Neurological Diagnosis Research Articles

Blood Glucose Range for Hyperglycemic PICU Children With Primary Neurologic Diagnoses: Analysis of the Heart and Lung Failure-Pediatric Insulin Titration Trial.

To compare two blood glucose (BG) ranges in critically ill children with and without primary neurologic diagnoses in the Heart and Lung Failure-Pediatric Insulin Titration trial (HALF-PINT; ClinicalTrials.gov Identifier NCT01565941). Non-prespecified post hoc analysis. Thirty-one PICUs in the United States, and one in Canada. Non-diabetic children enrolled from April 2012 to September 2016 with cardiovascular or respiratory failure and hyperglycemia. Patients in the neurologic subgroup had primary neurologic diagnoses on ICU admission. Patients were randomized to insulin infusion to target lower-BG (80-110 mg/dL; 4.4-6.1 mmol/L) or higher-BG (150-180 mg/dL; 8.3-10 mmol/L). Primary diagnosis (neurologic vs. non-neurologic), daily BG and insulin values, outcomes (number of PICU-free days through day 28 and 1-y post-PICU discharge adaptive behavior composite score of Vineland Adaptive Behavior Scales, Second Edition). Of 698 patients analyzed, 64 (30 lower-BG target, 34 higher-BG target) had primary neurologic diagnoses and 634 (319 lower-BG target, 315 higher-BG target) had non-neurologic diagnoses. Within the neurologic subgroup, patients in the lower-BG targeting group had fewer ICU-free days compared with those in the higher-BG targeting group (median 8.5 vs. 21.1 d), whereas there was no difference between BG groups in the non-neurologic subgroup (20.5 vs. 19.3 d; interaction p = 0.02). One-year adaptive behavior composite score was less favorable for the lower-BG targeting group in those with neurologic diagnoses (mean 63.3 vs. 87.6), but no different in those with non-neurologic diagnoses (81.9 vs. 78.4; interaction p = 0.02). Lower-BG targeting was associated with more hypoglycemia (< 60 mg/dL) in both diagnostic subgroups, with no differential effect across subgroups (p = 0.47). In this non-prespecified analysis of the HALF-PINT trial data, lower-BG targeting in hyperglycemic critically ill children with primary neurologic diagnoses was associated with unfavorable outcomes, while such BG targeting in those with non-neurologic diagnoses was not associated with adverse outcomes.

Multicentre case-control study on the association between COVID-19 vaccines and neurological disorders (COVIVAX).

The COVIVAX study assessed the association between COVID-19 vaccination and the risk of common neurological disorders in a multicenter case-control design. Vaccination exposure was compared between individuals with a first diagnosis of a neurological disorder (cases) and age- and sex-matched controls. A total of 624 participants were enrolled, and after random 1:1 matching 265 cases and 265 matched controls (total 530 participants) were included in the analyses. The most frequent neurological diagnosis in cases were stroke (60.4%), multiple sclerosis (11.3%) and seizures (6.4%). The proportion of vaccinated participants was 72.1% among cases and 79.6% among controls. A protective role of vaccination on the risk of developing a new neurological disorder was detected in the unadjusted analysis (OR 0.50; 95% CI 0.29-0.86; p = 0.0114). After adjustment for confounders, the number of vaccination doses received was associated with a reduced risk of developing new neurological disorders for participants aged over 60 years ( p = 0.0472; OR 0.14, 95% CI 0.03-0.68), with pre-existing comorbidities (p = 0.0122; OR 0.04, 95% CI 0.01-0.99) and for stroke (p = 0.0232; OR 0.04, 95% CI 0.02-0.97). The COVIVAX study provided no warning sign regarding an increase in the risk of developing new neurological disorders following COVID-19 vaccination of any type or doses. A potentially protective effect of multiple doses of COVID-19 vaccines against the risk of stroke in people aged over 60 needs to be confirmed by further studies.

Neuropathological comorbidity, genetics and cognition in a Chinese community-based autopsy cohort.

Neurodegenerative comorbidities are common and critical, yet data specific to the Chinese population remains limited. The study aims to investigate the prevalence and associations of neuropathologic changes and comorbidities, and their correlation with genetics and cognition in a community-dwelling autopsy cohort in China. Datasets of 610 participants were obtained from the National Human Brain Bank for Development and Function at the Chinese Academy of Medical Sciences/Peking Union Medical College. Neuropathological changes analysed included Alzheimer's disease neuropathological change (ADNC) (n = 331); α-synucleinopathies (n = 124) with 120 Lewy body disease (LBD) and 4 multiple system atrophy; limbic-predominant age-related TDP-43 encephalopathy neuropathologic changes (LATE-NC) (n = 341); primary age-related tauopathy (PART) (n = 231); argyrophilic grain disease (AGD) (n = 107); age-related tau astrogliopathy (ARTAG) (n = 144); cerebral amyloid angiopathy (CAA) (n = 183); hippocampus sclerosis (HS) (n = 46). Frontotemporal lobar degeneration, amyotrophic lateral sclerosis, and amygdala-predominant LBD are rare. Descriptive statistics and logistic regression models were used to assess the neuropathological associations. Increased age at death was correlated with increased severity in ADNC, LBD, and LATE-NC, as well as with a higher number of comorbidities. APOE ε4 allele frequency in the present autopsy cohort was 13.63%. The presence of the APOE ε4 allele was linked to an advanced ADNC stage and increased comorbidities. The co-pathology prevalence varied by pathologies, with notable increases in specific subgroups: within the ADNC subgroups, LBD, LATE-NC, CAA, and HS were more frequent in advanced stages; in the LATE-NC subgroups, ADNC, CAA, and ARTAG increased, while PART decreased in higher LATE-NC stages. PART cases presented the highest proportion of pure pathology (37.2%) compared to other groups. Advanced ADNC stages were significantly associated with higher LATE-NC stages, and vice versa. Neocortical LBD was correlated with elevated ADNC levels, and higher LATE-NC stages were associated with worsening LBD pathology. High level ADNC, neocortical LBD, and stage 3 of LATE-NC were identified as independent predictors of severe cognition status. Our study suggests that older age at death and APOE ε4 presence are the risk factors for neuropathologic comorbidities in Chinese people. The findings underscore the importance of considering comorbid neurologic diagnoses and therapies in clinical practice.

Trends of Mortality among Neuro-Medicine Inpatient admitted at a Tertiary Care Neuro Specialized Referral Hospital in Bangladesh

Background: Understanding the patterns and determinants of inpatient mortality among neurological patients presenting with medical problem at a tertiary care Neuro-Specialized Hospital is crucial for optimizing care delivery and improving patient outcomes. Objective: This study was aimed to investigate the factors contributing to inpatient mortality in this population. Methodology: This was a retrospective study of all patients who died during and after admission into Neuro Critical Care department of National Institute of Neurosciences and Hospital, Dhaka, Bangladesh. This is the largest tertiary care center and the only national referral center hospital in Bangladesh. Data on demography and events from 2017 to 2022 leading to death were collected and were analyzed from emergency unit, HDU and ward. The records were evaluated with the trends of mortality. The aged up to 92years with different treatment purpose was considered as study population. Data including patient demographics, primary neurological diagnoses were collected and analyzed. The subjects were collected from neuro-medicine inpatient departments. Results: A total of 244 deaths were recorded among the 1312 patients admitted during the 6-years period giving a mortality rate of 18.59% cases. Among them 59.1% cases were male and 40.9% cases were female. The highest number of the patients belongs to the age group 18-65 years 80.9%. According to length of stay in hospital more than 30 days was 48.51%. Most of the patient got admitted to the hospital in emergency ward 22.6%. Yearly mortality trends were lowest in the year 2019(10.3%) and gradually increased in the year 2022 (32.7%). Conclusion: In conclusion the death rate of patients is significant among the admitted neurological diseases conditions. Journal of National Institute of Neurosciences Bangladesh, January 2024;10(1):3-7

Frontotemporal Dementia Differential Diagnosis in Clinical Practice: A Single-Center Retrospective Review of Frontal Behavioral Referrals.

Many neurodegenerative syndromes present with impairment of frontal networks, especially frontoinsular networks affecting social and emotional cognition. People presenting with frontal network impairments may be considered for a frontotemporal dementia (FTD) diagnosis. We sought to examine the diagnostic mix of patients referred with frontal network impairments to a single cognitive neurology service. A retrospective review was conducted of all patients seen between January 2010 and December 2019 at the Eastern Cognitive Disorders Clinic, a quaternary cognitive neurology clinic in Melbourne, Australia. Patients were included if they met the following criteria: (1) were referred for suspected FTD or with a preexisting diagnosis of a FTD syndrome, (2) were referred for 'frontal behaviors' (i.e., disinhibition, disorganization, poor judgment, loss of empathy, apathy) and/or had an informant report of behavior change, and (3) had available referral documents and clinical consensus diagnosis. Referral diagnosis was compared against final diagnosis adjudicated by a consensus multidisciplinary team. Case details including age of symptom onset, Cambridge Behavioural Inventory-Revised scores, psychiatric history, and Charlson Comorbidity Index were compared against the final diagnosis. In total, 161 patients aged 42-82 years (mean = 64.5, SD = 9.0; 74.5% men) met inclusion criteria. The commonest final diagnosis was a FTD syndrome (44.6%: 26.7% behavioral variant FTD (bvFTD), 9.3% progressive supranuclear palsy, 6.2% semantic dementia, 1.2% corticobasal syndrome, and 1.2% FTD/motor neuron disease). A primary psychiatric disorder (PPD) was the next commonest diagnosis (15.5%), followed by vascular cognitive impairment (VCI, 10.6%), Alzheimer disease (AD, 9.9%), and other neurologic diagnoses (6.2%). A final diagnosis of bvFTD was associated with higher rates of medical comorbidities and more eating behavior abnormalities compared with a diagnosis of PPD. Screening cognitive tests and preexisting psychiatric history did not distinguish these 2 groups. A broad spectrum of neurologic and psychiatric disorders may present with impairments to frontal networks. Almost half of patients referred had a final FTD syndrome diagnosis, with bvFTD the commonest final diagnosis. People with PPD, VCI, and AD present with similar clinical profiles but are distinguishable using MRI and FDG-PET imaging. Medical and psychiatric comorbidities are common in people with bvFTD.

How Much More Time Neurologic Examination Adds to Outpatient Visits: A Study of Cross-Sectional Data.

The neurologic examination is a key part of neurologist visits. The neurologic examination leads to more accurate diagnoses, avoidance of unnecessary tests and procedures, and a stronger doctor-patient relationship. However, the neurologic examination takes time to perform, leading to longer visits with neurologists than with other specialists. We hypothesize that the neurologic examination adds quantifiable time to patient visits to a neurologist. We examined a 5-year cross-section of the National Ambulatory Medical Care Survey, 2012-2016, selecting visits to a neurologist. We extracted an indicator for neurologic examination, time spent with the patient in minutes, patient demographics, new or established visit, reasons for visit, new vs chronic problems, insurance status, geographic region, collection year, and survey design variables. We report descriptive statistics among patient visits with and without neurologic examinations and built a generalized linear model of visit time and neurologic examination with patient and visit information as covariates and interaction terms between neurologic examination and new/established visits. A subgroup analysis was conducted by reasons for visit. All analyses incorporated survey design variables for accurate standard errors. There were 4,009 patient visits among 211 neurologists, comprising 11.3 million annual visits in the weighted sample. Neurologic examination was reported in 58%, with no difference in demographics, geographic regions, or reasons for visit between those who did or did not receive a neurologic examination. The mean time spent with the patient in visits with a neurologic examination was 29.9 minutes, compared with 25.0 minutes without (p = 0.002). In the adjusted model, new visits with a neurologic examination were associated with 4.1 minutes greater time spent with the patient (95% CI + 0.6 minutes, +7.7 minutes, p = 0.02) and established visits with a neurologic examination were 4.6 minutes longer (95% CI + 1.5 minutes, +7.5 minutes, p = 0.006.) In subgroup analysis, association of neurologic examination with time spent with the patient was greatest for visits for pain (+6.7 minutes, 95% CI + 0.7 minutes, +12.9 minutes, p = 0.03) and known neurologic diagnoses (+7.5 minutes, 95% CI + 4.2 minutes, +10.7 minutes, p < 0.001). This study demonstrates the association of neurologic examinations with increased time spent with the patient in ambulatory care. Further work is needed to assess the effects on medical decision making, costs of care, and patient access to neurologists.

Ethnic and racial differences in children and young people withrespiratory and neurological post-acute sequelae of SARS-CoV-2: an electronic health record-based cohort study from the RECOVER Initiative.

Children from racial and ethnic minority groups are at greater risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but it is unclear whether they have increased risk for post-acute sequelae of SARS-CoV-2 (PASC). Our objectives were to assess whether the risk of respiratory and neurologic PASC differs by race/ethnicity and social drivers of health. We conducted a retrospective cohort study of individuals <21 years seeking care at 24 health systems across the U.S, using electronic health record (EHR) data. Our cohort included those with a positive SARS-CoV-2 molecular, serology or antigen test, or with a COVID-19, multisystem inflammatory disease in children, or PASC diagnosis from February 29, 2020 to August 1, 2022. We identified children/youth with at least 2 codes associated with respiratory and neurologic PASC. We measured associations between sociodemographic and clinical characteristics and respiratory and neurologic PASC using odds ratios and 95% confidence intervals estimated from multivariable logistic regression models adjusted for other sociodemographic characteristics, social vulnerability index or area deprivation index, time period of cohort entry, presence and complexity of chronic respiratory (respectively, neurologic) condition and healthcare utilization. Among 771,725 children in the cohort, 203,365 (26.3%) had SARS-CoV-2 infection. Among children with documented infection, 3217 children had respiratory PASC and 2009 children/youth had neurologic PASC. In logistic regression models, children <5 years (Odds Ratio [OR] 1.78, 95% CI 1.62-1.97), and of Hispanic White descent (OR 1.19, 95% CI 1.05-1.35) had higher odds of having respiratory PASC. Children/youth living in regions with higher area deprivation indices (OR 1.25, 95% CI 1.10-1.420 for 60-79th percentile) and with chronic complex respiratory conditions (OR 3.28, 95% CI 2.91-3.70) also had higher odds of respiratory PASC. In contrast, older (OR 1.57, 95% CI 1.40-1.77 for those aged 12-17 years), non-Hispanic White individuals and those with chronic pre-existing neurologic conditions (OR 2.04, 95% CI 1.78-2.35) were more likely to have a neurologic PASC diagnosis. Racial and ethnic differences in healthcare utilization for neurologic and respiratory PASC may reflect social drivers of health and inequities in access to care. National Institutes of Health.

Prevalence of Neurologic Disease Among Those in Same-Sex Relationships: Evidence from the Medical Expenditure Panel Survey.

Prior research has shown several health disparities affecting sexual minority people. Research on the neurologic health of sexual minority people has been limited. Our objective was to characterize the prevalence of neurologic disease and utilization of a neurologist among a population of sexual minority people. We conducted a cross-sectional analysis of sexual minority people, using people in same-sex relationships as a proxy for sexual minority status, from the Medical Expenditure Panel Survey (MEPS) from 2016 to 2020. The MEPS is a government-run survey that uses complex sampling to obtain a nationally representative sample. Our primary outcome was a diagnosis of any neurologic disease. We also completed stratified analyses by sex, race, and ethnicity. Our secondary outcome was visit to a neurologist within the past year. Logistic regression was used to compare the odds of both outcomes in those in same-sex relationships and those in different-sex relationships. Among 153,313 MEPS participants, there were 61,645 (40.2%) participants in relationships who were included in our sample. Of those, 822 (1.33%) participants were in same-sex relationships. Participants were, on average, aged 51 years (median 50 years, IQR 38-63); nearly 50% reported female sex and mostly non-Hispanic White (67.81%). Among those in same-sex relationships, 22.7% reported a neurologic diagnosis compared with 18.1% of those in different-sex relationships (OR 1.33; 95% CI 1.04-1.71). This difference was maintained with adjustment for age, sex, education, and insurance (OR 1.48; 95% CI 1.15-1.91). There was no significant difference in visit to a neurologist (adjusted OR 1.38; 95% CI 0.91-2.10). In this nationally representative sample, neurologic disease was more prevalent among those in same-sex relationships compared with those in different-sex relationships. Limited sample size and absent measurements of minority stress limited the etiologic search for factors driving this disparity. There was no significant difference in visit to a neurologist, and both groups reported their overall health as being similar. There is a need for more routine measurement of sexual orientation in neurologic research. This will allow us to detail differences in neurologic disease risk factors, prevalence, and outcomes. The end goal is the identification of opportunities for intervention and advancement of neurologic health equity.

The Impact of Selected Comorbidities on the Necessity for Physiotherapy in Patients Hospitalised with COVID-19

Abstract Data from 5173 patients hospitalized for COVID-19 at the University Hospital of Ostrava (UHO) between March 2020 and December 2021 were analysed in this retrospective study. The research aimed to find out whether the comorbidities being present increased the need for acute rehabilitation during COVID-19 hospitalization. Data were examined using descriptive statistics, Spearman's correlation coefficient, and binomial logistic regression. Among the total patient cohort (n = 5173), 27% required rehabilitation (RHB). The average age of patients was 64.9 ± 16.9 years, with rehabilitation durations ranging from 1 to 102 days. Of the rehabilitated patients, 92% (n = 1302) had hospital stays from 1 to 15 days, while 8% (n = 114) stayed more than 15 days. Patients had a median of 4 diagnoses each, with approximately one-fifth having more than six diagnoses. A weak but statistically significant positive association was observed for the length of rehabilitation and the number of diagnoses (Spearman’s correlation coefficient rs = 0.24). Adjusted statistical analysis revealed that patients with concomitant neurological conditions (G62, G81 according to ICD-10) (OR = 8.4; 95% CI 4.82–14.67) and certain respiratory diseases had the highest likelihood of requiring rehabilitation during their COVID-19 hospitalization. Additionally, patients with obesity were approximately 1.4 times more likely to need RHB than non-obese patients. The need for rehabilitation increased with the number of comorbidities, with the greatest need connected with neurological diagnosis. In light of these findings, more effective strategies for diagnosis, treatment and prevention can be developed for future epidemics or pandemics. It is imperative to reinforce health recommendations. The analysis of data enables the formulation of evidence-based public health guidelines that can serve as the foundation for a prompt and effective response in the event of another pandemic.

P-1336. Building Connections: Rise in Construction Projects correlated with New Cluster of Infantile Botulism in North Texas

Abstract Background Regional clustering of infantile botulism is well documented in throughout the United States. We report a new cluster of cases in Northeast Texas. Methods We performed a single center retrospective chart review of all patients with suspected and confirmed infant botulism admitted to Children’s Medical Center Dallas from January 1, 2010 through December 31, 2023. Environmental conditions near each patient’s home prior to hospitalization were analyzed. County level data on annual birth, population, and death rates was collected from The United States Census Bureau. Construction permit data from Tyler, Texas was analyzed. Results 46 infants with suspected infant botulism presented to care and received botulism immune globulin from 2010-2023. 3 infants were excluded due to alternative neurologic diagnosis. Features of cohort (N=43) without alternative diagnosis included in Table 1. 39 infants without honey exposure were included in environmental analysis: Group 1: 2010-2016 (N=8 infants), and Group 2: 2017-2023 (N=31 infants). The mean number of yearly residential construction permits issued (235.0 vs 352.7, p=0.01) and projects finalized (208.6 vs 333.5, p=0.01) increased from 2010-2016 to 2017-2022. The mean number of yearly commercial construction permits issued (40.1.0 vs 14.5, p=&amp;lt; 0.01) and projects finalized (36.9 vs 17.5, p=0.01) decreased between 2010-2016 as compared to 2017-2022. A sudden cessation of infantile botulism cases occurred during the COVID-19 pandemic that appears to coincide with delays in construction projects being complete. There were no significant differences between the 2 cohorts in environmental changes near the patient’s home address: temperature, precipitation, wind speed or direction, soil moisture, or drought index (Table 2). Specific humidity was significantly higher (p=0.01) in the 30-60 days before admission for patients presenting 2017-2023 as compared to 2010-2016 (-0.53 g/kg vs 0.70 g/kg). Conclusion Changes in local construction patterns are associated with a notable increase in infantile botulism cases in Northeast Texas over the past 14 years. Changes in environmental conditions do not appear to play a large role in this increasing case count. Disclosures All Authors: No reported disclosures

EEG Functional Connectivity and Deep Learning for Automated Diagnosis of Alzheimer's disease and Schizophrenia

Electroencephalogram (EEG) functional connectivity analysis provides important clues about brain network abnormalities, an important approach to diagnose complex neurological diseases such as Alzheimer’s disease and schizophrenia. Advanced computational analysis can effectively analyze disorders with unique disruptions in neural connectivity. Deep learning (DL) is one of these, and has emerged as a powerful tool to facilitate automation in diagnostic processes and accurate classification by the use of DL models. The application of DL techniques and EEG functional connectivity metrics for the automated diagnosis of Alzheimer’s disease and schizophrenia is investigated in this study. For analysis, EEG data from patients with these disorders were used. To quantify the interregional synchronization of neural activity, functional connectivity metrics, such as coherence and phase locking value were extracted. Convolutional Neural Networks (CNN) and Long Short Term Memory (LSTM) networks based multi class classification framework was designed to detect patterns related with the disorders. Results demonstrated DL framework performance at 94% for Alzheimer’s disease and 91% for schizophrenia. The DL models were then found to robustly replicate such inter-regional disruptions, with connectivity patterns analyzed via connectivity maps, revealing distinct inter-regional patterns in both conditions. This has also been demonstrated by the superior performance of DL methods in processing EEG data with complex and high dimensionality, and in extracting informative features for diagnosis. Finally, EEG functional connectivity metrics and DL methods greatly increase diagnostic accuracy for Alzheimer’s disease and schizophrenia. These findings point towards the transformative power of AI driven solutions in clinical diagnostics to achieve scalability and efficiency in neurological disorder diagnosis. Future research should be directed towards gap expanding application level of these models to other neurological conditions, and refinement of frameworks that can be implemented in a clinical setting.

Using artificial intelligence to optimize anti-seizure treatment and EEG-guided decisions in severe brain injury.

Electroencephalography (EEG) is invaluable in the management of acute neurological emergencies. Characteristic EEG changes have been identified in diverse neurologic conditions including stroke, trauma, and anoxia, and the increased utilization of continuous EEG (cEEG) has identified potentially harmful activity even in patients without overt clinical signs or neurologic diagnoses. Manual annotation by expert neurophysiologists is a major resource limitation in investigating the prognostic and therapeutic implications of these EEG patterns and in expanding EEG use to a broader set of patients who are likely to benefit. Artificial intelligence (AI) has already demonstrated clinical success in guiding cEEG allocation for patients at risk for seizures, and its potential uses in neurocritical care are expanding alongside improvements in AI itself. We review both current clinical uses of AI for EEG-guided management as well as ongoing research directions in automated seizure and ischemia detection, neurologic prognostication, and guidance of medical and surgical treatment.

Assessing pain in multiple sclerosis: Test-retest reliability of patient-reported outcome measures and accuracy of screening tools.

Pain is a common symptom of multiple sclerosis (MS). The reliability of outcome measures for pain and the accuracy of screening tools are essential for treatment purposes. This study investigated the test-retest reliability of Neuropathic Pain Scale (NPS), Neuropathic Pain Symptom Inventory (NPSI), Brief Pain Inventory-Short Form (BPI-SF), Nordic Musculoskeletal Questionnaire (NMQ), Douleur Neuropathique 4 (DN4), and painDETECT, and the accuracy of DN4 and painDETECT. 110 persons with MS were included (mean age: 45.35 ± 12.73; Expanded Disability Status Scale (EDSS): 3 (Interquartile range, IQR: 2.6)). The reliability (internal consistency, test-retest, measurement error) and accuracy (area under the curve (AUC), specificity, sensitivity, positive predictive value, and negative predictive value) were analyzed. All included pain assessment tools showed good test-retest reliability (Intraclass correlation coefficient, ICC, (95% confidence interval, CI): 0.85 (0.79-0.89)-0.89 (0.84-0.92)) and good-to-excellent internal consistency (Cronbach's α: 0.73-0.93). The test-retest reliability of NMQ was moderate to substantial (Cohen's κ = 0.54-0.87). The overall accuracy of DN4 compared to the neurologist's diagnosis was acceptable (AUC = 0.762), while that of painDETECT was poor (AUC = 0.682) and demonstrated inadequate predictive ability. All pain outcome measures were reliable in patients with MS (pwMS). DN4 can be used to screen neuropathic pain in MS. Reliability and Validity of Outcome Measures for Pain in MS https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000CRMD&selectaction=Edit&uid=U0006NAA&ts=2&cx=-jzvd6m Registration number: NCT05742152.

Adherence to Recommendations and Yield of Critical Care EEG Monitoring: A Prospective Multicentric Study.

The American Clinical Neurophysiology Society has provided a set of recommendations on the use of critical care EEG monitoring (CEEG). However, these recommendations have not been prospectively validated. We aimed to assess the adherence to the American Clinical Neurophysiology Society recommendations for obtaining CEEG for different indications and the yield of obtained CEEG according to these different indications. This was a multicenter prospective observational study of critically ill adult patients between April 01, 2022, and June 22, 2022, in two academic medical centers and a large teaching hospital. Indications for CEEG, according to the American Clinical Neurophysiology Society recommendations, were determined based on clinical data at the time of discharge from the intensive care unit. The use of CEEG and detection of electrographic seizures were retrieved from the EEG databases. A total of 600 patients were enrolled in this study. The primary admission diagnoses were medical (49%), surgical (30%), or neurologic/neurosurgical (21%). Approximately 60% of patients had an altered mental status. A few (6%) patients had a preceding clinical seizure, and 1% had generalized convulsive status epilepticus. Indications were identified in 226 admissions. Of these patients, 88 (39%) underwent CEEG. In addition, 12 patients underwent CEEG without clear indications. Of the 100 patients, 33 (33%) had electrographic seizures. Adherence to recommendations and yields was highest for refractory status epilepticus, altered mental status after any clinical seizure, and acute brain injury. Adherence and yield varied the most and were inversely correlated in the group of patients without acute brain injury, suggesting that additional clinical factors may have contributed to patient selection. Patients meeting American Clinical Neurophysiology Society indications and receiving CEEG had a high seizure risk. Emerging CEEG programs should focus on epilepsy-related and neurologic diagnosis. Although recommendations effectively identify groups of patients with a high seizure risk, additional clinical factors might further help select candidates in the low-risk group.

Neurological diagnosis of lower urinary tract dysfunction

Neurophysiological investigations are infrequently utilized in the diagnostic workup of lower urinary tract symptoms (LUTS). To determine the potential contributions of neurophysiological assessments in the diagnostic process of LUTS and their integration into systemic neurological and psychosomatic disorders. This study elucidates the role of neurophysiological tests specific to pelvic floor diagnostics, namely pudendal nerve somatosensory-evoked potentials (SEP) and external anal sphincter electromyography (EMG), through the presentation of two clinical case reports. When combined with clinical history, physical examination, and urodynamic studies, pudendal SEP and external anal sphincter EMG facilitate both diagnostic precision and the topographic localization of LUTS. This allows, particularly in conjunction with supplementary imaging modalities such as magnetic resonance imaging (MRI), for adefinitive diagnosis and, consequently, the formulation of individualized, targeted therapeutic strategies. The increased application of specific neurophysiological methods in the diagnostic evaluation of LUTS is warranted, particularly in complex cases. This approach not only enhances diagnostic accuracy but also aligns with the goal of developing personalized, specific, and resource-efficient therapeutic interventions.

A retrospective review of infant-inducible laryngeal obstruction a subtype of paradoxical vocal fold motion: Evaluation and management

IntroductionThere is a paucity of literature on pre-adolescent paradoxical vocal fold motion (PVFM), PVFM is a sub-type of inducible laryngeal obstruction. Studies typically focus on older patients, however the discovery of this entity in pre-adolescent pediatric patients has led to more questions about how this entity manifests differently and is treated differently in younger populations. Initially considered psychosomatic and commonly mistaken for asthma, PVFM etiology is now thought to be associated underlying neurologic conditions and may have irritant triggers with proposed mechanisms related to laryngeal hypersensitivity. Treatment is multimodal. Diagnosis is with flexible laryngoscopy and clinical exam but other modalities like functional endoscopic evaluation of swallow may provide more information than flexible laryngoscopy alone. MethodsAfter obtaining IRB approval, a retrospective review of all charts of patients ages 0–18 months (pre-adolescent pediatric patients) who underwent flexible endoscopic evaluation of swallow and/or flexible laryngoscopy from 1/2013–8/2021 was performed. Twenty-four subjects diagnosed with PVFM were identified. ResultsThe most common presenting symptom was stridor or coughing with feeds. 63 % were male, mean age at time of diagnosis was 3.4 months, and mean follow-up length was 11.4 months. Comorbidities included reflux (45 %), pulmonary diagnoses (25 %) and neurologic diagnoses (54 %). 16/24 subjects had otolaryngology diagnoses (laryngomalacia, tracheomalacia, subglottic stenosis, or ankyloglossia). 12/24 subjects were treated with conservative management such as anti-reflux medications or precautions. 33 % of patients treated with conservative management had complete symptom resolution. PVFM patients with neurologic comorbidities were more likely to require alternative feeding access (p < 0.05). All 11 subjects who required surgical feeding access had neurologic diagnoses. 5/10 of patients with neonatal abstinence syndrome (NAS) required alternative feeding means, and 40 % tolerated oral feeds after medical management of NAS. ConclusionOur findings suggest PVFM is most commonly seen in pre-adolescent pediatric patients with medical comorbidities. Healthy pre-adolescent pediatric patients with PVFM frequently improved with conservative management. The differential diagnosis of the stridulous infant should include PVFM. It is imperative to consider nutritional access in PVFM patients with neurologic comorbidities.

Applications of MR Finger printing derived T1 and T2 values in Adult brain: A Systematic review.

Magnetic resonance imaging (MRI) is essential for brain imaging, but conventional methods rely on qualitative contrast, are time-intensive, and prone to variability. Magnetic resonance finger printing (MRF) addresses these limitations by enabling fast, simultaneous mapping of multiple tissue properties like T1, T2. Using dynamic acquisition parameters and a precomputed signal dictionary, MRF provides robust, qualitative maps, improving diagnostic precision and expanding clinical and research applications in brain imaging. Database searches were performed through PubMed, Embase, Scopus, Web of science to identify relevant articles focusing on the application of MR finger printing in the adult brain. We utilized the preferred reporting items for systematic reviews and meta-analysis guidelines to extract data from the selected studies. Nine articles were included in the final review, with a total sample size of 332 participants. In healthy brains, notable regional, sex, age, and hemispheric variations were identified, particularly in the corpus callosum and thalamus. MRF effectively differentiated meningioma subtypes, glioma grades, and IDH mutation status, with T2 values providing particularly predictive for glioma classification. In brain metastases, significant relaxometry differences were noted between normal and lesional tissues. For multiple sclerosis, MRF values correlated with clinical and disability measures, distinguishing relapsing-remitting secondary progressive forms. In traumatic brain injury, longitudinal T1 changes strongly correlated with clinical recovery, surpassing T2 values. The systematic review highlighted MRD as a groundbreaking technique that enhances neurological diagnosis by simultaneously quantifying T1 and T2 relaxation times. With reduced acquisition times, MRF outperforms conventional MRI in detecting subtle pathologies, distinguishing properties, and providing reliable biomarkers.

Obstructive Sleep Apnea and a Maxillomandibular Advancement: Does Maxillomandibular Advancement have more success than nonsurgical treatment in decreasing OSA?

Introduction: Takotsubo syndrome (TTS) is a cardiomyopathy triggered by emotional or physical stress. This case report presents a unique instance of TTS associated with myasthenia gravis (MG) in which myasthenic crisis developed after TTS diagnosis and not before. Case Description: A 73-year-old man presented with difficulty swallowing, dysphonia, and dyspnea, showing moderate-severe left ventricular dysfunction. Blood tests revealed elevated troponin and BNP levels, while the ECG at the arrival showed an ST-elevation in anterior leads. Coronary angiography showed normal aspect of coronary vessels. Echocardiography confirmed TTS with apical ballooning. After few days, myasthenic symptoms emerged leading to a myasthenic crisis. The patient improved with acetylcholinesterase inhibitors and was discharged with pyridostigmine and prednisone. Follow-up revealed complete resolution of left ventricular dysfunction. Discussion: MG rarely affects the heart, but in this case, it led to TTS. Notably, TTS occurred before the myasthenic crisis, emphasizing the need for cardiac monitoring in patients with new neurological diagnoses and acute respiratory.

Advancements in Magnetic Resonance Imaging: Transforming Non-Invasive Diagnosis and Treatment Monitoring in Radiology

MRI is a crucial tool in radiology, enabling non-invasive diagnosis, disease staging, and treatment monitoring magnetic fields and radio waves. It produces detailed images by leveraging the magnetic properties of hydrogen atoms, allowing for precise anatomical insights without ionizing radiation. Techniques such as functional MRI (fMRI), diffusion-weighted imaging (DWI), and dynamic contrast-enhanced MRI (DCE-MRI) enhance tumor evaluation and understanding, aiding in the identification of high-risk patients and personalized treatments. MRI’s capabilities extend to imaging soft tissues, particularly beneficial for neurological diagnoses and research. Advanced methods provide insights into brain activity, tissue microstructure, and disease mechanisms, especially in cerebral small vessel disease (cSVD). Recent innovations, such as ultrahigh field MRI (7T), improve image resolution and facilitate the assessment of vascular health. These advancements enhance diagnostic accuracy and treatment strategies, ultimately improving patient outcomes.

ExerG – an exergame-based training device for the rehabilitation of older adults: a functional model usability study

BackgroundExergames are interactive technology-based exercise programs. By combining physical and cognitive training components, they aim to preserve independence in older adults and reduce their risk of falling. This study explored whether primary end users (PEU, healthy older adults and patients with neurological and geriatric diagnoses) and secondary end users (SEU, health professionals) evaluated the ExerG functional model to be usable, providing a positive experience and therefore acceptable.MethodsWe conducted a multi-methods study using several assessments to quantify usability and enjoyment outcomes, along with semi-structured interviews to gain an in-depth understanding of the users’ experiences. Descriptive statistics were used for quantitative outcome measures. For qualitative data, a thematic analysis (TA) using an inductive, data-driven approach was carried out to develop themes for each user group.ResultsWe interviewed 20 PEUs (13 healthy older adults, 7 patients) and 22 SEUs at two rehabilitation centres in Austria and Switzerland. Users' scores of over 70 on the System Usability Scale denoted good usability. On the Physical Activity Enjoyment Scale-16, both PEU groups rated the ExerG highly. Our TA approach identified four themes per user group. Themes from both PEU groups confirmed their enjoyment of training with the ExerG, however more variety and greater challenges were requested. Whilst the patient group appreciated the security given by the harness system, the healthy older adults reported feeling restricted. SEU themes reflected their approval of this novel training device, although a desire for increased difficulty and more individualisation was expressed. Clear instructions and an easy-to-use harness system were acknowledged and useful feedback for the developers emerged.ConclusionsThe ExerG is usable, offers a positive experience, and can therefore be regarded as an acceptable solution for the combined physical and mental training of older adults. Our findings contribute to the ongoing development of the ExerG, which will be a welcome addition to current training options for this target group. Further research is needed to confirm its effectiveness in preserving or improving functional independence in daily life and reducing the risk of falling.