Neurological Unit Research Articles

Evaluating the current practice of therapeutic positioning in neurological rehabilitation: a qualitative interview study

Background/Aims Therapeutic positioning is believed to enable the achievement of a good postural alignment, optimise rehabilitation and prevent the complications of immobility. It is considered important in the management of people with physical neurological impairments, but achieving a favourable position in a bed can be challenging. There is little evidence to inform present practice. Therefore, this study explored staff views and experiences of bed positioning practice on a regional neurological rehabilitation unit. Methods Face-to-face, semi-structured interviews were completed with a purposive sample of nurses, physiotherapists and occupational therapists working on a neurological rehabilitation unit. The interviews were audio recorded, transcribed and analysed using inductive thematic analysis. Results A total of 12 participants completed an interview and six themes were identified relating to positioning practice. An interaction of four of these themes (patient needs, staff role, communication and knowledge) influenced a fifth theme of staff experiences. The sixth theme of practical positioning resources identified a pattern of resource use within current practice. Conclusions Positioning was recognised as integral to rehabilitation, and staff experiences were influenced by the interaction of a range of factors. The participants’ views and experiences around practical positioning resources provide a valuable new insight into positioning practice. Further research is needed to evaluate these resources.

Assessment of COVID-19 lockdown effect on early Alzheimer Disease progression.

Recently, many aspects of daily life have changed due to the COVID-19 pandemic. Patients with Alzheimer Disease (AD) could be more vulnerable to those daily life changes as experts expected. Mainly, the lockdown involved reduced social contact and cognitive stimulation. So, it could affect the AD expression, increasing the patients' disabilities development. The aim of this study is to evaluate the effect of COVID-19 lockdown on cognitive impairment progression in early AD patients. The participants were patients with mild cognitive impairment due to AD (MCI-AD) from the Neurology Unit (La Fe Hospital), who were neuropsychologically evaluated (cognitive impairment, daily activity tests) twice over 2 years. They were classified into a case group (n = 21), evaluated before and after lockdown condition, and a control group (n = 20), evaluated entirely before the lockdown condition. All the participants showed increasing cognitive impairment and functional deterioration over the 2-year period of evaluation (p < 0.05). However, a faster worsening was not observed as a consequence of the COVID-19 pandemic and the lockdown condition. In fact, the statistical significance observed between the two study groups for daily life activities showed that the worsening was even lesser in the group evaluated under the lockdown condition. Medium-term effects of COVID-19 lockdown could not involve an acceleration of the cognitive decline in MCI-AD patients in a 2-year evaluation period. In addition, the least worsening observed for daily living activities in the case group was probably due to the change in routines. Therefore, the common assumption of cognitive worsening of AD progression due to the lockdown in comparison with normal disease progression was not demonstrated in this study, at least for MCI-AD cases. However, more longitudinal studies are required to evaluate long-term effects in these patients.

Admission Lipid Profile and Discharge Outcome in Ischemic and Hemorrhagic Stroke

Background: Changes in the lipid profile have been suggested as a risk factor for developing ischemic stroke. Their role in hemorrhagic stroke is not clear. The study aimed to evaluate the lipid profile levels and discharge outcomes of patients who were admitted to a tertiary hospital in Bangladesh and also to determine the difference in the lipid profile of patients with ischemic and hemorrhagic stroke.&#x0D; Materials and methods: This retrospective analytical study included 65 hospitalized stroke patients from the Neurology Unit of Chittagong Medical College Hospital. Data regarding age, sex, risk factors of stroke, lipid profile [Total Cholesterol (TC) Triglyceride (TG) Low-Density Lipoprotein cholesterol (LDL-C), and High-Density Lipoprotein Cholesterol (HDL-C)] levels, and discharged outcomes [Favourablemodified Rankin Scale (mRS)score £2 and unfavourable-mRS &gt;2] were extracted from the register and compared between ischemic and hemorrhagic stroke patients.&#x0D; Results: Out of 65 patients, 55 (84.6%) had ischemic and 10 (15.4%) had hemorrhagic stroke. Hypertension (67.7%), smoking (50%), diabetes (40%), and family history of stroke (38.5%) were common risk factors. The most common lipid abnormality was high LDL-C (86.2%), followed by low HDL-C (63.1%), high TG (47.7%), and high TC (35.4%). There was no difference in the lipid profile ofischemic and hemorrhagic stroke patients. Forty-seven (72.3%) patients were in poor functional status during discharge and discharged outcome was not associated with admission lipid profile. Compared to patients with unfavorable outcomes, patients with favorable outcomes at discharge were significantly younger, had shorter durations of hospitalization, had lower mRS scores at admission.&#x0D; Conclusion: Dyslipidemia in the form of high LDL-C and low HDL-C were common in stroke patients be it infarct or hemorrhage. There was no difference in the lipid profile of the two categories of stroke.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.22 (1); January 2023; Page 23-27

A Clinical Pharmacist-led Approach on Reducing Drug Related Problems Among Patients with Neurological Disorders: An Interventional Study

BackgroundNeurological disorders are common in the general population and the majority of patients have other chronic diseases, necessitating the use of multiple medications, which increases the incidence of drug-related problems (DRPs). Studies from different countries discovered an average of 0.29–1.45 DRPs per patient admitted into the neurology unit. ObjectivesTo identify common DRPs and to evaluate the impact of clinical pharmacist's interventions in resolving the identified DRPs in patients with neurological disorders. MethodsA prospective interventional study was conducted in the Department of Neurology in a tertiary care teaching hospital in Southern India, for a period of six months. Patients aged ≥18 years and had been hospitalized for >24 h, were intensively monitored until discharge for the occurrence of any DRPs and pharmacist interventions were provided. The identified DRPs were classified according to Hepler and Strand's Classification. ResultsA total of 310 prescriptions were reviewed, of which 174 patients (mean age 45.93 ± 2.49 years) experienced at least one DRP during their hospital stay. The average DRP per patient was found to be 1.75, with drug-drug interactions [254 (83%)] being the predominant DRPs, followed by adverse drug reactions [13 (4%)], and drug duplications [9 (3%)]. Most of the drug-drug interactions were pharmacokinetic [144 (56.69%)]. Hyponatremia [2 (15%)]; and nausea and vomiting [2 (15%)] were most commonly reported ADRs. All 306 DRPs involved active clinical pharmacist intervention, of which [275 (89.87%)] of pharmacists' interventions were accepted, which led to modification of the therapy. ConclusionMonitoring the use of drugs allowed the clinical pharmacist to detect DRPs and to suggest interventions that promote rational drug prescribing, therapy optimization and enhanced patient safety.

Mitigating impact of neurological rehabilitation unit decommissioning

Most inpatient rehabilitation services enjoy deep connections with their local communities. Therefore, decommissioning services often results in resentment and risks, which are shared by patients, clinicians and communities the unit serves. In this comment article, we discuss our experience dealing with the closure of a popular local neurological rehabilitation unit and how we tried not just to safeguard our patients but also to take the opportunity to further develop and improve our patients’ experience.

Healthcare worker burnout during the first COVID-19 lockdown in Italy: experiences from an intensive neurological rehabilitation unit.

The study aim was to investigate the prevalence of behavioral symptoms and burnout in healthcare workers in an intensive neurological rehabilitation unit in Messina, Italy, during the first COVID-19 lockdown in Italy. Forty-seven healthcare workers (including neurologists, physiatrists, nurses and rehabilitation therapists) were enrolled in this cross-sectional study from February 2020 to June 2020. Participants were administered the following psychometric tests to investigate burnout and related symptoms: the Maslach Burnout Inventory, which measures emotional exhaustion, depersonalization and reduced personal accomplishment; the Zung Self-Rating Depression Scale (SDS); the Pre-Sleep Arousal Scale (PSAS); the Dyadic Adjustment Scale; and the Buss-Perry Aggression Questionnaire (BPAQ). We found several correlations between test scores and burnout subdimensions. Emotional exhaustion was correlated with SDS (r = 0.67), PSAS-Cognitive (r = 0.67) and PSAS-Somatic (r = 0.70) scores, and moderately correlated with all BPAQ dimensions (r = 0.42). Depersonalization was moderately correlated with SDS (r = 0.54), PSAS-Cognitive (r = 0.53) and PSAS-Somatic (r = 0.50) scores. During the first COVID-19 lockdown in Italy, healthcare workers were more exposed to physical and mental exhaustion and burnout. Research evaluating organizational and system-level interventions to promote psychological well-being at work for healthcare workers are needed.

Bilateral Blindness as an Initial Finding of Occipital Lobes Meningioma Metastated from Lung Cancer

Introduction: Meningioma may increase intracranial pressure (ICP) and cause papilledema, which results bilateral blindness. Since elevated ICP is thought to be caused by an underlying condition, immediate neuroimaging is required to look into the possibility of papilledema. Patients with intracranial tumour sometimes being consulted to ophthalmologist with ocular problems as their complaint. The purpose of this report is to describe a case of papilledema as an initial finding of occipital lobes intracranial tumor metastated from lung cancer. Case presentation: A female, 50-year-old patient being consulted from the ward with chief complaint bilateral visual loss gradually worsening in the last three months. Further history taking revealed other symptoms including relapsing headache since a year ago. Patient also came to the ophthalmologist a year ago and get examinated because of the headache and the examination result is only refraction disorder. Patient had decrease of consciousness and started coughing with massive sputum production since a week ago before she is admitted to the hospital. Patient was undergone Lung CT scan, a large mass was found in left lung, then she is diagnosed with lung cancer. Before that she never have any complaints about shortness of breath and chronic cough. The visual acuity on both eyes were already no light perception at the initial visit. Anterior segment was calm but the pupil was mid dilatation with no light reflexes. Fundus examination revealed papilledema, the optic nerve heads edges was blurred. Intraocular pressures were 12 mmHg. A MRI was performed 3 months before the patient got admitted to the hospital and revealed a massive solid mass in the left occipital lobe (approx AP 4 x LL 5 x CC 5.5 cm). Radiological reading suggested a meningioma. The patient was immediately referred to pulmonologist, neurologist, together with surgical neurology unit. Conclusion: A patient with slow growing intracranial tumour may come quite late to seek medical attention since the symptoms are very mild and bearable. When being consulted, the visual acuity is already no light perception. Ophthalmologist must be aware and consider the metastases of lung cancer into intracranial tumour as a cause of visual loss and therefore not to delay its management.

A 5-Year Study of Antiseizure Medications (ASMs) Monitoring in Patients with Neuropsychiatric Disorders in an Italian Clinical Center.

Despite receiving appropriate antiseizure medications (ASMs), a relevant percentage of neuropsychiatric patients do not benefit from this approach, and one reason is subtherapeutic ASMs plasma concentration (C(p)) due to improper drug adherence, interindividual pharmacokinetic differences, or metabolic interactions among different drugs. For these reasons, therapeutic drug monitoring (TDM) by measuring ASMs C(p) is an effective tool that improves pharmacological therapies in clinical practice. Based on these premises, in the present real-world study, we analyzed the C(p) of the most used ASMs in diverse medical conditions, which were assayed during the years 2018-2022 at the University Hospital of Pisa, including about 24,000 samples. This population was largely heterogeneous, and our database did not contain clinical information about the patients. The most used ASMs were Valproate (VPA: 54.5%) and Levetiracetam (LEV: 18.6%), followed by Oxcarbazepine (OxCBZ: 8.3%) and Carbamazepine (CBZ: 7.2%), whereas the associations LEV/VPA, Ethosuximide (ESM)/VPA, and CBZ/VPA were the most frequently proposed. In about 2/3 of assays, ASMs C(p) was in range, except for VPA, which was underdosed in almost half of the samples. Importantly, toxic levels of ASMs C(p) were found very rarely. For VPA, there was a decrease of mean C(p) across ages, from adolescents to older patients, while the C(p) of LEV, CBZ, OxCBZ, and Topiramate (TPM) showed a slight tendency to increase. When we compared females and males, we found that for VPA, the average age was higher for females, whereas women taking Lamotrigine (LTG) and OxCBZ were younger than men. Then, comparing ASMs used in neurologic and psychiatric disorders, based on the request form, it emerged that the mean C(p) of CBZ, OxCBZ, and LTG on samples collected in the Psychiatric Unit was lower compared to the Neurology and Child Neuropsychiatry Units. Finally, the ASMs subjected to multiple dosing starting from an initial subtherapeutic C(p) increased their level at different time points within a year, reaching the reference range for some of them. In conclusion, the present study suggests that TDM is widely applied to monitor ASMs C(p), finding many of them within the reference range, as a demonstration of its utility in clinical practice.

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.

Outcome of patients older than 85 years hospitalized in a neurology unit

BackgroundAdvanced age is a major determinant of mortality and poor outcome at any level. In hospitalized patients, advanced age is a major issue in terms of prognosis, resource use, and therapeutic choices.AimsWe aimed at assessing the 1 year outcome of elderly patients admitted to a neurology unit for various acute conditions.MethodsConsecutive patients admitted to a neurology unit were enrolled and followed-up at 3, 6, and 12 months with structured phone interviews gathering information about mortality, disability, hospital readmissions, and place of residency. Inclusion criteria were age ≥ 85 years, availability of written consent and phone contact; no exclusion criteria were applied.ResultsOver a period of 16 months, 131 patients (88.8 ± 3.3, 92 females, 39 males) were admitted. The pre-hospitalization modified Rankin Scale (mRS) median (IQR) score, obtainable in 125 patients, was 2 (0, 3) and > 3 in 28/125 (22.4%) patients. Fifty-eight (46.8%) patients had pre-existing dementia (this information was missing for one patient). Eleven patients died during hospitalization. Of the 120 discharged patients, 60 (50%) were alive at 12 months, 41 died during follow-up (34.2%), and 19 (15.8%) were lost. At 12 months, out of the 60 alive patients, 29 (48.3%) had a mRS > 3. We did not detect predictors of 12-month survival. Predictors of 12-month worsening of functional status were pre-hospitalization mRS, pre-existing cognitive impairment, and male sex.ConclusionsOne-year mortality of elderly patients admitted to a neurology unit is extremely high. After one year, less than one fourth of elderly patients hospitalised for an acute neurological disease are left with only no-to-moderate disability.

Brain linear measurements for differentiating normal pressure hydrocephalus from Alzheimer's disease: an exploratory study.

Easy and reliable tools for the differential diagnosis between idiopathic normal pressure hydrocephalus (iNPH) and Alzheimer's disease (AD) are needed. In this cross-sectional study iNPH and AD patients referred to the Neurology Unit of the University of Catania from 1 January 2020 to 1 December 2022 were enrolled. The following brain linear measurements (BLMs) were calculated: Evan's index (EI), the parieto-occipital ratio (POR) and the temporal ratio (TR). For each index, sensitivity, specificity and the area under the curve (AUC) were calculated. Moreover, a cumulative index, the BLM index, was also considered. Fifty patients (25 iNPH and 25 AD) were enrolled. In differentiating iNPH from AD, EI had the highest AUC (0.956), POR had the highest specificity (100%) whilst TR had the highest sensitivity (92%). The BLM index differentiated iNPH and AD with a sensitivity of 96%, a specificity of 92% and an AUC of 0.963 with an optimal cut-off value of 0.303. Evan's index, POR and TR may be useful in the differential diagnosis between iNPH and AD. At an individual level, the BLM index represents a valid and reliable tool to achieve an accurate differentiation between these two conditions.

A Case Report of Limb Dystonia Management in a Nigerian Hospital: Physiotherapy Perspective

Background: Dystonia is a common movement disorder characterized by abnormal postures of the affected body part. The disabilities associated with dystonia are socially disabling and disfiguring, ranging from pain, loss of muscle strength and activities of daily living, poor quality of sleep and even depression. This article presents a case report of physiotherapy approach in the management of a patient with limb dystonia with major focus on pain management, balance control and functional independence. Case Presentation and Treatment Outcome: A case report of the management of a 48-year old female patient with limb dystonia. Patient was referred from the neurology unit, department of Internal Medicine, University of Port Harcourt Teaching Hospital (UPTH) to the neurology unit of the physiotherapy department, UPTH as a case of lower limb dystonia with an unknown cause. Appropriate physiotherapy intervention was given for a period of 12 weeks after a thorough assessment of the patient. The Numerical Pain Rating Scale (NPRS) was used to assess the level of pain in the affect limbs. The Berge Balance Scale (BBS) was used to assess the patient’s balance while Barthel Index (BI) was used to assess the functional independence of the patient. The case report was presented in line with CAse REport (CARE) guideline for case reports. All ethical procedures were followed. Treatment Outcome revealed that the score on Berg Balance Scale increased from 25 to 45 while that of Barthel Index scale increased from 13 to 18 after 12 weeks of intervention. Pain level on Range of Motion (ROM) based on the Numerical Pain Rating Scale (NPRS) reduced from 4/10 to 0/10 on the upper limb and from 9/10 to 1/10 on the lower limbs. Conclusion: Physiotherapy is effective in the management limb dystonia. Early referral to Physiotherapy is key to pain management, balance control and overall functional independence of the patients.

0916 Q4 no More: Optimizing Clincial Decision Support to Decrease Inpatient Sleep Disruptions

Abstract Introduction Orders such as vital signs (VS) and neurological checks (NC) contain frequency options to help clinicians align workflows with patient needs. However, these clinical decision support (CDS) systems often default to around-the-clock, and clinicians may over-accept around-the-clock, leading to unnecessary sleep disruptions. Methods We added two radio buttons to VS/NC orders: q4 hour while awake (q4WA) and TID while awake (TIDWA). We gave presentations on CDS to inpatient neurology unit (INU) residents and staff pre-intervention. We sent reminders to INU residents to review and modify (when appropriate) around-the-clock orders via secure chat. We defined the pre-intervention period as six months before and the post-intervention period as six months following. Order frequencies and NC/VS performed from 11 pm–7 am were obtained via EHR. Pre- and post-intervention data were analyzed using interrupted time-series analysis (ITSA). Results Post-intervention, there was a significant decrease in q4 order frequencies (VS 15% and NC 17%,p&amp;lt; 0.001) across the institution. Subgroup analysis of the INU revealed more significant reductions in q4 frequencies (VS 54% and NC 48%, p&amp;lt; 0.001). Sleep-friendly orders significantly increased for VS and NC (0% to 6.7%, 0% to 7.8%). Sub-group analysis of the INU was again more profound, with sleep-friendly orders increasing from 0% to 16% for both VS and NC. Additionally, overnight VS and NC performed decreased by 11% and 17% post-intervention (p&amp;lt; 0.001) at the institution, with a further reduction in the INU (45% and 35% decrease for VS and NC, p&amp;lt; 0.001). The case-mix index was appropriately lower in the population with while awake orders (1.2749) versus around-the-clock orders (2.2684) Conclusion CDS modifications significantly increased sleep-friendly orders while reducing around-the-clock order frequencies and NC/VS completed overnight. These results were more profound on the INU, indicating that a combination of CDS changes, education, and chat reminders demonstrated a higher impact than CDS changes alone. Support (if any)

Psychological experiences of patients recovering from severe COVID-19 in rehabilitation: A qualitative study.

The aim of this study was to describe the experiences of post-sedation COVID-19 patients in rehabilitation. Eleven Israeli men and women were interviewed in semi-structured interviews. They were patients recovering in a neurological rehabilitation unit from severe COVID-19 post-mechanical ventilation and sedation. Five themes were generated through thematic analysis: "an unexpected turn of events," "filling the gaps," "emotional reactions," "ambiguity regarding medical condition," and "sense and meaning-making." Findings suggest a need for improved communication between patients and medical staff to enhance a sense of control and coherence. Psychological support should be considered to facilitate sense and meaning-making processes during hospitalization.

Clinical and molecular features of patients with amyotrophic lateral sclerosis and SOD1 mutations: a monocentric study.

SOD1 was the first gene associated with both familial and sporadic forms of amyotrophic lateral sclerosis (ALS) and is the second most mutated gene in Caucasian ALS patients. Given their high clinical and molecular heterogeneity, a detailed characterization of SOD1-ALS patients could improve knowledge about the natural history of this disease. Here, the authors aimed to provide a clinical and molecular description of a monocentric cohort of SOD1-ALS patients. Amyotrophic lateral sclerosis (ALS) patients referring to the neurology unit of our center between 2008 and 2021 were clinically assessed and underwent molecular testing for SOD1. Segregation studies in available family members and in silico analysis were performed to sustain the pathogenicity of the identified SOD1 variants. Among the 576 patients in our cohort, we identified 19 individuals harboring a mutation in SOD1 (3.3%), including 15 (78.9%) with a familial and four (21.1%) with a sporadic form. The spinal onset of the disease was observed in all patients, and survival was extremely variable, ranging from 8 months to over 30 years. Twelve different SOD1 missense variants were identified in our cohort, including one novel mutation (p.Pro67Leu). In the present series, we provided the first description of an Italian monocentric cohort of SOD1-ALS patients, and we expanded the repertoire of SOD1 mutations. Our cohort presents several remarkable features, including variable expressivity in the same family, atypical presentation (ataxia, cognitive impairment, and other extra-motor symptoms), and different modes of inheritance of a given mutation in the same family. Given the recent authorization of SOD1-directed antisense oligonucleotide for use in SOD1-ALS patients, we recommend prompt screening for SOD1 mutations in novel ALS patients with familiar or sporadic presentations.

Factors Affecting the Delay of intravenous Thrombolysis in Hyperacute Ischemic Stroke Patients: A Single Centre Study.

Intravenous thrombolysis with r-tPA is the gold standard procedure in managing acute ischemic stroke recommended by the World Stroke Association, which is performed by injecting the drug r-tPA (Alteplase) intravenously. Generally, the preparation time to achieve thrombolysis is divided into pre-hospital and in-hospital. If this time can be shortened, the efficacy of thrombolysis can be increased. This study aims to determine the factors that can affect the delay in thrombolysis. This is an analytic observational study with a retrospective cohort design in ischemic stroke confirmed by a neurologist at the neurology emergency unit of Hasan Sadikin Hospital (RSHS) from January 2021 to December 2021 and divided into two groups, delay and non-delay thrombolysis. A logistic regression test was performed to determine the independent predictor of delayed thrombolysis. There were 141 patients with an ischemic stroke diagnosis confirmed by a neurologist at the neurological emergency unit at Hasan Sadikin Hospital (RSHS) from January 2021 to December 2021. A total of 118 (83.69%) patients were included in the "delay" category, while 23 (16.31%) patients were included in the "non-delay" category. Patients included in the "delay" category had an average age of 58.29+11.19 years with a male-to-female sex ratio of 57%, while patients included in the "non-delay" category had an average age of 55.57+15.55 years with a male-to-female sex ratio of 66%. The NIHSS admission score was a significant risk factor for delayed thrombolysis. Through multiple logistic regression, it was found that age, onset, female gender, NIHSS admission score, and NIHSS discharge score were independent predictors of delayed thrombolysis. However, all of them were not statistically significant. Gender, risk factors for dyslipidemia, and arrival onset are independent predictors of delayed thrombolysis. Prehospital factors contribute relatively more to the delay in thrombolytic action.

Cardiac magnetic resonance findings and prognosis in type 1 myotonic dystrophy.

Cardiac involvement is a major determinant of prognosis in type 1 myotonic dystrophy (DM1), but limited information is available about myocardial remodeling and tissue changes. The aim of the study was to investigate cardiac magnetic resonance (CMR) findings and their prognostic significance in DM1. We retrospectively identified all DM1 patients referred from a neurology unit to our CMR laboratory from 2009 to 2020. Thirty-four patients were included (aged 45 ± 12, 62% male individuals) and compared with 68 age-matched and gender-matched healthy volunteers (43 male individuals, age 48 ± 15 years). At CMR, biventricular and biatrial volumes were significantly smaller (all P < 0.05), as was left ventricular mass (P < 0.001); left ventricular ejection fraction (LVEF) and right ventricular ejection fraction (RVEF) were significantly lower (all P < 0.01). Five (15%) patients had a LVEF less than 50% and four (12%) a RVEF less than 50%. Nine patients (26%) showed mid-wall late gadolinium enhancement (LGE; 5 ± 2% of LVM), and 14 (41%) fatty infiltration. Native T1 in the interventricular septum (1041 ± 53 ms) was higher than for healthy controls (1017 ± 28 ms) and approached the upper reference limit (1089 ms); the extracellular volume was slightly increased (33 ± 2%, reference <30%). Over 3.7 years (2.0-5.0), 6 (18%) patients died of extracardiac causes, 5 (15%) underwent device implantation; 5 of 21 (24%) developed repetitive ventricular ectopic beats (VEBs) on Holter monitoring. LGE mass was associated with the occurrence of repetitive VEBs (P = 0.002). Lower LV stroke volume (P = 0.017), lower RVEF (P = 0.016), a higher LVMi/LVEDVI ratio (P = 0.016), fatty infiltration (P = 0.04), and LGE extent (P < 0.001) were associated with death. DM1 patients display structural and functional cardiac abnormalities, with variable degrees of cardiac muscle hypotrophy, fibrosis, and fatty infiltration. Such changes, as evaluated by CMR, seem to be associated with the development of ventricular arrhythmias and a worse outcome.

Best practices in the use of human immunoglobulin preparations for intravenous administration in the treatment of rare neurological diseases

Aim. To describe best practices in using human normal immunoglobulin in patients with immune-mediated neurological disorders according to the data of one clinical center.Materials and methods. From 2016 to 2021, 20 patients with various autoimmune disorders of the peripheral and central nervous system were treated with human normal immunoglobulin at the Neurology Unit No.1 of Pavlov First Saint Petersburg State Medical University. Treatment efficacy was assessed by changes in the neurological examination data according to specialized scales for specific diseases or clinical manifestations (INCAT, QMGS, MoCA, EDSS). Safety of the therapy was assessed considering the instructions to the drug.Results. In the vast majority of patients, treatment allowed to stabilize the course of the disease or was accompanied by pronounced regression.Conclusion. The considered clinical cases of the use of human normal immunoglobulin preparations demonstrate the possibility of their use in the treatment of a number of autoimmune neurological diseases for unregistered indications.

A retrospective multicentric study on the effectiveness of intravenous brivaracetam in seizure clusters: Data from the Italian experience

ObjectiveNearly half of people with epilepsy (PWE) are expected to develop seizure clusters (SC), with the subsequent risk of hospitalization. The aim of the present study was to evaluate the use, effectiveness and safety of intravenous (IV) brivaracetam (BRV) in the treatment of SC. MethodsRetrospective multicentric study of patients with SC (≥ 2 seizures/24 h) who received IV BRV. Data collection occurred from January 2019 to April 2022 in 25 Italian neurology units. Primary efficacy outcome was seizure freedom up to 24 h from BRV administration. We also evaluated the risk of evolution into Status Epilepticus (SE) at 6, 12 and 24 h after treatment initiation. A Cox regression model was used to identify outcome predictors. Results97 patients were included (mean age 62 years), 74 (76%) of whom had a history of epilepsy (with drug resistant seizures in 49% of cases). BRV was administered as first line treatment in 16% of the episodes, while it was used as first or second drug after benzodiazepines failure in 49% and 35% of episodes, respectively. On the one hand, 58% patients were seizure free at 24 h after BRV administration and no other rescue medications were used in 75 out of 97 cases (77%) On the other hand, SC evolved into SE in 17% of cases. A higher probability of seizure relapse and/or evolution into SE was observed in patients without a prior history of epilepsy (HR 2.0; 95% CI 1.03 – 4.1) and in case of BRV administration as second/third line drug (HR 3.2; 95% CI 1.1 – 9.7). No severe treatment emergent adverse events were observed. SignificanceIn our cohort, IV BRV resulted to be well tolerated for the treatment of SC and it could be considered as a treatment option, particularly in case of in-hospital onset. However, the underlying etiology seems to be the main outcome predictor.

Using Nursing Assessments of Mobility and Activity to Prioritize Patients Most Likely to Need Rehabilitation Services

ObjectiveTo identify nursing assessments of mobility and activity associated with lower-value rehabilitation services. DesignRetrospective cohort analysis of admissions from December 2016 to September 2019 SettingMedicine, neurology, and surgery units (n=47) at a tertiary hospital. ParticipantsWe included patients with a length of stay ≥7 days on units that routinely assessed patient function (n=18,065 patients). InterventionsNot applicable. Main OutcomeWe examined the utility of nursing assessments of function to identify patients who received lower-value rehabilitation consults, defined as those who received ≤1 therapy visit. MeasuresPatient function was assessed using 2 Activity Measure for Post-Acute Care (AM-PAC or “6 clicks”) inpatient short forms: (1) basic mobility (eg, bed mobility, walking) and (2) daily activity (eg, grooming, toileting). ResultsUsing an AM-PAC cutoff value of ≥23 correctly identified 92.5% and 98.7% of lower-value physical therapy and occupational therapy visits, respectively. In our cohort, using a cutoff value of ≥23 on the AM-PAC would have eliminated 3482 (36%) of lower-value physical therapy consults and 4076 (34%) of lower-value occupational therapy consults. ConclusionsNursing assessment, using AM-PAC scores, can be used to help identify lower-value rehabilitation consults, which can then be reallocated to patients with greater rehabilitation needs. Based on our results, an AM-PAC cutoff value of ≥23 can be used as a guide to help prioritize patients with greater rehabilitation needs.