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Mashup Score: 18Multisensory Hallucinatory Experiences in Migraine - 5 month(s) ago
Background and Objectives Visual auras in migraine have been extensively studied, but less is known about unusual experiences in other sensory domains, including whether they should be diagnostically considered as part of aura symptoms. This study aimed to examine the prevalence of multisensory aura experiences in migraine and their phenomenologic and clinical correlates. Methods Respondents were 729 participants with probable migraine, who completed an online study examining unusual sensory experiences. These comprised aura experiences in the auditory, visual, olfactory, somatic-tactile, and gustatory domains. Basic demographic and clinical information and migraine symptomatology were also collected. To facilitate groupwise comparisons, participants with probable migraine were divided into those with and without (visual) aura experiences. Results Endorsement of visual aura experiences was the highest (42.1%), whether in a single modality (44.2%) or multiple (55.8%) modalities, followe
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Mashup Score: 52Zonisamide - 5 month(s) ago
Purpose of Review Zonisamide (ZNS) was first approved in the United States in 2000 for the adjunctive treatment of patients aged 16 years or older with partial (focal) seizures. Although ZNS has been proven to treat multiple seizure types, it has been largely underutilized in US clinical practice. Recent Findings Published literature demonstrated that antiseizure medications (ASMs) acting on Na+ and Ca2+ channels may add beneficial effects in many seizure types by reducing seizure frequency and leading to overall improvements. In addition, effects of ZNS may lead to clinical improvements in Parkinson disease, alcohol and sleep disorders, pain, and migraine. ZNS is available in multiple formulations and is a safe and effective, broad spectrum ASM. Summary The purpose of this review was to provide an update to what is known about the efficacy of ZNS and where it shows benefits in the treatment of patients with epilepsy and other CNS disorders through its many unique mechanisms of action.
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Mashup Score: 44Parakinesia Brachialis Oscitans in a Patient With a First Manifestation of Multiple Sclerosis - 5 month(s) ago
Objectives Parakinesia brachialis oscitans (PBO) is the involuntary movement of an otherwise paretic upper limb triggered by yawning. We describe the first case of PBO in a patient with a first manifestation of tumefactive multiple sclerosis (MS). Methods A 35-year-old man presented to the emergency department with a first episode of generalized seizure. Neurologic examination revealed left-sided spastic hemiparesis, predominantly affecting his upper limb. Brain MRI showed a tumefactive right hemisphere lesion consistent with demyelination. CSF did not document unmatched oligoclonal bands. Results Two weeks after admission and, despite being unable to voluntarily raise his left arm, the patient noticed a repeated and reproducible involuntary raise of this limb upon yawning, consistent with PBO. In the following weeks, the phenomenon diminished both in frequency and movement amplitude alongside motor recovery. An MRI performed 2 months later showed progression of the demyelinating lesio
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Mashup Score: 17Work, Parenting, and Well-being - 5 month(s) ago
Background and Objectives COVID-19 reframed the relationship between work and home and, in general, made both more difficult—especially for parents. We hypothesized that, among neurologists, the effects of the pandemic on productivity and on well-being would be greater on those with children than on those without children and that the effects would be greater on women with children than on men with children. Methods We conducted an international electronic survey launched by the Practice Current section of the American Academy of Neurology. The survey included questions on demographics (self-identified gender, number of children and elderly dependents, childcare support, and country and state when applicable), workflow changes because of COVID-19, impacted domains, and productivity and well-being using the Likert scale. Counts are presented as descriptive statistics. Statistical analysis was performed using Mann-Whitney U and Kruskal-Wallis tests. Results We collected 243 fully complet
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Mashup Score: 27Heart Brain Clinic - 5 month(s) ago
Background and Objectives Multidisciplinary clinics have been shown to improve care. Patients with patent foramen ovale (PFO)–associated stroke need evaluation by cardiology and neurology specialists. We report our experience creating a multidisciplinary Structural Heart Brain Clinic (HBC) with a focus on patients with PFO-associated stroke. Methods Demographic and clinical data were retrospectively collected for patients with PFO-associated ischemic stroke. Patients with PFO-associated stroke were divided into a standard care group and Heart Brain Clinic group for analysis. Outcome measures included time from stroke to PFO closure and number of clinic visits before decision regarding closure. Nonparametric analysis evaluated differences in median time to visit and clinical decision, while the chi square analysis compared differences in categorical variables between groups. Results From February 2017 to December 2021, 120 patients were evaluated for PFO-associated stroke. The Structura
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Mashup Score: 12Death and ADL Dependency After Scoring Zero on the NIHSS - 5 month(s) ago
Background and Objectives Of all strokes, mild strokes (defined as 5 points or less on the National Institutes of Health Stroke Scale [NIHSS]) are in the majority. However, up to one-third of patients with mild strokes still exhibit significant deficits 3 months after the stroke. Studies on the presumably mildest strokes, defined by zero points on the NIHSS (0-NIHSS) at admission, are scarce. Hence, we aimed to study patient characteristics and outcomes among patients with 0-NIHSS strokes. Methods Our retrospective registry-based study included a total of 6,491 adult patients with stroke admitted to 3 different stroke units in Gothenburg, Sweden, from November 2014 to June 2019. Our main outcome was a composite measure including death and activities of daily living (ADL) dependency 3 months after the stroke. Analyses of patient characteristics were followed by adjusted analyses including multiple confounders. Results In total, 5,945 patients had data on NIHSS at admission, of whom 1,41
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Free to read: This Swedish retrospective registry-based study found that 6% of the patients were either dead or ADL-dependent 3mo after a 0-NIHSS #stroke, highlighting these strokes are not always benign & more extensive symptom screening might be needed. https://t.co/KFh1MLR4HY https://t.co/ywvoRKY5Xx
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Mashup Score: 7Incorporating Genetic Testing Into the Care of Patients With Amyotrophic Lateral Sclerosis/Frontotemporal Degeneration Spectrum Disorders - 5 month(s) ago
Purpose of Review Amyotrophic lateral sclerosis (ALS) and frontotemporal degeneration (FTD) spectrum disorders have a strong genetic component. Genetic counselors are a limited resource, and therefore, other providers must be prepared to integrate genetic testing into their practice. Recent Findings Recent ALS/FTD studies have demonstrated that lack of family history does not preclude a genetic etiology. The benefits of a genetic diagnosis have expanded to include the potential to treat; thus, genetic testing is increasingly recommended to be offered to all persons with ALS/FTD. Summary Offering genetic testing to persons with ALS/FTD spectrum disorders should be part of routine clinical neurologic care. All genetic testing should include discussion about the medical and psychosocial implications of testing for the patient and family members. Neurologists should be prepared to facilitate this process and recognize when referral to a genetic counselor is indicated.
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Mashup Score: 8Characterization of Migraine in Children and Adolescents With Generalized Joint Hypermobility - 5 month(s) ago
Background and Objectives The prevalence of generalized joint hypermobility (GJH) is 5–65% in children and adolescents. The hypothesis of this study was to see whether there is an association between headache characteristics and GJH in children and adolescents with migraine. Methods We performed a primary retrospective case-control analysis of an established database of patients with headache aged 5–17 years. Results We included 5435 participants. Approximately 31.6% of participants (1,719/5,435) were diagnosed with GJH (Beighton score ≥ 6). Nausea (73.1% vs 67.5%, χ2 with 1 degree of freedom = 17.0, p < 0.0001), phonophobia (87.3% vs 78.8%, χ2 with 1 degree of freedom = 18.0, p < 0.0001), and the PedMIDAS score (48.2 ± 52.5, 95% CI 45.7–50.6 vs 41.6 ± 51.2, 95% CI 40.0–43.3, effect size = 0.13, p < 0.0001) were noted to be more severe in participants with GJH than those without GJH. Discussion Youths with GJH and migraine were noted to have more severe migraine characteristics.
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Mashup Score: 4Multisystemic RFC1-Related Disorder - 5 month(s) ago
Background and Objectives The RFC1 spectrum has become considerably expanded as multisystemic features beyond the triad of cerebellar ataxia, neuropathy, and vestibular areflexia syndrome (CANVAS) have started to be unveiled, although many still require clinical replication. Here, we aimed to clinically characterize a cohort of RFC1 -positive patients by addressing both classic and multisystemic features. In a second part of this study, we prospectively assessed small nerve fibers (SNF) and autonomic function in a subset of these RFC1 -related patients. Methods We retrospectively enrolled 67 RFC1-positive patients from multiple neurologic centers in Portugal. All patients underwent full neurologic and vestibular evaluation, as well as neuroimaging and neurophysiologic studies. For SNF and autonomic testing (n = 15), we performed skin biopsies, quantitative sensory testing, sudoscan, sympathetic skin response, heart rate deep breathing, and tilt test. Results Multisystemic features beyo
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Mashup Score: 212Diffusion-Restricted Lesions of the Splenium - 5 month(s) ago
Background and Objectives Diffusion-restricted (DR) lesions of the splenium are encountered in a wide variety of pathologies, and their significance is often unclear. We sought to report the spectrum of clinical presentations, neuroimaging patterns, and the predictors of radiographic and clinical outcomes from DR splenial lesions. Methods This was a single-center, retrospective cohort study from January 1, 2009, to August 1, 2020. A consecutive sample of 3,490 individuals who underwent brain MRI with reported corpus callosum lesions during the study period were evaluated for DR lesions in the corpus callosum. DR lesions were defined as increased signal intensity on diffusion-weighted imaging sequences with decreased signal intensity on apparent diffusion coefficient. Patients with prior neurosurgical procedures, hemorrhage-associated DR, anoxic brain injury, and chronic or previously known or characterized disease processes in the corpus callosum were excluded. Clinical and radiologic
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Study findings provide preliminary indication that unusual olfactory, somatic-tactile, and gustatory experiences in #migraine are common and could be clinically significant as aura symptoms. Learn more: https://t.co/8AVPKa9VN0 #NeuroTwitter https://t.co/XplxZaFpZA