Topics In Neurology Research Articles

De neurología cosmética, cirugía bariátrica y otros temas

De neurología cosmética, cirugía bariátrica y otros temas

H. Charlton Bastian on Kinaesthetic Centers and Concepts of Aphasia (S59.003)

Objective: To describe Bastian9s views on kinaesthesia and aphasia. Background H. Charlton Bastian (1837-1915), a distinguished neurologist at the National Hospital, Queen Square, was an astute clinician, innovative theoretician, and prolific expositor on a variety of neurological topics. Design/Methods: Focused review and synthesis of Bastian9s scientific writings on aphasia, kinaesthesia, and related topics. Results: In 1869, eight years after Broca9s seminal reports on aphemia, Bastian published two extensive articles, the themes of which he revisited often during his long career. The first was on “muscle sense” and its relation to the “physiology of thinking” and speech (Brit. Med. J.). In time, Bastian rejected outright the notion of a motor cortex. Volitional movement depended on kinaesthetic centers concerned with sensory impressions consequent to movement. Paralysis after cortical injury reflected an inability to revive “muscle sense” images. The second article concerned “various forms of loss of speech” (Brit. Foreign Med. Chirurg. Rev.). Here, Bastian proposed an innovative conceptual framework for disorders of speech, reading, and writing. Words were revived as sounds, not motor processes. He anticipated better known works by Kussmaul on alexia and by Wernicke on sensory (Wernicke9s) aphasia. Later Bastian proposed four left hemisphere centers for word memories: an auditory word center (temporal lobe), a visual word center (occipital lobe), and kinaesthetic word centers for spoken language (glosso-kinaesthetic center, third frontal convolution) and written language (cheiro-kinaesthetic center, mid Rolandic region). Although highly regarded, Bastian came to be marginalized through repeated clashes with scientific luminaries. At the National Hospital, these included colleagues John Hughlings Jackson and David Ferrier. In research on the origin and evolution of life, these included Louis Pasteur and Thomas Huxley. Conclusions: Bastian was influential in early discussions of functional representation within the cerebrum, but iconoclastic views detracted from his lasting influence. Disclosure: Dr. Henderson has received research support from Cambridge University Press.

Evaluating Sex and Gender Competencies in the Medical Curriculum: A Case Study

Sex and gender differences exist in the manifestation and prevalence of many conditions and diseases. Yet many clinician training programs neglect to integrate this information across their curricula. This study aimed to measure the sex and gender medical knowledge of medical students enrolled in a program without an explicit directive to integrate sex and gender differences across a block system of core subjects. A forced-choice instrument consisting of 35 multiple-choice and true or false questions was adapted from an evaluation tool used in the European Curriculum in Gender Medicine held at Charité Hospital, Berlin, in September 2010. Fourth-year (response rate 93%) and second-year (response rate 70%) students enrolled in Mayo Medical School completed the instrument. More than 50% of students in both classes indicated that topics related to sex and gender were covered in gynecology, cardiology, and pediatrics, and <20% of students indicated inclusion of such topics in nephrology, neurology, and orthopedics. More than twice as many second-year students indicated that topics dealing with sex and gender were included in immunology course material compared with fourth-year students. A consensus of written comments indicated that concepts of sex and gender-based medicine need to be embedded into existing curriculum, with an emphasis on clinically relevant information. Although this study represents only one medical school in the United States, information regarding sex and gender aspects of medicine is not consistently included in this curriculum without an explicit directive. These results can provide guidance for curriculum improvement to train future physicians.

A controlled study of team-based learning for undergraduate clinical neurology education

BackgroundTeam-based learning (TBL), a new active learning method, has not been reported for neurology education. We aimed to determine if TBL was more effective than passive learning (PL) in improving knowledge outcomes in two key neurology topics - neurological localization and neurological emergencies.MethodsWe conducted a modified crossover study during a nine-week internal medicine posting involving 49 third-year medical undergraduates, using TBL as the active intervention, compared against self-reading as a PL control, for teaching the two topics. Primary outcome was the mean percentage change in test scores immediately after (post-test 1) and 48 hours after TBL (post-test 2), compared to a baseline pre-test. Student engagement was the secondary outcome.ResultsMean percentage change in scores was greater in the TBL versus the PL group in post-test 1 (8.8% vs 4.3%, p = 0.023) and post-test 2 (11.4% vs 3.4%, p = 0.001). After adjustment for gender and second year examination grades, mean percentage change in scores remained greater in the TBL versus the PL group for post-test 1 (10.3% vs 5.8%, mean difference 4.5%,95% CI 0.7 - 8.3%, p = 0.021) and post-test 2 (13.0% vs 4.9%, mean difference 8.1%,95% CI 3.7 - 12.5%, p = 0.001), indicating further score improvement 48 hours post-TBL. Academically weaker students, identified by poorer examination grades, showed a greater increase in scores with TBL versus strong students (p < 0.02). Measures of engagement were high in the TBL group, suggesting that continued improvements in scores 48 hours post-TBL may result from self-directed learning.ConclusionsCompared to PL, TBL showed greater improvement in knowledge scores, with continued improvement up to 48 hours later. This effect is larger in academically weaker students. TBL is an effective method for improving knowledge in neurological localization and neurological emergencies in undergraduates.

Nerve Injuries and the Fixed Dystonias of CRPS

Nerve injury is a known precipitant of complex regional pain syndrome (CRPS). However, is nerve injury a primary cause of CRPS dystonia? In 2009, Oaklander and her colleagues [1] reviewed peripheral aspects of CRPS, asking whether diverse symptoms of this neuropathic pain disorder are linked to small-fiber neuropathies. These authors also described a possible role for large-fiber neuropathies in the etiology of CRPS-fixed dystonias. This hypothesis adds a valuable new perspective to one of the most controversial topics in neurology: the fixed dystonias of CRPS. During, and after, the American Civil War, Dr. Silas Weir Mitchell described both intense burning pain (causalgia) and fixed dystonias in a subset of wounded Union soldiers, as well as civilians, who had suffered nerve injuries [2]. In a number of these patients, remission of the CRPS comorbidities occurred within days to weeks after therapies were initiated (e.g., passive movement and splinting of inflamed/immobilized joints, massage and electrical stimulation of contracted muscles, and chemical blistering of causalgic skin). The rapid onset and rapid remission of …

Neurology for internal medicine residents: Working towards a national Canadian curriculum consensus

Background: Partly due to the absence of a standardized neurology curriculum, internal medicine residents often perceive neurology lowest in terms of the level of knowledge and clinical confidence.Aims: To compare the learning needs of internal medicine residents with the perceived learning needs of neurology and internal medicine program directors and to integrate these needs by developing a focused nationwide neurology curriculum for internal medicine residents rotating through neurology.Methods: Medical residents and neurology and internal medicine program directors from programs across the Canada were asked to complete an online survey and to rank an exhaustive list of neurology topics. A modified Delphi approach was used to obtain consensus on the top 20 topics to include in the curriculum.Results: Over 80% of residents felt their competency in neurology was average or below after completing their neurology rotation. There was very high correlation between the topics ranked by residents and staff. We were able to achieve consensus on 20 topics to be included in a neurology curriculum for internal medicine residents.Conclusion: Through a modified Delphi approach we were able to produce a neurology curriculum for internal medicine residents rotating through neurology based on the input of program directors across the country.

AAN International Attendee Summit 2010

The American Academy of Neurology (AAN) will again host an International Attendee Summit at the 2010 Annual Meeting in Toronto, Ontario. The Summit will take place on Monday, April 12th, from 12:00 pm to 1:00 pm (location yet undetermined). This is a free event for all members and nonmembers of the AAN. ![][1] The event will be hosted by Hanns Lochmuller, Chair of the AAN′s International Subcommittee. Members of the AAN′s Membership Committee and International Subcommittee will be attending this event, as well as other leaders of the AAN. Leaders of the AAN′s Science Committee and Education Committee will also be present to provide brief highlights of hot topics in international neurology. There will be time to ask any questions you may have about international membership in the AAN. If you would like to attend this free event, please e-mail Laurie Weyandt at lweyandt@aan.com. This newsletter reports … [1]: /embed/graphic-1.gif

El auge mundial de las neurociencias: XIV Congreso Internacional de Medicina (Madrid, 1903)

The neurosciences developed at a swift pace throughout the 19th century. In Spain, following the intellectual poverty of the absolutist rule of King Ferdinand, medicine took on a new flourishing lease of life in the last third of the century under the leadership of its most distinguished proponent, Santiago Ramon y Cajal. In April 1903, and in spite of the country's multiple political and social ups and downs, Madrid organised a great medical convention (14th International Congress of Medicine) that gathered together the foremost figures in the neurosciences. This work attempts to describe the situation in which neurology found itself at that time, as well as the socio-political context, and to highlight the most important contributions that were made in our specialty. A whole medical generation from around the world enthusiastically took part and 1681 communications and papers were presented, many of which dealt with neurological topics. Special mention should be made of the presentations by Cajal, who described the histological structure of the optic thalamus, and by Pavlov, who gave details of his theory of conditioned reflexes for the very first time.

Education Research: Neurology residency training in the new millennium

To survey adult neurology program directors (ANPD) to identify their most pressing needs at a time of dramatic change in neurology resident education. All US ANPD were surveyed in 2007 using an instrument adjusted from a 1999 survey instrument. The goal was to characterize current program content, the institution and evaluation of the core competencies, program director characteristics, program director support, the institution of work duty hour requirements, resident support, and the curriculum needs of program directors and programs. A response rate of 82.9% was obtained. There is a significant disconnect between administration time spent by ANPD and departmental/institutional support of this, with ANPD spending approximately 35% of a 50-hour week on administration with only 16.7% salary support. Rearrangement of rotations or services has been the most common mode for ANPD to deal with work duty hour requirements, with few programs employing mid level providers. Most ANPD do not feel work duty hour reform has improved resident education. More residents are entering fellowships following graduation than documented in the past. Curriculum deficiencies still exist for ANPD to meet all Neurology Program Requirements, especially for nontraditional neurology topics outside the conventional bounds of clinical neurology (e.g., practice management). Nearly one quarter of neurology residency programs do not have a meeting or book fund for every resident in the program. Adult neurology program directors (ANPDs) face multiple important financial and organizational hurdles. At a time of increasing complexity in medical education, ANPDs need more institutional support.

Julius Althaus (1833–1900). Neurologist and cultural polymath; founder of Maida Vale Hospital

Born, educated and trained in Germany, Julius Althaus migrated to London at the start of a long career in neurological medicine. He was a voluminous writer on a wide range of topics in both general medicine and neurology, especially electrotherapy. In addition, his textbooks form a snapshot of current concepts of great historical interest in areas such as epilepsy and cerebrovascular disease. He was an early and very successful author in the field of popular science journalism. His writing also covered many topics of general interest and his readership was both professional and public alike. His multilingual skills and Continental derivation provided him with international connections, placing him at the advancing edge of neurological development. Both Althaus and his wife Anna were superb musicians, the centre of a wide circle of friends and like-minded acquaintances, and contributed substantially to the cultural life of London. Althaus played a major, almost single-handed role in the founding and development of the Maida Vale Hospital for Nervous Diseases. He left behind a great legacy of both culture and neurology for his adopted country.

Neurology of the Arts: Painting, Music, Literature

Neurology of the Arts: Painting, Music, Literature edited by F. Clifford Rose , 438 pp., Imperial College Press, 2004, $88.00 Being a book review editor is a hazardous business. Let a particularly good volume cross your desk and the remainder of the day is shot. By far the most dangerous book I have recently received is Neurology and the Arts: Painting, Music, Literature edited by F. Clifford Rose. I advise readers not to buy it until you have time to read it cover to cover, because once you open the book, you will not stop until you get to the index. This compact 438-page volume is part of an occasional series on various neurologic topics made possible by a private memorial endowment to the Medical Society of London. Unlike many conference proceedings, however, this book is well edited with engaging writing that is pleasurable to read. It is divided into four sections: Introduction, Art, Music, …

The neurologic content of S. Weir Mitchell's fiction

Silas Weir Mitchell (1829 to 1914), one of the most important neurologists in American Medicine, was known for his seminal work on the phantom limb syndrome, causalgia, and nerve injuries. He was also a prolific writer of novels and short stories. The neurologic content of this fiction has not been studied. To assess the extent that references to neurologic topics were present in Mitchell's fiction, whether these neurologic references reflected Mitchell's scientific interests and contributions, and whether his fictional accounts of neurologic topics would precede those in his scientific writings. The authors read Silas Weir Mitchell's novels and short stories. Seventeen (63.0%) of 27 fictional works contained neurologic references. Fifty-five (69.6%) of 79 references were brief (a single word or sentence). In two works, a neurologic theme was central to the plot. Some of the neurologic content was sophisticated (aphasia, brain laterality). Phantom limb syndrome, causalgia, and nerve injuries were not prominent in his fiction. Neurologic consequences of battle injuries were featured in 10 (37.0%) works. With the exception of "The Case of George Dedlow" (i.e., phantom limb syndrome), Mitchell's fictional accounts of neurologic topics followed his presentation of these topics in the scientific literature. The majority of Mitchell's fictional works contained references to neurologic topics but most contained brief references. The number of references to Mitchell's specific scientific interests (phantom limb syndrome, causalgia) was small, although more generally, references to the neurology of battle injuries occurred more frequently.

The bullet that hit a nerve: the history of Lucja Frey and her syndrome

Duphenix first described gustatory sweating in 1757. The underlying pathogenesis was not appreciated until 1923, when Lucja Frey, a Polish neurologist, observed the phenomenon in a Polish soldier with an infected bullet wound in the parotid gland and suggested that the auriculo-temporal nerve played a role. Lucja Frey was born in Lwów, Poland, in 1889 and began her medical studies in Lwów before moving to Warsaw to work as a neurologist. She amassed a total of 43 publications on various neurological topics over her career. Unfortunately, during the Second World War she was enlisted into the Lwów ghetto, where she worked until her death in 1943. We present the history of Frey's syndrome, particularly the life of Lucja Frey and the syndrome she described.

Neurologic Education in Emergency Medicine Training Programs

Neurologic complaints are a frequent cause of emergency department visits. The morbidity and mortality of neurologic complaints such as headache and stroke can be extensive. Thus, emergency medicine residency programs should ensure adequate training in such neurologic emergencies. The authors sought to determine what methods are being used to educate residents on neurologic emergencies. A two-page survey was mailed to directors of all 126 accredited emergency medicine residency programs in the United States. The number and types of lectures to residents, required rotations, and electives offered were assessed. Means, standard deviations (SDs), and proportions are used to describe the data. Ninety-five percent confidence intervals of proportions (95% CIs) were calculated. The response rate was 78% (98 of 126). Programs had a mean (+/- SD) of 5.4 (+/- 1.0) hours of didactic lectures per week, with a mean of 12.0 (+/- 5.9) lecture hours devoted to neurologic emergencies annually. A neurology rotation was required for 16 of the 92 programs providing these data (17.4%; 95% CI = 10.6% to 27.0%), and a neurosurgery rotation was required for 14 of these 92 programs (15.2%; 95% CI = 8.9% to 24.6%). One program (1.1%; 95% CI = 0.1% to 6.8%) required both a neurology and a neurosurgery rotation, and one program (1.1%; 95% CI = 0.1% to 6.8%) required either a neurology or a neurosurgery rotation. On 15 of the 32 required neurologic rotations (46.9%; 95% CI = 29.5% to 65.0%), time was spent only in the intensive care unit. The remaining 17 rotations used outpatient clinic and general floor neurology settings. Electives in neurology, neurosurgery, or neuroradiology were available for 32 programs (32.7%; 95% CI = 24.2% to 42.4%) but were seldom used. Currently, the primary method of educating residents to treat neurologic emergencies is through didactic lectures, as opposed to clinical rotations in neurology or neurosurgery. Improving resident education in neurologic emergencies within the current educational format must focus on improving didactic lectures in neurologic topics. Expanding clinical rotations or electives to enhance education in neurologic emergencies also warrants future attention.

Neurologic Education in Emergency Medicine Training Programs

Objectives: Neurologic complaints are a frequent cause of emergency department visits. The morbidity and mortality of neurologic complaints such as headache and stroke can be extensive. Thus, emergency medicine residency programs should ensure adequate training in such neurologic emergencies. The authors sought to determine what methods are being used to educate residents on neurologic emergencies. Methods: A two-page survey was mailed to directors of all 126 accredited emergency medicine residency programs in the United States. The number and types of lectures to residents, required rotations, and electives offered were assessed. Means, standard deviations (SDs), and proportions are used to describe the data. Ninety-five percent confidence intervals of proportions (95% CIs) were calculated. Results: The response rate was 78% (98 of 126). Programs had a mean (± SD) of 5.4 (± 1.0) hours of didactic lectures per week, with a mean of 12.0 (± 5.9) lecture hours devoted to neurologic emergencies annually. A neurology rotation was required for 16 of the 92 programs providing these data (17.4%; 95% CI = 10.6% to 27.0%), and a neurosurgery rotation was required for 14 of these 92 programs (15.2%; 95% CI = 8.9% to 24.6%). One program (1.1%; 95% CI = 0.1% to 6.8%) required both a neurology and a neurosurgery rotation, and one program (1.1%; 95% CI = 0.1% to 6.8%) required either a neurology or a neurosurgery rotation. On 15 of the 32 required neurologic rotations (46.9%; 95% CI = 29.5% to 65.0%), time was spent only in the intensive care unit. The remaining 17 rotations used outpatient clinic and general floor neurology settings. Electives in neurology, neurosurgery, or neuroradiology were available for 32 programs (32.7%; 95% CI = 24.2% to 42.4%) but were seldom used. Conclusions: Currently, the primary method of educating residents to treat neurologic emergencies is through didactic lectures, as opposed to clinical rotations in neurology or neurosurgery. Improving resident education in neurologic emergencies within the current educational format must focus on improving didactic lectures in neurologic topics. Expanding clinical rotations or electives to enhance education in neurologic emergencies also warrants future attention.

NEUROPSYCHIATRY AND BEHAVIOURAL NEUROSCIENCE

NEUROPSYCHIATRY AND BEHAVIORAL NEUROSCIENCE By Jeffrey L. Cummings and Michael S. Mega 2003. Pp 428. Oxford: Oxford University Press Price £69.50. ISBN 0‐19‐513858‐9 Neuropsychiatry and Behavioural Neuroscience is the successor to Jeffrey Cummings’s original work published in 1985. The authors’ preface and introduction styles it as a ‘progress report in the evolution of neuropsychiatry and of the authors’ understanding of neuropsychiatric disease and treatment’ (page ix). The authors therefore clearly set forth on an ambitious undertaking. One of the requirements of any critical review must therefore be to assess how successfully this aim has been achieved. The book is very large and heavy—certainly not one to contemplate as a handy pocket‐sized carry‐along for reference at the patient’s bedside. The cover is colourful and attractive, suitably adorned with a couple of brain sections from an FDG‐PET scan, which gives appeal and is perhaps a taster for more inside. The coverage of material over 414 pages (including the index) and 26 chapters, as set out on the contents page, is wide‐ranging. The chapter titles are an eclectic mix of anticipatable neurological topics, such as ‘Dementia’, ‘Epilepsy’,‘Movement disorders’; and more psychiatric fodder, such as ‘Anxiety disorders’, ‘Violence and aggression’ and ‘Hallucinations’. There is a curious, perhaps inconsistent, mix of chapter titles aimed at neurological brain dysfunction, e.g. ‘Frontal lobe dysfunction’, and symptom‐led discussion, e.g. ‘Disturbance of mood and affect’. Despite the images on the front cover from PET scans, one does not find a specific chapter devoted to neuroimaging as a single subject, i.e. a clear and thorough description and discussion around basic techniques (particularly for the novice in this area), examples of findings from different types of neuroimaging, the …

On the 150th birthday of Paul Julius Möbius (1853-1907)

In memory of Paul Julius Möbius (1853-1907) on the occasion of his 150th birthday Among his profession Leipzig neurologist and psychiatrist Paul Julius Möbius made a name for himself by clinical studies on singular neurological topics. Several of these contributions have been acknowledged until today by giving his name to these symptoms or illnesses (cf. 'Möbius sign', 'Möbius syndrome', 'Möbius disease'). It was also him who divided nervous illnesses into endogenous and exogenous ones. Furthermore, Möbius made significant contributions towards the understanding of the causes for some mental illnesses, e.g. it was him who postulated a psychogenic development of hysteria. Through his pathographies as well as his work as a major reviewer and editor of 'Schmidt's Annals of Domestic and Foreign Entire Medicine' Möbius became known to a greater public. Even more well-known, if not infamous, Möbius's name is for his pamphlet on 'The Physiological Mental Weakness of Woman'. As a result of it's repeated republication he was accused to be hating women and his major contributions towards the progress of the neurosciences have been neglected.

Keeping Up with Neurology on the Web

Keeping Up with Neurology on the Web

Alfred Hauptmann - the fate of a german neurologist of jewish origin

The pathway through life of the German psychiatrist and neurologist Alfred Hauptmann (1881 - 1948) and his work is described. It is exemplary for so many of his contemporaries of Jewish origin, who were forced to emigrate under the National Socialist dictatorship. Hauptmann's career was most of all marked by the short, but to him formative time with Max Nonne. Throughout his life his research focused on neurological topics. In 1926, Hauptmann got the chair of psychiatry at Halle University in order to continue the important neurological tradition of Eduard Hitzig, Carl Wernicke and Gabriel Anton. Until 1935, he worked as the director of the psychiatric clinic in Halle, but in the course of the Reichsbürgergesetz he had to give up his chair and his work as a doctor. The way into emigration, which was accelerated by the temporary imprisonment in the concentration camp Dachau, is described considering personal documents. After his emigration into the United States, Hauptmann was not too successful in starting new as a scientist. His most important contribution is still the article on the efficacy of Phenobarbital as an antiepileptic, which had been written already in 1912. For this reason, the Alfred-Hauptmann-Award for epilepsy research is awarded. In 1941 - after his emigration - he and Siegfried Joseph Thannhauser described the autosomal dominantly transmitted myopathy for the first time, which is today described as Hauptmann-Thannhauser myodystrophy. The name of Alfred Hauptmann should be unforgettable not only because of the entrance into medical nomenclature, but it should also remind of the man Alfred Hauptmann, standing for all those whose similar fates are still unknown until now.

Prioritising systematic review topics in neurology

Prioritising systematic review topics in neurology