. A short educational reflection is provided for each diagnosis considered. 'Augenblickdiagnose' is an engaging teaching resource that also contributes to 'neurophilia', that is, a fascination for neurology, perhaps increasingly in today's modern neurology practice. However, multiple cognitive biases underlying mental shortcuts may lead to an incorrect diagnosis. It is important to stress that good clinical practice in neurology requires taking a thorough history and performing a careful neurological examination.

Statistical guidance provided to authors by clinical neurology and neuroscience journals.

Transparent reporting and appropriate interpretation of statistical methods and results is important to facilitate scientific evaluation and enable future replication. The goal of this study was to describe statistical reporting guidance provided to authors by Clinical Neurology and Neuroscience journals. For first-quartile journals in each discipline (per Clarivate InCites), information collected from Instructions to Authors website sections included: whether journals required presentation of sample size justification, estimates of precision, and method of checking assumptions; and guidance for interpretation of p-values and appropriate presentation of descriptive statistics and graphs. Journal endorsement of common but statistically non-specific published transparent reporting guidelines for human and animal research was also collected, to capture the select statistical reporting items included in each guideline. Journals (n=85) frequently did not require/recommend: sample size justifications (15% not required; 62% only required per external transparent reporting guideline), estimates of precision (15% not required; 41% only required per external guidelines), or disclosure of method of checking assumptions (46%); nor provide guidance for reporting/interpretation of p-values (71%), reporting of descriptive statistics (75%), nor use of appropriate graphs (92%). Endorsement of statistically non-specific standalone reporting guidelines ranged between 52% and 68%, depending on guideline. There is opportunity for journals to facilitate improvement in transparency of statistical methods and results for Clinical Neurology and Neuroscience studies by providing guidelines and advice to authors at manuscript submission.

Diagnostic and Therapeutic Approaches in Neurorehabilitation after Traumatic Brain Injury and Disorders of Consciousness

Severe traumatic brain injury (TBI) may cause disorders of consciousness (DoC) in the form of coma, unresponsive wakefulness syndrome (UWS), or minimally conscious state (MCS). Despite significant advancements made over the last two decades in detecting, predicting, and promoting the recovery of consciousness in TBI patients with DoC, the available diagnostic and treatment choices remain limited. In cases of severe TBI, the dissolution of consciousness both in the acute and post-acute phases constitutes one of the major clinical findings and challenges. In clinical settings, neurologists and neurorehabilitation specialists are called on to discern the level of consciousness in patients who are unable to communicate, and to project outcomes and recommend approaches to treatment. Standards of care are not available to guide clinical decision-making for this population, often leading to inconsistent, inaccurate, and inappropriate care. Recent studies refer to network-based mechanisms of consciousness as a more promising method to predict outcomes and functional recovery. A further goal is the modulation of neural networks underlying awareness and arousal as the main components of consciousness. This review centers on the difficulties in characterizing individuals experiencing post-traumatic DoC and on the recent advancements made in the identification and prognostication of consciousness recovery through the utilization of advanced neuroimaging and electrophysiological techniques as well as biomarkers. Moreover, we discuss new treatment approaches and summarize recent therapeutic recommendations.

Professional Fulfillment: A Pilot Study to Decrease Burnout in Clinical Academic Neurology Faculty

A pilot project, NeuroMessage, was implemented to improve professional fulfillment for full-time academic clinical neurologists through restructuring administrative non–patient-facing support. It was a targeted intervention to improve the number and quality of clinical messages received through an appropriate triage system. A messaging triage algorithm was developed to decrease physician time spent on in-basket messages. The administrative team and a research assistant were trained to manage nonclinical messages. Although the program did decrease total participant in-basket messages, the neurologist subjects did not find the intervention decreased time spent on responding to in-basket messages or improved physician job satisfaction. Improved triaging and additional administrative support for in-basket messages did not notably decrease time spent on managing in-basket messages. Further research may help understand what types of clinical support may be helpful to improve burnout. Clinical support to triage messages, so that only rare urgent messages get through to the physician, should be studied to see if aligning duties that are uniquely suited for a physician improves personal achievement and decreases burnout.

New Strategy of Micronutrients Combined with Dietary and Lifestyle Adjustment for Alzheimer’s Disease Therapy and Partially Restoration

Alzheimer’s Disease (AD) is the leading cause of dementia resulting in memory loss, difficulty with thinking, and behavioral changes. To date, AD is continuously known as an incurative disease of the aged, and therefore has been widely considered as a challenge for clinical neurology both in the therapy, prevention and prognosis as well, thus bringing about heavy burden to not only the patients, their family, but also even the society. In this review, it has been proposed a new strategy synthetically implemented for the prevention and even partially restoration of Alzheimer’s Disease (AD), in which multiple micronutrients, combined with diet and lifestyle adjustment, were used for AD patients and people who already had the pro-phase symptom. Based on the notions, evidence and beneficial methods are put forward. It is promising to install a better and more efficacious AD administration system, with aim to reduce the incidence rate and elevate the life quality of AD patients in a sooner future.