Neurology Clinic Research Articles

Telemedicine in Pediatric Neurology: A Survey of Patient and Provider Experience.

Over recent years there has been a shift in clinical practice to support care delivery via telemedicine. This study aims to highlight the patient and provider experience of telemedicine over 2.5 years within a Canadian Pediatric Neurology clinic. A REDCap survey was sent to all patients/parents and providers with a telemedicine appointment between March 2020 and September 2022. Seven providers and 272 patients responded. Ninety-one percent of patients and 100% of providers were satisfied with telemedicine. Ninety percent of patients and 100% of providers found telemedicine more convenient. Eighty-seven percent of patients and 100% of providers were interested in future telemedicine appointments. Main challenges were with performing a physical examination and technological issues. Our survey shows that the majority of patients and providers had highly positive experiences with telemedicine and were interested in continuing care via telemedicine. This study supports incorporating telemedicine into future pediatric neurology practice.

Validation of a Set of Clinical Criteria for the Diagnosis of Secondary Progressive Multiple Sclerosis

Background/Objectives: Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system characterized by progressive impairment of neuronal transmission due to focal demyelination. The most common form is RRMS (relapsing-remitting multiple sclerosis), which, under the influence of certain factors, can progress to SPMS (secondary progressive multiple sclerosis). Our study aimed to validate the criteria proposed by a working group of the Romanian Society of Neurology versus the criteria proposed by a group of experts from Spain, Karolinska, and Croatia concerning the progression from RRMS to SPMS. Methods: This was done by gathering epidemiological data (age, gender) and by applying clinical tests such as the 9HPT (9-hole peg test), 25FWT (25-foot walk test), and EDSS (expanded disability status scale) tests and the SDMT test (symbol digit modalities test). The present research is a cohort study that included a number of 120 patients diagnosed with MS according to the McDonald Diagnostic Criteria 2017. The study was carried out between January 2023 and April 2024, including patients hospitalized in the Neurology Clinic of the Clinical Rehabilitation Hospital from Iasi, Romania. The data were collected at baseline (T0) and at a 12-month interval (T1). Results: The statistical analysis was conducted using Kaiser–Meyer–Olkin analysis, which indicated a value of 0.683, thus validating the clinical tests used. The correlation matrix and the linear regression for all the tests showed highly significant statistical results. Furthermore, the ROC curve analysis of the criteria suggested by the working group of the Romanian Society of Neurology demonstrated that the EDSS, 9HPT, and 25FWT are highly sensitive in diagnosing SPMS, an opinion that is shared with the Spanish experts, but not with the Karolinska expert panel. Using the criteria given by the Croatian expert group in the ROC curve analysis showed that only the EDSS was strongly significant for the progression to the SPMS phase. Conclusions: In conclusion, all clinical methods used demonstrated that they are valid and can contribute to identifying patients with an increased risk of progression. The model proposed by the Romanian Society of Neurology working group is similar to other countries’ expert opinions and can be used to detect the risk of disease progression and establish a more tailored therapeutic management of SPMS.

Collaborative Care to Improve Quality of Life for Anxiety and Depression in Posttraumatic Epilepsy (CoCarePTE): Protocol for a Randomized Hybrid Effectiveness-Implementation Trial.

Anxiety and depression in people with epilepsy are common and associated with poor outcomes; yet, they often go untreated due to poor mental health specialist access. Collaborative care is an integrated care model with a strong evidence base in primary care and medical settings, but it has not been evaluated in neurology clinics. Evaluating implementation outcomes when translating evidence-based interventions to new clinical settings to inform future scaling and incorporation into real-world practice is important. The Collaborative Care for Posttraumatic Epilepsy (CoCarePTE) trial aims to evaluate the effectiveness (improvement in emotional quality of life) and implementation of a collaborative care intervention for people with anxiety or depressive symptoms and posttraumatic epilepsy. CoCarePTE is a 2-site, randomized, single-blind, hybrid type 1 effectiveness-implementation trial that will randomize 60 adults to receive either neurology-based collaborative care or usual care. Adults receiving neurological care at participating centers with anxiety or depressive symptoms and a history of at least mild traumatic brain injury before epilepsy onset will be enrolled. The collaborative care intervention is a 24-week stepped-care model with video or telephone calls every 2 weeks by a care manager for measurement-based anxiety and depression care, seizure care monitoring, and brief therapy intervention delivery. This is supplemented by antidepressant prescribing recommendations by psychiatrists for neurologists via case conferences and care manager-facilitated team communication. In step 2 of the intervention, individuals with <50% symptom reduction by 10 weeks will receive an added 8-session remote cognitive behavioral therapy program. The study is powered to detect a moderate improvement in emotional quality of life. As a hybrid type 1 trial, effectiveness is the primary focus, with the primary outcome being a change in emotional quality of life at 6 months in the intervention group compared to control. Secondary effectiveness outcomes are 6-month changes in depression, anxiety, and overall quality of life. Implementation outcomes, including fidelity, acceptability, feasibility, and appropriateness, are evaluated before implementation and at 3 months. The primary effectiveness analysis will compare changes in emotional quality of life scores from baseline to 6 months between the intervention and control arms using multiple linear regression modeling, adjusting for study site and using an intent-to-treat approach. Enrollment commenced in 2023, with modifications in the inclusion and exclusion made after the first 6 enrollees due to slow recruitment. Enrollment is expected to continue at least into early 2025. The CoCarePTE trial is novel in its use of a hybrid effectiveness-implementation design to evaluate an evidence-based mental health intervention in epilepsy, and by incorporating seizure care into a collaborative care model. If a significant improvement in emotional quality of life is found in the intervention group compared to usual care, this would support next step scaling or clinical implementation. ClinicalTrials.gov NCT05353452; https://www.clinicaltrials.gov/study/NCT05353452. DERR1-10.2196/59329.

Using Multilevel Models and Generalized Estimating Equation Models to Account for Clustering in Neurology Clinical Research.

In clinical and health services research, clustered data (also known as data with a multilevel or hierarchical structure) are frequently encountered. For example, patients may be clustered or nested within hospitals. Understanding when data have a multilevel structure is important because clustering of individuals can induce a homogeneity in outcomes within clusters, so that, even after adjusting for measured covariates, outcomes for 2 individuals in the same cluster are more likely to be similar than outcomes for 2 individuals from different clusters. Using conventional statistical regression models to analyze clustered data can result in incorrect conclusions being drawn. In particular, estimated CIs may be artificially narrow, and significance levels may be artificially low. As a result, one may conclude that there is a statistically significant association when there is none. To avoid this problem, investigators should ensure that their analyses use techniques that account for clustering of data. Generalized linear models estimated using generalized estimating equation (GEE) methods and multilevel regression models (also known as hierarchical regression models, mixed-effects models, or random-effects models) are two such techniques. We provide an introduction to clustered or multilevel data and describe how GEE models or multilevel models can be used for the analysis of multilevel data.

Utilization of Single-Pulse Transcranial-Evoked Potentials in Neurological and Psychiatric Clinical Practice: A Narrative Review

Background: The utility of single-pulse TMS (transcranial magnetic stimulation)-evoked EEG (electroencephalograph) potentials (TEPs) has been extensively studied in the past three decades. TEPs have been shown to provide insights into features of cortical excitability and connectivity, reflecting mechanisms of excitatory/inhibitory balance, in various neurological and psychiatric conditions. In the present study, we sought to review and summarize the most studied neurological and psychiatric clinical indications utilizing single-pulse TEP and describe its promise as an informative novel tool for the evaluation of brain physiology. Methods: A thorough search of PubMed, Embase, and Google Scholar for original research utilizing single-pulse TMS-EEG and the measurement of TEP was conducted. Our review focused on the indications and outcomes most clinically relevant, commonly studied, and well-supported scientifically. Results: We included a total of 55 publications and summarized them by clinical application. We categorized these publications into seven sub-sections: healthy aging, Alzheimer’s disease (AD), disorders of consciousness (DOCs), stroke rehabilitation and recovery, major depressive disorder (MDD), Parkinson’s disease (PD), as well as prediction and monitoring of treatment response. Conclusions: TEP is a useful measurement of mechanisms underlying neuronal networks. It may be utilized in several clinical applications. Its most prominent uses include monitoring of consciousness levels in DOCs, monitoring and prediction of treatment response in MDD, and diagnosis of AD. Additional applications including the monitoring of stroke rehabilitation and recovery, as well as a diagnostic aid for PD, have also shown encouraging results but require further evidence from randomized controlled trials (RCTs).

The Prevalence of Depressive Symptoms in Patients with Idiopathic Parkinson's Disease: Cross-Sectional Study from Somalia.

Depression is one of the most common non-motor symptom of Parkinson's disease (PD), with an increasing prevalence in recent years. It causes significant psychological consequences that affect the disease course, overall quality of life, and functioning. The objective of this study was to determine the prevalence of depression in outpatients with Parkinson's disease evaluated in the neurology clinic at tertiary hospital in Mogadishu, Somalia. A cross-sectional study was conducted among 50 PD patients without dementia to determine the prevalence of depression at the neurology clinic of the Mogadishu Somalia Türkiye Training and Research Hospital between February and November 2022. All eligible participants were interviewed by a team of doctors using a structured questionnaire that consisted of sociodemographics and clinical characteristics, the Beck Depression Inventory-II (BDI-II) for depression assessment, and the Modified Hoehn and Yahr Scale for PD staging. Of the 50 PD participants, 60% were male and 58% were older than 60 years. 20% of them had a family history of PD and HTN as comorbid conditions. The prevalence of depression among the participants was 46% (95% CI 31.8-60.7). Of the patients with depression, 22% and 24% had mild and moderate depressive symptoms, respectively. The Mann-Whitney U-test revealed a statistically significant association between depression symptoms and the presence of comorbidity (χ2 = 136.50, p<0.01). The Kruskal-Wallis test revealed a statistically significant association between depression symptoms and a longer duration of PD (χ2 (2) = 18.21, p<0.01) and advanced stages of PD (χ2 (2) = 13.74, p<0.01). This is the first study conducted on patients with PD in Somalia and found that a significant proportion of these patients experienced depressive symptoms. We also highlighted that factors such the presence of medical comorbidities, high monthly income, advanced PD stage, longer duration of PD, and use of multiple medications for PD were significantly associated with the presence of depressive symptoms.

The clock drawing test (CDT) in the digital era: Underperformance of generation Z adults

Background and objectivesThe clock drawing test (CDT) is a widely recognized neurocognitive test for executive and visuospatial functions. However, no normative data exist for Generation Z young adults (born on or after 1997). The widespread use of digital displays among this generation may impair performance on the analog CDT. MethodsYoung Generation Z adults with at least 12 years of education, who were evaluated at the Israel Defense Forces (IDF) outpatient neurology clinic between 2021 and 2022, completed a CDT using the Manos-Wu method and drew a digital clock. Patients with possible cognitive impairment were excluded. ResultsThree hundred Generation Z patients were recruited, with a mean age of 19.7 ± 1.2 years. 171 (57.0 %) were female. Mean CDT score was 8.1 ± 2.5 out of 10 (Manos & Wu). A lower CDT score was associated with younger age (p = 0.031). No association was found with chief complaint, presence of ADHD diagnosis, gender, or postsecondary education. Digital clock drawing (4/4 digits) was successful in 100 % of patients. DiscussionGeneration Z adults demonstrate lower CDT scores than previously reported for older generations. The CDT may require revision to maintain its specificity for this population. Developing an alternative, digital-based tool for cognitive screening in young generations could be advisable.

Etiology and Characteristics of Pseudotumoral Lesions and Tumefactive Demyelination in Multiple Sclerosis

IntroductionCerebral pseudotumoral lesions (CPTL) (>2cm) on magnetic resonance imaging (MRI) may pose a clinical challenge. A majority will occur in the context of multiple sclerosis (MS) – also referred to as tumefactive demyelinating lesions (TDL). The aim of this study was to define and analyze clinical, MRI, and paraclinical data for MS and non-MS patients. MethodsThis prospective study included adult patients with CPTL on brain MRI referred to the Neurology Clinic, Belgrade as a tertiary University Center (2019-2023) for clinical workup and treatment. Demographic, clinical, MRI, and paraclinical data were reviewed. ResultsThis study included 75 patients, of which 58.7% had MS. Fourteen patients had previously been diagnosed with MS, while 30 (68.2%) received the diagnosis of MS in the later course. The concordance of initial and final diagnoses was 52%. Relapsing disease (p<0.001) and brainstem presentation (p=0.039) were significantly more common in MS patients. Headache (p= 0.008) and lethal outcome (p=0.014) were significantly more common in the non-MS group. Lesions were ring-like more frequently in the MS group (p<0.001), while patients in the non-MS group frequently displayed infiltrative (p=0.001) and nonspecific lesions (p=0.002). The presence of headache and megacystic morphology was associated with the presence of pathology other than MS while the relapsing disease was in favor of MS. ConclusionMultiple sclerosis was the most common cause of CPTL. Headache, relapsing course of disease, and megacystic morphology may help discern MS from non-MS pathology. These findings should be challenged in future studies examining larger cohorts.

Comparison of Serum and Cerebrospinal Fluid Neurofilament Light Chain Concentrations Measured by Ella™ and Lumipulse™ in Patients with Cognitive Impairment.

Neurofilament light chain proteins (NfLs) are considered a promising biomarker of neuroaxonal damage in several neurological diseases. Their measurement in the serum and cerebrospinal fluid (CSF) of patients with dementia may be especially useful. Our aim was to compare the NfL measurement performance of two advanced technologies, specifically the Ella™ microfluidic platform and the Lumipulse™ fully automated system, in patients with cognitive disorders. Thirty subjects with neurodegenerative cognitive disorders (10 with Alzheimer's Disease, 10 with Frontotemporal Dementia, and 10 with non-progressive Mild Cognitive Impairment) seen at the Cognitive Neurology Clinic of Modena University Hospital (Italy) underwent CSF and serum NfL measurement with both the Ella™ microfluidic platform (Bio-Techne, Minneapolis, MN, USA)) and the Lumipulse™ fully automated system for the CLEIA (Fujirebio Inc., Ghent, Belgium). Correlation and regression analyses were applied to assess the association between NfL concentrations obtained with the two assays in CSF and serum. The Passing-Bablok regression method was employed to evaluate the agreement between the assays. There were high correlations between the two assays (r = 0.976, 95% CI. 0.950-0.989 for CSF vs. r = 0.923, 95% CI 0.842-0.964 for serum). A Passing-Bablok regression model was estimated to explain the relationship between the two assays, allowing us to switch from one to the other when only one assay was available. We found a good degree of correlation between the two methods in patients with neurocognitive disorders. We also established a method that will allow comparisons between results obtained with either technique, allowing for meta-analyses and larger sample sizes.

Evaluation of the relationship between thrombophilia gene mutations and demographic data, imaging findings and stroke subtypes in young patients followed up with a diagnosis of stroke

Aims: A stroke is defined as a focal or generalized neurological deficit that develops suddenly, lasts for more than 24 hours, or ends in death within this period, with a cause other than a vascular cause. Stroke is among the leading causes of morbidity and mortality in the general population. In our study, we examined the prevalence of all prothrombotic gene mutations observed in patients with and without predisposing risk factors for young patients with stroke and discussed their roles in stroke formation in the context of existing literature. Methods: In the present study, we conducted a retrospective review of the medical records of 300 patients aged 18 to 49 years who were hospitalized in the neurology clinic of our hospital between June 2023 and June 2024 and diagnosed with acute arterial ischemic stroke based on anamnesis, neurological examination, and radiological imaging (CT and MRI) results. The study cohort comprised 47 patients (23 males, 24 females) aged between 18 and 49 years with a diagnosis of ischemic stroke. In our study, we examined ischemic stroke-related gene polymorphisms in patients with early-onset ischemic stroke (before the age of 50 years). This study aims to investigate the prevalence of Factor V-Leiden, prothrombin-G20210A, methylenetetrahydrofolate reductase (MTHFR) C677T, MTHFR A1298C, SERPIN 1, and Factor II polymorphisms in young patients with ischemic stroke. Results: A total of 47 patients, comprising 23 males and 24 females, were included in the study. The mean age of the patients was 40.34 ± 6.37 years. According to the TOAST classification system, 17 patients (36.2%) were diagnosed with large artery atherothrombosis, one patient (2.1%) had a cardioembolic infarction, and 29 patients (61.7%) had a small artery occlusion. In our study, when evaluating the thrombophilia mutation subtypes in young ischemic stroke patients, 23.4% (n=11) of the patients were found to be heterozygous for the FVL mutation, while 76.6% (n=36) had no mutation. Concerning the SERPIN 1 mutation, 40.4% (n=19) of the patients were heterozygous, 23.4% (n=11) were homozygous, and 36.2% (n=17) exhibited no mutation. The distribution of patients according to MTHFR C677T mutation revealed that 57.4% (n=27) were heterozygous, 19.1% (n=9) were homozygous, and 23.4% (n=11) had no mutation. Considering the distribution of patients according to the MTHFR A1298C gene mutation, a total of 38.3% (n=18) of the patients were heterozygous, 14.9% (n=7) were homozygous, and 46.9% (n=22) had no mutation. Upon analysis of the distribution of patients according to factor XIII mutation, it was identified that 19.1% (n=9) were heterozygous, 2.1% (n=1) were homozygous, and 78.7% (n=37) of the patients exhibited no mutation. Upon analysis of the distribution of patients according to prothrombin (Factor II) mutation, it was identified that 8.5% (n=4) were heterozygous, while 91.5% (n=43) exhibited no mutation. Conclusion: Although stroke is less prevalent in young adults, the underlying etiology is highly varied. Further research, including the investigation of genetic and prothrombotic mutations, is vital for the prevention of recurrent strokes in young adults.

Outdoor artificial light at night and risk of conversion from mild cognitive impairment to dementia

Abstract Background A few studies have suggested that exposure to lighting during night hours, i.e. light at night (LAN), may increase the risk of dementia. In this study, we aimed to evaluate the association between exposure to outdoor artificial LAN and risk of conversion to dementia in an Italian cohort of subjects with mild cognitive impairment (MCI). Methods We recruited subjects with a diagnosis of MCI at the Cognitive Neurology Clinic of Modena Hospital in the period 2008-2014, and we followed these subjects up to 2021 for conversion to dementia. We collected their residential history and we assessed LAN exposure at subjects’ residences using satellite imagery data available from the Visible Infrared Imaging Radiometer Suite (VIIRS) for the period 2014-2022. Using a Cox-proportional hazards model adjusted for relevant confounders, we computed the hazard ratio (HR) of dementia with 95% confidence interval (CI) according to increasing LAN exposure through linear, categorical, and non-linear restricted-cubic spline models. Results Out of 53 recruited subjects, 34 converted to dementia of any type including 26 Alzheimer’s dementia. In linear regression analysis, LAN exposure was positively associated with dementia conversion (HR 1.03, 95% CI 1.00-1.06 for 1-unit increase). Using as reference the lowest tertile, subjects at both intermediate and highest tertiles of LAN exposure showed increased risk of dementia conversion (HRs 2.26, 95% CI 0.88-5.85, and 2.89, 95% CI 1.10-7.58). In spline regression analysis, the risk linearly increased up to a LAN exposure of 30 nW/cm2/sr, above which a plateau seemed to be reached. Results were almost confirmed when limited to conversion to Alzheimer’s dementia, except for an almost linear relation. Conclusions Our findings suggest that exposure to outdoor artificial LAN may increase conversion from MCI to any type of dementia, especially above 30 nW/cm2/sr, while such relation appears to be almost linear for Alzheimer’s dementia. Key messages • Light at night exposure above 30 nW/cm2/sr was associated with risk of conversion to dementia. • Light at night showed almost linear association with risk of conversion to Alzheimer’s dementia.

Challenges for Family Caregivers of Persons With Mild Cognitive Impairment: A Qualitative Longitudinal Study.

Family caregivers of persons with mild cognitive impairment attempt to understand the behavioural and functional changes exhibited by their relative. However, how caregivers respond to initial changes and changes over time has not been explored. The purpose of this qualitative study was to explore the experience of family caregivers responding to changes in their relative's memory, behaviours, and physical functions over 2 years. Eleven family caregivers of a relative with mild cognitive impairment were purposively recruited from neurological clinics in Taiwan. Face-to-face semi-structured interviews were conducted within 6-months of referral; three follow-ups were conducted at 6-month intervals. Content analysis of 41 transcribed audio-recorded interviews revealed the longitudinal changes in their relative with cognitive impairment was made caregiving challenging. Three themes described the challenges: (1) Changes related to their relative's cognitive impairment, which included increases in mood fluctuations, erratic behaviours, and reductions in physical abilities; (2) changes in their relative's comorbidities, which included adapting to new symptoms and treatments for a chronic disease, monitoring medication adherence and drug interactions; and (3) changes in caregiver burden, which increased levels of stress, uncertainty, and anxiety resulting in greater role strain. Caregiving became more challenging with time, especially caregivers whose relative developed dementia during the study period. These findings offer insight into the trajectory of the experience of family caregivers attempting to understand changes in cognition, behaviours, and physical functions for their relative with mild cognitive impairment over 2 years, which could help mental healthcare providers develop support services to reduce caregiver role strain.

Clinical Reasoning Unveiled: Demystifying Heuristics and Hermeneutics in Neurological Clinical Practice

Introduction: Medical practice, particularly in Neurology, is often influenced by cognitive biases that can compromise diagnostic and therapeutic accuracy, leading to significant patient consequences. Clinical reasoning strategies are fundamental, yet the complexity of these processes is frequently underestimated. Understanding these strategies is crucial to ensure accurate diagnoses and effective treatments, thereby reducing clinical errors and optimizing patient outcomes. Despite extensive literature on cognitive biases, there is a need for a systematic synthesis addressing the peculiarities of neurological clinical reasoning, considering heuristics (mental shortcuts or rules of thumb that simplify decision-making) and hermeneutics (the theory and methodology of interpretation, especially of textual and symbolic content). Objectives: To review and systematize the main clinical reasoning strategies in Neurology, highlighting common biases and proposing methods to improve diagnostic and therapeutic accuracy. Methodology: A comprehensive literature review focusing on familiarity biases, Dual Process Theory, and heuristics (anchoring, availability, and representativeness). Additionally, the application of hermeneutics in hypothesis formulation and the importance of understanding the patient as a complex system were analyzed. Results: Specialized neurologists often rely on heuristics, which means a cognitive shortcut. Recognizing this process can mitigate anchoring and availability biases. The hermeneutic approach, on the other hand, is essential for interpreting variables in the patient’s context, integrating historical and social aspects. Conclusion: Understanding clinical reasoning processes and systematically teaching these strategies are crucial to enhancing the efficiency and effectiveness of clinical decision-making, reducing diagnostic errors, and improving patient outcomes.

An Instructional Module for Functional Dissociative Seizures (FDS) in Hindi: Enhancing Communication and Management in India.

Functional dissociative seizures (FDS) are very common in neurology clinics, they straddle both neurology and psychiatry. In India, scarce resources and guidelines are available for effectively conveying their diagnosis and management, which leads to a substantial gap in care. We aimed to provide an instructional module for FDS, tailored to clinicians, patients, and caregivers in Hindi, to enhance communication of diagnosis and facilitate suitable management strategies. The instructional module development process was based on clinical settings and expert opinions. A standard translation process was performed to ensure the linguistic and cultural equivalence. Validation was carried out by a panel of 15 validators, comprising 13 neurologists and two psychiatrists, to identify key psychoeducation components and their significance. They were provided a questionnaire consisting of five questions that were related to completeness, understandability, legibility, clarification, and usefulness of educational material for clinicians, patients, and caregivers. Items were rated using a 5-point Likert scale. There was agreement on four items (Q1, Q3, Q4, and Q5), whereas approximately 85% of the validators agreed on the remaining one item (Q2). The instructional module demonstrated high content validity as indicated by both item level-content validity index (0.98) and scale-level content validity index (0.97), alongside content validity ratio and modified kappa statistics. The developed Hindi instructional module for FDS serves as a valuable tool to enhance the communication of FDS diagnosis and dispel misconceptions. This offers a comprehensive resource for clinicians, patients, and caregivers in India, potentially bridging gap in FDS care.

Cognitive recovery of post critical care patients with and without COVID-19: differences and similarities, an observational study

BackgroundCoronavirus disease (COVID-19) patients treated in an intensive care unit (ICU) are at high risk of developing cognitive impairments of a “post-intensive care syndrome” (PICS). We explored whether critically ill COVID-19 and non-COVID-19 survivors differ in their post-ICU recovery course in terms of severity and affected cognitive domains.MethodsAn observational prospective study was conducted in a German post-acute neurological early rehabilitation clinic. Critically ill patients with or without SARS-CoV-2 infection (at least mechanically ventilated for one week) underwent repeated standardized assessments during their subsequent inpatient rehabilitation stay. Cognitive functions (information processing speed, learning, recognition, short-term and working-memory, word fluency, flexibility) assigned to different domains (attention, memory, executive functions) were assessed as primary outcome. Secondary outcomes included mental (depression, anxiety) and physical (Barthel index, modified ranking scale) state.ResultsOut of 92 eligible patients (screened between June 2021 and August 2023), 34 were examined, and 30 were available for analysis (15 per group). Both groups were ventilated for a similar period (COVID-19 vs. Non-COVID-19: median: 48 vs. 53 days). Patients of COVID-19 group spend on average 10 days longer at ICU and developed slightly more complications, but subsequent inpatient rehabilitation was of comparable duration (median: 36.5 vs. 37 days). On the group-level both groups showed similar cognitive dysfunctions with striking impairments (normative T-scores < 41) in information processing speed, word fluency, flexibility, and recognition memory on admission. Significant gains until discharge were only revealed for information processing speed in both groups (main effect visit, mean difference [95%CI] − 7.5 [− 13.1, − 2.0]). Physical and mental state were also similarly affected in both groups on admission, but improved over time, indicating that overall recovery for higher-order cognitive functions is slowest. Interestingly, majority of patients stated correctly being still physically disabled, while a discrepancy was found between subjective and objective evaluation of cognitive health.ConclusionsResults suggest a substantial overlap of cognitive, mental and physical dysfunction in post-acute recovery of ICU survivors independent of SARS-CoV-2 infection which warrants further monitoring to reduce the risk of long-term burden and enable a return to previous functionality.Trial registrationRetrospectively registered at https://drks.de/search/de/trial/DRKS00025523, 21.06.2021.

The Relationship of Stroke Incidents With Clients’ Quality of Life

Stroke is a condition where the blood supply to the brain is disrupted or reduced due to blockage (ischemic stroke) or rupture of blood vessels (hemorrhagic stroke). Stroke can cause physical disability, this can affect psychological, emotional, cognitive and even social conditions. So post-stroke sufferers will experience changes in their quality of life. The aim of this research is to analyze the relationship between the incidence of stroke and the quality of life of clients at RSUD Ibnu Sina Gresik. This research uses an observational research design with a cross sectional approach. The total population was 451 clients, 82 samples were studied using consecutive sampling techniques. The instrument used in the research was the WHOQOL-BREF questionnaire and then the collected data was analyzed using the SPSS Chi-Square Test. Almost all of the stroke clients who were controlled at the neurological clinic at Ibnu Sina Gresik Regional Hospital experienced a stroke once, 62 (75.6%) of the clients and almost all of the quality of life of stroke clients who were controlled at the neurological clinic at Ibnu Sina Gresik Regional Hospital experienced a fairly good quality of life. 66 (80.5%) clients. The results of the collected data were then analyzed to obtain P = 0.624 &gt; 0.05, so H1 was rejected and H0 was accepted. In conclusion, there is no relationship between the incidence of stroke and the quality of life of clients at Ibnu Sina Gresik Regional Hospital. Keywords : Stroke, Quality of Life, Clients

Effect of Helicobacter pylori Eradication on Serum Level of Valproic Acid in Children with Idiopathic Generalized Epilepsy.

The purpose of this study was to determine the influence of H. pylori eradication on the serum level of the orally administered valproic acid (VPA) in children with idiopathic generalized epilepsy; Methods: This prospective cohort observational study included 100 children with idiopathic generalized epilepsy, recruited from a neurology clinic from May 2021 to December 2021. The patients were divided into two groups, each containing 50 children. The first group had a positive H. pylori stool antigen and H. pylori-related symptoms, while the second group had a negative antigen. H. pylori Eradication therapy was given to the positive H. pylori group. The serum level of VPA was obtained at baseline and 4 weeks after eradication therapy. Despite there being no significant difference between the H. pylori-positive and H. pylori-negative groups regarding the baseline VPA serum level (79.9 ± 13.9 and 77.9 ± 13.1 mcg/mL), respectively, the serum VPA level had significantly increased after H. pylori eradication therapy (99.4 ± 11 mcg/mL) (p value = 0.000), as opposed to the H. pylori-negative group (85.3 ± 10.9 mcg/mL) (p value = 0.142). Furthermore, there was a statistically significant association with a negative correlation between the VPA serum level after eradication and the number of epileptic attacks per month (p value = 0.033, R value = -0.301) and the dose of VPA (p value = 0.046, R value = -0.284). The eradication of H. pylori resulted in a highly significant improvement in the serum level of the orally given VPA in children with idiopathic generalized epilepsy, as well as an indirect decrease in the frequency of epileptic events per month, allowing for dose reduction. Eradication therapy may have anticonvulsant properties and might indirectly aid in the management of epileptic activity. H. pylori screening for children with idiopathic generalized epilepsy can optimize serum VPA levels, potentially leading to better seizure control. To our knowledge, this is the first study in the literature to describe the effect of H. pylori eradication on the serum level of the orally administered VPA in children with idiopathic generalized epilepsy.

Comparing the frequency, antifungal susceptibility, and enzymatic profiles of the oral fungal composition in patients with and without Alzheimer's disease admitted to a neurology clinic.

Studies have shown that changes in the frequency of oral microorganisms may play a key role in the development of Alzheimer's disease (AD). However, no research has been conducted on the oral fungal composition in AD-patients. The present study aimed to investigate the changes in the frequency of oral fungal composition, the antifungal susceptibility, and the enzymatic profiles of oral fungal composition in patients suffering from AD compared to non-AD individuals. In the present analytical cross-sectional study during 12 months, 76 hospitalized patients with AD were matched with 76 individuals without AD. A sterile serum physiology-moistened cotton-tipped swab was used to sample the mouth area. All swabs were cultured on Sabouraud Chloramphenicol Agar. Fungal identified were confirmed through the PCR-sequencing techniques. Enzyme activity index (EAI) for important pathogenic factors including proteinase, esterase and hemolysin was measured using relevant protocols. The susceptibility to 8 antifungal agents (nystatin, voriconazole, itraconazole, fluconazole, posaconazole, amphotericin B, 5-fluorocytosine, and caspofungin) against fungal strains obtained from AD-patients was evaluated according to the Clinical and Laboratory Standards Institute (CLSI) guidelines, document M38-A2 for filamentous fungi, and document M27-A4 for yeasts. The results showed that compared to the non-AD individuals, the prevalence of oral fungal composition in AD group was 1.6 times higher. Candida albicans was the most common fungal species isolated from oral swab samples of AD group (n=53, 80%) and non-AD group (n=28, 40%), and the diversity of the oral fungal composition in AD-patients were lower than non-AD individuals. Among the 3 investigated virulence factors, a statistically significant difference was shown in terms of hemolysin activity level between the two studied groups (p<0.05) and the activity level of esterase and proteinase enzymes did not show a significant difference in the two studied groups (p>0.05). The results showed that almost all of the tested isolates were susceptible to nystatin, the most widely prescribed antifungal to treat superficial infections, and only 1.69 % (2/118) of the Candida isolates were resistant to this antifungal drug. Understanding the changes in the frequency of oral fungal composition the antifungal susceptibility, and the enzymatic profiles of oral fungal composition in patients suffering from AD compared to non-AD individuals makes it possible to better understand the etiology of this disease.

Neurologists’ understanding of reproductive medicine options for genetic forms of motor neuron disease

Objectives To examine the knowledge, confidence and practice of motor neuron disease (MND) clinicians toward discussing reproductive options with people who carry a causal variant in an MND gene (both clinically affected and asymptomatic). Methods An online cross-sectional survey was distributed nationwide to UK MND clinicians and clinical geneticists and genetic counselors. The survey assessed respondents’ understanding on reproductive medicine techniques; their confidence in discussing reproductive medicine options and their access to information resources. Results Seventy six clinicians responded to the online survey (45 neurology clinicians and 31 clinical geneticists). MND clinicians had limited knowledge and low confidence in discussing reproductive medicine options. Geneticists were more likely to carry out reproductive genetic counseling with very few MND clinicians reporting undertaking these discussions. Further, 57% of the 45 MND clinicians surveyed reported to have never made a referral for reproductive genetic counseling. Multiple barriers to offering reproductive counseling or referral were identified including a lack of knowledge, lack of awareness of the different options, lack of clinic time and uncertainty around issues such as funding for PGT and whose responsibility it comes under. Conclusions There is a need for training and education on reproductive options and referral for these options needs to be integrated within the health system. Developing more resources for both clinicians and patients is required as MND clinicians reported a lack of resources.

Pattern and Predictors of Neurologic Comorbidities Among African Children with Epilepsy

Abstract Background Epilepsy is the most common neurologic disorder affecting children in Nigeria. It is often associated with other neurologic comorbidities in addition to epileptic seizures, such as attention deficit hyperactivity disorder (ADHD) and cognitive, visual, and hearing impairments, which can be unrecognized while focusing on the seizures. Methods This cross-sectional study assessed the prevalence, pattern, and predictors of neurologic comorbidities among 100 children with epilepsy (CWE) attending the pediatric neurology clinic of Jos University Teaching Hospital, Jos, Nigeria, and age- and sex-matched controls selected consecutively. Data were summarized using frequencies and proportions. Chi-squared and Mann–Whitney U tests were used to test the categorical values, while logistic regression was used to determine the predictive factors for neurologic comorbidities. Results The prevalence of neurologic comorbidities among CWE versus controls was 65 vs. 15% (p &lt; 0.001). Factors associated with neurologic comorbidities in CWE include younger age at onset of epileptic seizures (p &lt; 0.003), severity of seizures (p &lt; 0.001), history of status epilepticus (p &lt; 0.044), background history of intracranial infections (p &lt; 0.029), and the use of combination antiepileptic drugs (p &lt; 0.001). Predictors of comorbidities in CWE were treatment with sodium valproate and polytherapy. Conclusion Neurologic comorbidities are more frequent among CWE than controls; therefore, screening for neurologic comorbidities should be routine when assessing and managing CWE.