Neurology Service Research Articles

Characteristics of cerebral venous thrombosis in patients from two university hospitals in Colombia between 2018-2020

Describir las características clínicas, demográficas y radiológicas, y los factores de riesgo de una serie de pacientes con trombosis venosa cerebral de dos hospitales de Colombia. Materiales y métodos. Es un estudio descriptivo retrospectivo de pacientes hospitalizados, atendidos en el servicio de neurología de dos hospitales de Bogotá desde diciembre de 2018 hasta diciembre del 2020. Se incluyeron 33 pacientes. Las frecuencias más altas correspondieron a mujeres en edad fértil, en puerperio (n=7; 33,3 %) y pacientes con patologías autoinmunes (n=10; 30,3 %). El síntoma inicial más común fue la cefalea (n=31; 93,9 %), seguido de focalización neurológica (n=9; 27,2%) y crisis epiléptica (n=8; 24,2 %). El 51 % (n=17) de los pacientes tuvo un examen físico normal. El infarto venoso cerebral se presentó en el 21,1 % (n=7), la hemorragia subaracnoidea en el 12,1 % (n=4) y el hematoma intraparenquimatoso en el 9 % (n=3) del total de pacientes. El 60,6 % (n=20) quedó con nivel independiente en la escala funcional de Barthel. Ningún paciente falleció. Se encontraron características sociodemográficas, clínicas y radiológicas similares a lo reportado en la literatura mundial. Con respecto a las diferencias, se encontró en nuestro estudio compromiso de la circulación venosa cerebral profunda en un porcentaje ligeramente mayor a lo descrito, pero sin aumento de complicaciones, ni mortalidad.

The impact of headache disorders: a prospective analysis of headache referrals to outpatient and inpatient neurology and emergency services in an Irish University teaching hospital

BackgroundHeadache represents a significant proportion of disability globally in general practice, neurology outpatient settings, and emergency departments. There is scant literature regarding the impact of headache on healthcare services in Ireland.AimsWe aimed to investigate headache burden across the emergency department, inpatient stays, and neurology outpatient department referrals in an Irish University teaching hospital.MethodsWe prospectively collected data regarding emergency department presentations, inpatient neurology consultations, and neurology outpatient referrals for patients with headache between 13th January and 8th March 2020. Data were analyzed using descriptive statistics.ResultsThere were 180 emergency department attendances, 50 inpatient consultations, and 76 outpatient referrals with headache. Neurological examinations were often incomplete; neuroimaging was commonly employed. Migraine was the most frequent headache diagnosis at discharge in the emergency department and among inpatients after neurology review. Diagnostic uncertainty was identified—33% of patients left the emergency department with no diagnosis, and “unknown/unspecified headache” was recorded on 49% of outpatient referrals and 30% of inpatient consult requests. Medication overuse headache coexisted with migraine in nine patients in the inpatient group. Prophylaxis had been trialed in 56% of patients with migraine referred to outpatients.ConclusionsPrimary headache disorders have a large impact on hospital services. Diagnostic uncertainty is common; neuroimaging is relied upon. Appropriate care pathways, education, and resource allocation should be prioritized.

Improving Neurology Inpatient Fall Rate: Effect of a Collaborative Interdisciplinary Quality Improvement Initiative

ObjectiveTo reduce unwitnessed inpatient falls on the neurology services floor at an academic medical center by 20% over 15 months. Patients and MethodsA 9-item preintervention survey was administered to neurology nurses, resident physicians, and support staff. Based on survey data, interventions targeting fall prevention were implemented. Providers were educated during monthly in-person training sessions regarding the use of patient bed/chair alarms. Safety checklists were posted inside each patient’s room reminding staff to ensure that bed/chair alarms were on, call lights and personal items were within reach, and patients’ restroom needs were addressed. Preimplementation (January 1, 2020, to March 31, 2021) and postimplementation (April 1, 2021, to June 31, 2022) rates of falls in the neurology inpatient unit were recorded. Adult patients hospitalized in 4 other medical inpatient units not receiving the intervention served as a control group. ResultsRates of falls, unwitnessed falls, and falls with injury all decreased after intervention in the neurology unit, with rates of unwitnessed falls decreasing by 44% (2.74 unwitnessed falls per 1000 patient-days before intervention to 1.53 unwitnessed falls per 1000 patient-days after intervention; P=.04). Preintervention survey data revealed a need for education and reminders on inpatient fall prevention best practices given a lack of knowledge on how to operate fall prevention devices, driving the implemented intervention. All staff reported significant improvement in operating patient bed/chair alarms after intervention (P<.001). ConclusionA collaborative, multidisciplinary approach focusing on provider fall prevention education and staff checklists is a potential technique to reduce neurology inpatient fall rates.

Impact of the NIHSS scale in the Stroke Unit of the Ramón y Cajal University Hospital: A tool to improve the quality of care

IntroductionStroke is a time-dependent pathology which requires a rapid and universal neurological assessment tool. Since October 2021, following training of nursing staff, the NIHSS scale has been implemented in order to increase comparability, concordance and improve communication with the medical team. Objectives1. To examine the concordance among scores of the NIHSS scale implemented by nursing staff and medical team in Neurology Service of the Ramón y Cajal Hospital. 2. To describe the subjective perception of using the NIHSS scale from the nursing staff in the Neurology Service of the Ramón y Cajal Hospital. MethodCross-sectional observational study that included 100 patients distributed in two periods of three months each in the Stroke Unit of the Ramón y Cajal Hospital. The NIHSS scale scores given by nursing and neurology were collected, as well as the discordant items of each assessment. Statistical analyzes included frequencies, percentages, Cronbach's alpha and the Intraclass Correlation Coefficient. A survey was conducted among the 22 professionals to assess the degree of acceptance. ResultsA high concordance (68% and 70% in each period) was achieved between the nursing and neurology. A total of 94% of professionals reported to get used to the NIHSS scale. ConclusionsThe implementation of the NIHSS scale is a clear opportunity for improvement in the stroke unit, facilitating communication between nursing and neurology teams, due to agreement between scores and increasing quality of medical care.

Satisfacción del neurólogo y de los pacientes con diagnóstico de epilepsia en una consulta de seguimiento a través de telemedicina sincrónica en el Hospital San José de Arjona (Bolívar), 2014-2015

Introducción: la gran demanda de pacientes en servicios de consulta especializada de neurología y la poca oferta de profesionales entrenados y médicos especialistas, principalmente en zonas aisladas por circunstancias geográficas o políticas, nos obligan a buscar nuevos recursos como la telemedicina a fin de mejorar el tiempo de consulta.&#x0D; Objetivo: explorar el grado de satisfacción del neurólogo y de los pacientes con epilepsia en una consulta por telemedicina en el Hospital San José de Arjona con conexión al Hospital de San José en Bogotá.&#x0D; Materiales y métodos: estudio observacional prospectivo en pacientes mayores de 15 años con diagnóstico de epilepsia. Se diligenció el instrumento de evaluación de satisfacción del neurólogo y de los pacientes, que contiene una escala aplicada en Canadá, la cual consta de diecinueve preguntas, validadas en Colombia gracias a la prueba piloto realizada en el 2012 por nuestro Grupo de Neurología y Telemedicina, implementada para evaluar la satisfacción de los pacientes en la consulta de epilepsia por telemedicina. Además, este cuestionario está diseñado según una escala de Thurstone que consta de cinco alternativas de respuesta, las cuales en orden son: "muy en desacuerdo", "en desacuerdo", "neutral", "de acuerdo", "muy de acuerdo". El reclutamiento de los pacientes se hizo mediante carteles alusivos al estudio, uno a dos meses antes de la realización de este.&#x0D; Resultados: se valoraron 39 pacientes, de los cuales 51,3% eran mujeres, con una edad promedio 35 años DE ± 16. La satisfacción de los pacientes con la consulta de telemedicina se calificó "muy de acuerdo" en un 83,8%, el 91,9% ve la telemedicina como una vía aceptable para recibir atención en salud en y 94,6% considera que ahorra más dinero en comparación con la visita convencional. La satisfacción de dos neurólogos con la consulta de telemedicina se distribuye uniformemente entre "muy de acuerdo" y "de acuerdo".&#x0D; Conclusión: según los resultados de este estudio, podemos concluir que tanto los pacientes como los neurólogos que realizaron la consulta guiada por telemedicina están satisfechos con el uso de esta herramienta, siendo este método una alternativa para la atención en salud.

Network Analysis of Comorbid Depressive and Anxious Symptoms in Family Caregivers of People with Dementia

ABSTRACT Objectives The aim of this study is an in-depth approach to depressive-anxious comorbidity in caregivers according to stress reactivity to disruptive behaviors using network analysis. Methods The sample was composed of 317 primary family caregivers recruited through Day Care Centers and Neurology Services. The sample was split into low and high stress reactivity groups, based on their reports of reaction to disruptive behaviors. Depressive and anxious symptoms, daily hours dedicated to caregiving, time of caring, frequency of disruptive behaviors, co-residence, and kinship were also cross-sectionally measured. Results The sample had a mean age of 62.38 years (SD = 12.97) and 68.5% were women. Regarding the network analysis, while the low reactivity group presents a sparse network, with no connection between anxious and depressive symptoms, the high reactivity group shows a high connection of intra and intercategory symptoms, with apathy, sadness, feeling depressed, and tension being the bridge symptoms between disorders. Conclusions Caregivers’ stress reaction to disruptive behaviors might be a key factor for understanding comorbidity between depressive and anxious symptoms. Clinical implications Tension, apathy, sadness, and feeling depressed should be clinical targets in the interventions, as they act as bridge symptoms between anxious and depressive symptomatology.

Prevalence of End-of-Life Signs and Symptoms in Glioblastoma Patients: A Descriptive and Retrospective Study

Introduction: Glioblastoma is often associated with a poor prognosis. The end-of-life signs and symptoms of these people differ from the rest of the cancer population. Objective: To identify the main signs and symptoms present in the last seven days of life of patients with glioblastoma in a neurological oncology service. Methods: A descriptive and retrospective study was carried out. The sample included patients diagnosed with glioblastoma with medical and nursing records of the last seven days of life that were admitted to the Neurology service and admitted to the institution by the neuro-oncology consultation between 2019 and 2020. Data was collected from the medical records of the patients. Results: Medical records of 17 patients were selected for this study. The main signs and symptoms present in the last seven days of their lives were decreased level of consciousness (94%), rare and unexpected events (94%), respiratory dysfunction (88%), and loss of swallowing ability (76%). Conclusion: The objectives of this study were achieved. However, it is important to conduct studies in this population with more representative samples, since most literature is focused on the oncologic population in general.

Inpatient Neurology Deaths and Factors Associated With Discharge to Hospice.

The Neurology Mortality Review Committee at our institution identified variability in location of death for patients on our inpatient neurology services. Hospice may increase the number of patients dying in their preferred locations. This study aimed to characterize patients who die on inpatient neurology services and explore barriers to discharge to hospice. This retrospective study was completed at a single, quaternary care medical center that is a Level I Trauma Center and Comprehensive Stroke Center. Patients discharged by an inpatient neurology service between 6/2019-1/2021 were identified and electronic medical record review was performed on patients who died in the hospital and who were discharged to hospice. 69 inpatient deaths and 74 discharges to hospice occurred during the study period. Of the 69 deaths, 54 occurred following withdrawal of life sustaining treatment (WLST), of which 14 had a referral to hospice placed. There were 88 "hospice-referred" patients and 40 "hospice-eligible" patients. Hospice-referred patients were less likely to require the intensive care unit than hospice-eligible patients. Hospice-referred patients had their code status changed to Do Not Intubate earlier and were more likely to have advanced directives available. Our data highlight opportunities for further research to improve discharge to hospice including interhospital transfers, advanced directives, earlier goals of care discussions, palliative care consultations, and increased hospice bed availability. Importantly, it highlights the limitations of using in-hospital mortality as a quality indicator in this patient population.

Transition of Care in Adolescents with Epilepsy: Perspective of Pediatric Neurologists in India.

This cross-sectional study was designed to determine the current status of transition of care for adolescents with epilepsy to adult neurological services in India and to understand pediatric neurologists' perspectives. After approval from the appropriate Ethics Committee, a pre-designed questionnaire was distributed electronically. Twenty-seven pediatric neurologists from 11 cities across India responded. Pediatric care ended under 15 y for 55.4% responders and at 18 y in another 40.7%. Eighty nine percent introduced the concept of transition or had transition discussions with their patients and parents. Majority of providers did not have a formal plan for transferring the children with epilepsy to an adult neurologist, and very few had transition clinics. Communication with adult neurologists was also variable. Several pediatric neurologists followed patients after transfer for varying periods of time. This study demonstrates increasing awareness regarding the importance of transition of care in this population.

Frequency of non-generalized tonic clonic seizures in a referral population of dogs

Absence seizures are a type of generalized onset seizure associated in humans with brief activity interruptions, unresponsiveness and staring. Absence seizures are infrequently reported in veterinary patients, visually indistinguishable from focal seizures, and so may be grouped as non-generalized tonic clonic seizures (non-GTCS). The objective of this retrospective study was to provide a preliminary understanding of the frequency of non-GTCS in dogs and estimate its prevalence by evaluating the distribution of seizure types presented to a referral hospital over 4 years (May 2017-April 2021), as determined from the medical record history and electroencephalography (EEG) diagnostic testing where available. A total of 528 cases were included via a medical record search for dogs with epilepsy and/or seizures presented to the neurology or emergency services. Cases were categorized into seizure types based on reported clinical signs. Each year, 53–63 % of seizure cases were described as generalized tonic clonic seizures (GTCS), 9–15 % GTCS with additional events and 29–35 % suspected non-GTCS. EEG confirmed absence seizures in 12 of 44 EEGs, 5 cases having a history of GTCS and seven without prior GTCS. This preliminary study suggests that non-GTCS may be relatively common as one third of seizure cases in the referral population presented with non-GTCS clinical signs. Prospective studies using EEG are merited to definitively determine the prevalence of these different seizure types in dogs. Acknowledging the impact of these seizures will improve awareness, aiding veterinarians in their recognition, diagnosis and potential treatment options.

Impacto de la escala NIHSS en la Unidad de Ictus del Hospital Universitario Ramón y Cajal: una herramienta para mejorar la calidad asistencial

IntroductionStroke is a time-dependent pathology which requires a rapid and universal neurological assessment tool. Since October 2021, following training of nursing staff, the NIHSS scale has been implemented in order to increase comparability, concordance and improve communication with the medical team. Objectives1. To examine the concordance among scores of the NIHSS scale implemented by nursing staff and medical team in the Neurology Service of the Ramón y Cajal Hospital. 2. To describe the subjective perception of using the NIHSS scale from the nursing staff in the Neurology Service of the Ramón y Cajal Hospital. MethodCross-sectional observational study that included 100 patients distributed in two periods of three months each in the Stroke Unit of the Ramón y Cajal Hospital. The NIHSS scale scores given by nursing and neurology were collected, as well as the discordant items of each assessment. Statistical analyzes included frequencies, percentages, Cronbach's alpha and the Intraclass Correlation Coefficient. A survey was conducted among the 22 nursing professionals to assess the degree of acceptance. ResultsA high concordance (68% and 70% in each period) was achieved between the nursing and neurology scores. A total of 94% of professionals reported to get used to the NIHSS scale. ConclusionsThe implementation of the NIHSS scale is a clear opportunity for improvement in the stroke unit, facilitating communication between nursing and neurology teams, due to agreement between scores and increasing quality of medical care.

The Experiences of Mothers With BedboundChildren: Care Burden

This study was carried out to evaluate the problems experienced by mothers with bedridden children and to determine the effects of care burdens on mothers.The study was carried out on mothers who had a bedridden child who was in the Neurology Service between November 2016 and May 2017. The data were collected through a 19-question introductoryform and the caregiver burden scale developed by Zarit. The data were evaluated using a computer. In statistical analysis, t-test, analysis of variance and chi-square test were used in independent samples. A p-value less than 0.05 was considered statistically significant.The moderateage of 200 mothers participating in the study was found to be 30.8 ± 7.0 years, and themoderatecare burden score was found to be 35.1 ± 24.3, and it was evaluated as mild to moderate. It was found that the younger the mother's age and the age of the child cared for, the greater the burden of care, and the longer the duration of care, the higher the burden of care. Being widowed, having a job and not having social security are factors that increase the burden of care. The effect of all these variables on burden of care was not statistically significant. The main problems that mothers experience while providing care are psychological problems and musculoskeletal problems.In order to minimize the burden of care for mothers withbedridden children, other family members should be included in the care, and parents should be supported psychologically.

Management of vagus nerve simulation therapy in the peri-operative period: Guidelines from the Association of Anaesthetists: Guidelines from the Association of Anaesthetists.

Vagus nerve stimulation is a well-established treatment option for patients with drug-resistant epilepsy and has an expanding range of other clinical indications. Side effects of vagus nerve stimulation therapy include: cough; voice changes; vocal cord adduction; rarely, obstructive sleep apnoea; and arrhythmia. Patients with implanted vagus nerve stimulation devices may present for unrelated surgery and critical care to clinicians who are unfamiliar with their function and safe management. These guidelines have been formulated by multidisciplinary consensus based on case reports, case series and expert opinion to support clinicians in the management of patients with these devices. The aim is to provide specific guidance on the management of vagus nerve stimulation devices in the following scenarios: the peri-operative period; peripartum period; during critical illness; and in the MRI suite. Patients should be aware of the importance of carrying their personal vagus nerve stimulation device magnet with them at all times to facilitate urgent device deactivation if necessary. We advise that it is generally safer to formally deactivate vagus nerve stimulation devices before general and spinal anaesthesia. During periods of critical illness associated with haemodynamic instability, we also advise cessation of vagus nerve stimulation and early consultation with neurology services.

Fetal Neurology Practice Survey (P10-9.001)

<h3>Objective:</h3> To study the fetal neurology care delivery across centers in the US. <h3>Background:</h3> Fetal neurology is a rapidly evolving subspecialty that centers on the diagnosis and treatment of neurologic conditions of the developing brain. Innovations in fetal diagnostic tools and therapies have resulted in an increased need for specialized training. Prenatal diagnostic input with postnatal continuity of care can better address sequelae including developmental, behavioral, epileptic and mental health disorders. Despite the growing need for fetal neurology services, little is known about the current practice. <h3>Design/Methods:</h3> The Fetal Neurology Consortium (representatives from 9 sites across the US) distributed a survey characterizing fetal neurologic care delivery to practicing child neurologists using a Redcap database posted to the Child Neurology Society member website in November 2021 and March 2022. The results were summarized using descriptive statistics. <h3>Results:</h3> Representatives from 43 US institutions responded. Most centers had a fetal diagnostic center (n=38/43, 88%), with about half using a fetal neurology registry. Most performed fetal ultrasound and MRI on site. The annual fetal consultations ranged between &lt;20 for 40% to &gt;100 for 17%. About 50% of respondents were subspecialty trained. Earliest gestational age of fetal MRI was 16–19 weeks in 30% and 20–23 weeks in 30%. 25% of respondents participated in interdisciplinary consultations. Majority of the respondents followed neurodevelopment clinically. 91% were interested in participating in a collaborative national registry. The top-five priorities ranked by respondents were clinical guidelines, long-term follow-up data, imaging, practice improvement and prenatal counseling technique. <h3>Conclusions:</h3> This survey highlights heterogeneity in fetal neurology practice, lack of standardization, and high demand for practice guidelines and education. Interdisciplinary collaborations will be crucial for relevant curriculum and program development, including increasing attention to healthcare disparities. This synergy among different disciplines will improve outcomes and may reduce the burden of neurological diseases with fetal origins across the lifespan. <b>Disclosure:</b> Dr. Tarui has nothing to disclose. Dr. Venkatesan has nothing to disclose. Dr. Gano has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Clifford Law Offices. The institution of Dr. Gano has received research support from Cerebral Palsy Alliance Research Foundation. Dr. Lemmon has received research support from NINDS. Dr. Lemmon has received research support from BAND foundation. Dr. Lemmon has received research support from Doris Duke Charitable Foundation. The institution of Dr. Mulkey has received research support from Thrasher Research Fund. The institution of Dr. Mulkey has received research support from Centers of Disease Control. The institution of Dr. Mulkey has received research support from National Institutes of Health. The institution of Dr. Pardo has received research support from UCB Biosciences. The institution of Dr. Pardo has received research support from The Patrick G. and Shirley W. Ryan Foundation . The institution of Dr. Pardo has received research support from NINDS- Stroke Trials Network. The institution of Dr. Pardo has received research support from NINDS-I-ACQUIRE. The institution of Dr. Pardo has received research support from NINDS- VIPS-II. Dr. Emrick has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Arkema. The institution of Dr. Emrick has received research support from Lysogene. The institution of Dr. Emrick has received research support from PTC. The institution of Dr. Emrick has received research support from Roche. The institution of Dr. Emrick has received research support from NIH. Dr. Scher has nothing to disclose. Dr. Agarwal has nothing to disclose.

The Completion of a PGY-1 Neurology Bootcamp Leads to Increased Trainee Knowledge and Confidence in Neurologic Emergencies Management and Procedural Skills (P2-2.001)

<h3>Objective:</h3> To evaluate the impact of an end-of-the-year, post-graduate year 1 (PGY-1) simulation-based neurology bootcamp on trainee knowledge, self-confidence, and skill independence regarding acute neurologic emergencies management and bedside procedural skills. <h3>Background:</h3> The post-graduate year 2 (PGY-2) neurology resident is often the first line of triage for evaluation of acute neurologic deterioration on the inpatient neurology service, requiring autonomy and responsibility. We implemented and evaluated a bootcamp prior to this critical training period. <h3>Design/Methods:</h3> In this prospective cohort study, 14 rising PGY-2 neurology residents attended a two-day bootcamp with a simulation-based curriculum led by neurology faculty practicing cerebrovascular, critical care, and inpatient neurology medicine. Pre- and postbootcamp, trainees completed multiple-choice knowledge assessments and via Likert scales, self-reported confidence in managing neurologic emergencies. Faculty observed and rated trainee ability to independently perform five neurologic procedures (lumbar puncture, external ventricular drain [EVD] management, botulinum toxin injection for migraine, digital fundoscopy, and pupillometry), with residents additionally reporting their own perceived degree of independence. <h3>Results:</h3> Proportion of trainees demonstrating independence per faculty rating significantly increased for all five procedural skills post-bootcamp (for all, p &lt; .05). Trainee self-reported independence of EVD management, pupillometry, and fundoscopy skills also increased postbootcamp (for all, p &lt; .05), with &lt; 25% of trainees reporting total independence pre-bootcamp to 50%, 86%, and 79% post-bootcamp, respectively. Knowledge assessment scores increased from a pre-bootcamp mean of 54% of questions correct to mean 70% correct (p = 0.002), driven by increases in vascular neurologic emergency and procedural knowledge. On a 5-point Likert scale, trainee self-reported confidence in emergency management increased from median 2.5 (a little confident) to median 4 (fairly confident) (p &lt; .001) <h3>Conclusions:</h3> A simulation-based, two-day bootcamp with focus on acute cerebrovascular neurologic emergencies and neurologic procedural skills showed significant improvements in trainee knowledge along with faculty-observed and self-reported confidence and independence. <b>Disclosure:</b> An immediate family member of Dr. Swetlik has received personal compensation for serving as an employee of Pfizer. Dr. Buletko has nothing to disclose. Dr. Marquardt has nothing to disclose. Dr. Higgins has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Organon. Ms. Hassett has nothing to disclose.

Preclinical Neuroscience Education: Planting the Seed for a Career in Neurology (P11-2.006)

<h3>Objective:</h3> The objective is to share experiences and tools from a reformed neuroscience curriculum that fosters a positive message about neurology as a career choice. <h3>Background:</h3> A shortage of neurologists in the United States (US) is an exponential threat to providing neurologic services to a diverse population that transcends life from childhood to aging adulthood. Dall and colleagues reported a 19% reduction of practicing neurologists in the US is projected by 2025.¹ In 2021, only 1.9% of US senior medical students were matched into residency positions in adult neurology and 0.5% in child neurology.² Efforts aimed at planting seeds of inspiration and mitigating “neurophobia” in medical students in their pre-clerkship phase should be an intentional strategy to attract the next generation to neurology. <h3>Design/Methods:</h3> The design is the neuroscience education model. The University of Toledo College of Medicine and Life Sciences implemented a reformed MD curriculum in 2017. The architecture of the model interweaves the basic and clinical sciences to create a story that goes beyond content delivery but includes faculty reflections, student interest groups in neurology, early clinical experience, and a framework of messaging that defines the hidden curriculum from the practicing neurologist. <h3>Results:</h3> Five years into our persistent continuous quality improvement process, we are now seeing an outcome that showed 7.9% of our graduating students (14/176 students) matched in neurology, including child neurology in 2021. <h3>Conclusions:</h3> The college has a required 4-week neurology clerkship rotation that has consistently rated the highest in student satisfaction (&gt;90%) compared to all other clinical experiences. In preclinical education, there is a competition for what deserves time in an already busy four-year MD experience. We developed a model that would not only teach the basic tenets of neurologic science but observed interest in neurology spike to a level not previously observed. <b>Disclosure:</b> Dr. Laukka has nothing to disclose. Dr. Rashid has nothing to disclose.

The Gomez-Lopez-Hernandez Syndrome: the contribution of two Hispanic giants of Pediatric Neurology. (P4-3.004)

<h3>Objective:</h3> Detail the history of the Gomez-Lopez-Hernandez syndrome (GLHS) which highlights the contribution of two giants of Pediatric Neurology of Hispanic Origin. <h3>Background:</h3> GLHS also known as cerebello-trigeminal dermal dysplasia, is a rare neurocutaneous condition of variable phenotype which was first described by two Hispanic renowned pediatric neurologists: Drs. Manuel Gomez and Arturo Lopez-Hernandez. GLHS is characterized by rhombencephalosynapsis, alopecia, and trigeminal anesthesia. Dr. Gomez of Spanish-Cuban origin is known for his long tenure as former head of Pediatric Neurology, Mayo Clinic, founder of the Child Neurology Society and his strong interest in the phakomatoses. His index GLHS case was of a 4.5-year-old girl with absent corneal reflexes, alopecia, delayed motor function, and bilateral facial analgesia [1979]. Gomez postulated that arrest of the neuroectoderm development resulted in the abnormal trigeminal innervation. Dr. Lopez-Hernandez is one of the fathers of Pediatric Neurology in Mexico having established the first pediatric neurology service at the National Institute of Pediatrics and later serving as its first head of the Neurology Department. In 1982 Lopez-Hernandez reported two unrelated girls with craniosynostosis, ataxia, trigeminal anesthesia and parietal alopecia associated with pons-vermis fusion. The GLHS eponym was first used in the literature in 1997. To date there are nearly 60 cases reported. The phenotype has been expanded to include short stature, craniofacial anomalies, growth hormone deficiency, hydrocephalus, and neuropsychiatric symptoms. No genetic cause has been identified. <h3>Design/Methods:</h3> Not applicable <h3>Results:</h3> Not applicable <h3>Conclusions:</h3> The specialty of Pediatric Neurology emerged during the 20^th century. During this period, many neurologists played significant roles in revolutionizing this field. The Gomez-Lopez-Hernandez syndrome serves to highlight the contributions of two notable giants of pediatric neurology of Hispanic origin, at a time when there was limited representation of minorities in the medical profession. <b>Disclosure:</b> Ms. Liang has nothing to disclose. Dr. Viereck has nothing to disclose. The institution of Dr. Liow has received research support from UCB. The institution of Dr. Liow has received research support from Livanova. The institution of Dr. Liow has received research support from Biogen. The institution of Dr. Liow has received research support from Novartis. The institution of Dr. Liow has received research support from Eisai. The institution of Dr. Liow has received research support from Engage Therapeutics. The institution of Dr. Liow has received research support from SK Lifescience. The institution of Dr. Liow has received research support from Cerevel. The institution of Dr. Liow has received research support from Xenon. The institution of Dr. Liow has received research support from NeuroDerm. The institution of Dr. Liow has received research support from Avanir. The institution of Dr. Liow has received research support from Annovis. The institution of Dr. Liow has received research support from Acadia. Enrique Carrazana has received personal compensation for serving as an employee of Neurelis. Enrique Carrazana has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Neurelis, Alexza, Zogenix. Enrique Carrazana has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Hawaii-Biotech, CND Life Sciences. Enrique Carrazana has stock in Neurelis, Marinus, .

Baló’s concentric sclerosis in the pediatric population: literature review and analysis of clinical cases in the context of follow up observation

Baló’s concentric sclerosis is a rare variant of atypical pseudotumor demyelination, having a pathogenetic similarity with multiple sclerosis and a characteristic neuroimaging pattern with relative clinical heterogeneity. In children and adolescents, Baló’s concentric sclerosis even rarer than in adults, is represented in the scientific literature by single descriptions of clinical cases with a polymorphic clinical phenotype and various anamnestic prerequisites (for example, infectious). Moreover, the published cases do not involve the analysis of a long-term clinical following up in children and adolescents with this pathology, possibly due to their transition to adult neurological services as they grow up. This sample does not allow the analysis of cases of Baló’s concentric sclerosis with pediatric debuts and answer questions about the clinical features and therapeutic needs for such patients. Especially a lot of questions have accumulated concerning approaches to the treatment of patients with the classical, mono-focal form of Baló’s concentric sclerosis. The lack of scientific and clinical information hinders the adoption of administrative decisions on prescribing drugs from the PITRS group (drugs that change the course of multiple sclerosis) to such patients. &#x0D; To replenish the literature base of pediatric cases of Baló’s concentric sclerosis, we analyzed the Russian experience of long-term (from 2 to 6 years) curation of three juvenile patients with acute non-infectious demyelinating episode and monofocal concentric lesion of the white matter of the brain. Russian data demonstrate the long-term efficacy and tolerability of drugs from the PITRS group among pediatric patients with Baló’s concentric sclerosis.

Sleep in multiple sclerosis and neuromyelitis optica spectrum disorder-the SEMN study.

This study aimed to (1) evaluate in patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) the presence of sleep disorders such as hypersomnia, fatigue, risk of apnea, and the presence of restless legs syndrome/Willis-Ekbom disease (RLS/WED); (2) evaluate quality of sleep in patients with MS and NMOSD; and (3) correlate them with clinical and imaging data. The study was cross-sectional and was carried out in the sector of demyelinating diseases of the neurology service of HUGV-UFAM, Manaus, Brazil, from January 2017 to December 2020. Our sample consisted of 60 patients, 41 with MS and 19 with NMOSD. We found that patients with MS and NMOSD have poor sleep quality (65%) and hypersomnia (53% in MS; 47% in NMOSD), but low risk of apnea by STOP-BANG. The frequency of RLS/WE found was 14% in MS, and 5% in NMOSD. No correlation existed between sleep quality, number of relapses, and sleep quality for the Expanded Disability Status Scale (EDSS), i.e., fatigue/illness duration. Patients with MS and NMOSD have poor sleep quality, excessive sleepiness, and are at low risk for OSA, yet the frequency of RLS/WED is like that of the general population. There does not seem to be a significant difference between these sleep disorders in these demyelinating diseases of the CNS.

Mortality risk in adults with intellectual disabilities and epilepsy: an England and Wales case-control study.

People with epilepsy (PWE) and people with intellectual disabilities (ID) both live shorter lives than the general population and both conditions increase the risk of death further. We aimed to measure associations between certain risk factors for death in PWE and ID. A retrospective case-control study was conducted in ten regions in England and Wales. Data were collected on PWE registered with secondary care ID and neurology services between 2017 and 2021. Prevalence rates of neurodevelopmental, psychiatric and medical diagnoses, seizure frequency, psychotropic and antiseizure medications (ASM) prescribed, and health activity (epilepsy reviews/risk assessments/care plans/compliance etc.) recorded were compared between the two groups. 190 PWE and ID who died were compared with 910 living controls. People who died were less likely to have had an epilepsy risk assessment but had a greater prevalence of genetic conditions, older age, poor physical health, generalized tonic-clonic seizures, polypharmacy (not ASMs) and antipsychotic use. The multivariable logistic regression for risk of epilepsy-related death identified that age over 50, medical condition prevalence, antipsychotic medication use and the lack of an epilepsy review in the last 12months as associated with increased risk of death. Reviews by psychiatrists in ID services was associated with a 72% reduction in the odds of death compared neurology services. Polypharmacy and use of antipsychotics may be associated with death but not ASMs. Greater and closer monitoring by creating capable health communities may reduce the risk of death. ID services maybe more likely to provide this holistic approach.