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This study explored the prospective use of the Ages and Stages Questionnaires-3 in follow-up after cardiac surgery.
Materials and Method:
For children undergoing cardiac surgery at 5 United Kingdom centres, the Ages and Stages Questionnaires-3 were administered 6 months and 2 years later, with an outcome based on pre-defined cut-points: Red = 1 or more domain scores >2 standard deviations below the normative mean, Amber = 1 or more domain scores 1–2 standard deviations below the normal range based on the manual, Green = scores within the normal range based on the manual.
Results:
From a cohort of 554 children <60 months old at surgery, 306 participated in the postoperative assessment: 117 (38.3%) were scored as Green, 57 (18.6%) as Amber, and 132 (43.1%) as Red. Children aged 6 months at first assessment (neonatal surgery) were likely to score Red (113/124, 85.6%) compared to older age groups (n = 32/182, 17.6%). Considering risk factors of congenital heart complexity, univentricular status, congenital comorbidity, and child age in a logistic regression model for the outcome of Ages and Stages score Red, only younger age was significant (p < 0.001). 87 children had surgery in infancy and were reassessed as toddlers. Of these, 43 (49.2%) improved, 30 (34.5%) stayed the same, and 13 (16.1%) worsened. Improved scores were predominantly in those who had a first assessment at 6 months old.
Discussion:
The Ages and Stages Questionnaires results are most challenging to interpret in young babies of 6 months old who are affected by complex CHD.
If you love neuroanatomy, chances are that you also love a good puzzle. Providing a fun and refreshing alternative method of learning and reviewing neuroanatomical structures, this engaging book is perfect for those who love both neuroanatomy and riddles. 150 four-line riddles describe specific high-yield neuroanatomical structures in cryptic form. These could be lobes or general regions of the brain, blood vessels supplying key neurological structures, specific anatomical brain structures, or neuroanatomical spaces and passages. Hints such as general location in the body, the structure's function or dysfunction if impaired, or its Latin or Greek name origin are incorporated. On the following page from each riddle, the answer is given along with a complete description of the structure, history of the structure, clinical correlation and more key information For even more challenging neuroscience puzzles, consider the Neurology Riddle Book, which includes riddles about neurological syndromes, conditions and diseases.
If you love neurology, chances are that you also love a good puzzle. Providing a fun and refreshing alternative method of learning and reviewing neurological syndromes, conditions and diseases, this engaging book is perfect for those who love both neurology and riddles. 150 four-line riddles describe common neurodegenerative diseases and movement disorders as well as rare but commonly board-tested stroke syndromes, seizure disorders and infectious diseases. Each riddle contains cryptic clues such as patient demographic, clinical presentation and underlying pathophysiology for each condition and there are hints in case you get stuck. On the following page you will find the answer to the riddle along with a complete description of the condition, including the history of the disease, pathophysiology, clinical presentation, diagnostics, treatment and prognosis to aid learning. For even more challenging neuroscience puzzles, consider the Neuroanatomy Riddle Book, which includes riddles about clinically-relevant neuroanatomical structures.
Stendhal syndrome represents a compelling psychosomatic response, characterised by intense emotional and physiological reactions to viewing art, that intersects the fields of psychiatry, neurology and aesthetics. Despite lacking formal diagnostic recognition, a confluence of historical anecdotes and contemporary research underscores its validity as a unique neuropsychiatric phenomenon. This review endeavours to integrate insights from various scholarly domains to elucidate the syndrome's clinical manifestations, neurobiological foundations and its cultural and psychological relevance. Through an examination of historical contexts, clinical case studies and the underlying neurological mechanisms, this article aims to provide a comprehensive overview of Stendhal syndrome, thereby contributing to the broader discourse on neuroaesthetics and the profound impact of art on human emotion and cognition.
Many young people report that anxiety in the face of climate change causes impairing levels of distress. Understanding their anxiety includes understanding neurochemical changes to their brains in the face of rising temperatures, natural disasters, disease pandemics, and other stressors. By learning about the ways in which the developing brain balances safety and exploration behaviors, we can encourage resilience and avoid climate-related despair, helping children and adolescents navigate this unprecedented crisis.
Patients presenting to the emergency department with acute vertigo pose a diagnostic challenge. While ‘benign’ peripheral vestibulopathy is the most common cause, the possibility of a posterior circulation stroke is paradoxically the most feared and missed diagnosis in the emergency department.
Objectives
This review will attempt to cover the significant advances in the ability to diagnose acute vertigo that have occurred in the last two decades. The review discusses the role of neurological examinations, imaging and specific oculomotor examinations. The review then discusses the relative attributes of the Head Impulse-Nystagmus-Test of Skew plus hearing (‘HINTS+’) examination, the timing, triggers and targeted bedside eye examinations (‘TiTrATE’), the associated symptoms, timing and triggers, examination signs and testing (‘ATTEST’) algorithm, and the spontaneous nystagmus, direction, head impulse testing and standing (‘STANDING’) algorithm. The most recent technological advancements in video-oculography guided care are discussed, as well as other potential advances for clinicians to look out for.
Edited by
Rachel Thomasson, Manchester Centre for Clinical Neurosciences,Elspeth Guthrie, Leeds Institute of Health Sciences,Allan House, Leeds Institute of Health Sciences
Historically, the boundaries between neurology, neuropathology and psychiatry were somewhat blurred as clinicians were encouraged to see disorders of brain and mind as arising from a common organic denominator. It was not uncommon to see psychiatrists at the microscope making landmark discoveries (Alois Alzheimer and Solomon Carter-Fuller, to name just two of them), yet the twentieth century saw these three disciplines fractionate. Neurology and neuropathology retained collaborative threads as neurology became established as the speciality of organic brain disease, while psychiatry did not regain traction as a credible medico-scientific discipline for several decades. Thankfully, the boundaries between the three disciplines are once again blurred as it has become clear that many neurological conditions include symptoms commonly recognised and treated by psychiatrists. This chapter outlines how to approach assessment and diagnosis and gives an overview of psychiatric presentations in several core neurology topics including stroke, epilepsy, Parkinson’s disease and autoimmune disorders.
Through qualitative surveys, a team of law students, law professors, physicians, and residents explored the perceptions of neurology residents towards referral to appropriate legal resources in an academic training program. Respondents reported feeling uncomfortable screening their patients for health-harming legal needs, which many attributed to a lack of training in this area. These findings indicate that neurology residents would benefit from training on screening for social factors that may be impacting their patients’ health.
In this brief communication, we discuss the current landscape and unmet needs of pediatric to adult transition care in neurology. Optimizing transition care is a priority for patients, families, and providers with growing discussion in neurology. We also introduce the activities of the University of Toronto Pediatric-Adult Transition Working Group – a collaborative interdivisional and inter-subspeciality group of faculty, advanced-practice providers, trainees, and patient-family advisors pursuing collaboration with patients, families, and universities from across Canada. We envision that these efforts will result in a national neurology transition strategy that will inform designation of health authority attention and funding.
The principles of electromyography, including single-fibre electromyography and nerve conduction studies, are described simply, supported by clear diagrams and screenshots of high quality recordings. After a brief overview of anatomy, physiology, pathology and technical matters including electrodes, amplifiers and volume conduction, the way these principles aid the diagnosis of disorders of nerves, muscles and neuromuscular junctions is explained. The book concludes with the findings in common clinical conditions and explores the concept of normal vs abnormal values. This is an invaluable introductory text for trainees in clinical neurophysiology. Clinicians in specialties such as neurology, orthopaedic surgery, rheumatology, general medicine, physical medicine and rehabilitation will benefit from guidance on selecting patients for referral and assistance with the interpretation of the results. Based on the expertise of an author who has spent 25 years practising and teaching the subject, readers can be assured of a wealth of knowledge within these pages.
Until the late twentieth century, literary scholars often assumed that Victorian scientific advances challenged the dominance of religion, theorizing that religious institutions and beliefs decline with modernity. More recently, scholars affiliated with the “religious turn” in Victorian studies have suggested Christian denominations gradually embraced scientific ideas, with new religious movements such as Spiritualism and Theosophy enabling Victorians to preserve elements of Christianity (e.g., belief in an afterlife) in a rapidly changing world. This chapter intervenes in these debates using two very different novels as case studies: Oscar Wilde’s The Picture of Dorian Gray (1890, 1891) and Marie Corelli’s The Sorrows of Satan (1895), both of which freely mix Christianity with science: Wilde blends Catholicism, neuroscience, and aestheticism, while Corelli creatively revises scientific theories to align with her heterodox faith. With their occult and pseudoscientific leanings these works ask us to reconsider what counted as religion or science and to redraw the boundaries of faith to encompass unorthodox trends.
With virtual interviews for residency applications, residency program websites have become increasingly important resources for applicants. We evaluated the comprehensiveness of US and Canadian neurology residency program website, comparing this to published rankings of the best neurology and neurosurgery hospitals (for US programs) and number of residency positions (for US and Canadian programs). US program websites were found to be largely more comprehensive than Canadian websites, more extensive websites were associated with better program rankings and fewer residency seats in the US, and US regional differences in comprehensiveness were present. We recommend standardized guidelines to increase website comprehensiveness across programs.
The ongoing developments of psychiatric classification systems have largely improved reliability of diagnosis, including that of schizophrenia. However, with an unknown pathophysiology and lacking biomarkers, its validity still remains low, requiring further advancements. Research has helped establish multiple sclerosis (MS) as the central nervous system (CNS) disorder with an established pathophysiology, defined biomarkers and therefore good validity and significantly improved treatment options. Before proposing next steps in research that aim to improve the diagnostic process of schizophrenia, it is imperative to recognize its clinical heterogeneity. Indeed, individuals with schizophrenia show high interindividual variability in terms of symptomatic manifestation, response to treatment, course of illness and functional outcomes. There is also a multiplicity of risk factors that contribute to the development of schizophrenia. Moreover, accumulating evidence indicates that several dimensions of psychopathology and risk factors cross current diagnostic categorizations. Schizophrenia shares a number of similarities with MS, which is a demyelinating disease of the CNS. These similarities appear in the context of age of onset, geographical distribution, involvement of immune-inflammatory processes, neurocognitive impairment and various trajectories of illness course. This article provides a critical appraisal of diagnostic process in schizophrenia, taking into consideration advancements that have been made in the diagnosis and management of MS. Based on the comparison between the two disorders, key directions for studies that aim to improve diagnostic process in schizophrenia are formulated. All of them converge on the necessity to deconstruct the psychosis spectrum and adopt dimensional approaches with deep phenotyping to refine current diagnostic boundaries.
In this chapter, we aim to provide a solid review of studies on the neurobiology of language aptitude and the role of two other important variables, namely musicality and working memory. We stress the importance of taking findings from the cognitive neurosciences into consideration and extend current models on language aptitude by taking neurocognitive perspectives into account. We highlight the importance of stable anatomical and functional markers for individual differences in language learning and aptitude and suggest more closely investigating the interdependency between musical abilities, musical training and language learning. While we argue that working memory is an essential prerequisite for language learning and is largely genetically driven, we propose to include musical abilities in a cognitive starter kit for language aptitude.
The term ‘autophagy’ literally translates to ‘self-eating’ and alterations to autophagy have been identified as one of the several molecular changes that occur with aging in a variety of species. Autophagy and aging, have a complicated and multifaceted relationship that has recently come to light thanks to breakthroughs in our understanding of the various substrates of autophagy on tissue homoeostasis. Several studies have been conducted to reveal the relationship between autophagy and age-related diseases. The present review looks at a few new aspects of autophagy and speculates on how they might be connected to both aging and the onset and progression of disease. Additionally, we go over the most recent preclinical data supporting the use of autophagy modulators as age-related illnesses including cancer, cardiovascular and neurodegenerative diseases, and metabolic dysfunction. It is crucial to discover important targets in the autophagy pathway in order to create innovative therapies that effectively target autophagy. Natural products have pharmacological properties that can be therapeutically advantageous for the treatment of several diseases and they also serve as valuable sources of inspiration for the development of possible new small-molecule drugs. Indeed, recent scientific studies have shown that several natural products including alkaloids, terpenoids, steroids, and phenolics, have the ability to alter a number of important autophagic signalling pathways and exert therapeutic effects, thus, a wide range of potential targets in various stages of autophagy have been discovered. In this review, we summarised the naturally occurring active compounds that may control the autophagic signalling pathways.
Mental health and functional difficulties are highly comorbid across neurological disorders, but supportive care options are limited. This randomised controlled trial assessed the efficacy of a novel transdiagnostic internet-delivered psychological intervention for adults with neurological disorders.
Methods
221 participants with a confirmed diagnosis of epilepsy, multiple sclerosis, Parkinson's disease, or an acquired brain injury were allocated to either an immediate treatment group (n = 115) or treatment-as-usual waitlist control (n = 106). The intervention, the Wellbeing Neuro Course, was delivered online via the eCentreClinic website. The Course includes six lessons, based on cognitive behavioural therapy, delivered over 10 weeks with support from a psychologist via email and telephone. Primary outcomes were symptoms of depression (PHQ-9), anxiety (GAD-7) and disability (WHODAS 2.0).
Results
215 participants commenced the trial (treatment n = 111; control n = 104) and were included in intention-to-treat analysis. At post-treatment, we observed significant between-group differences in depression (PHQ-9; difference = 3.07 [95% CI 2.04–4.11], g = 0.62), anxiety (GAD-7; difference = 1.87 [0.92–2.81], g = 0.41) and disability (WHODAS 2.0 difference = 3.08 [1.09–5.06], g = 0.31), that favoured treatment (all ps < 0.001). Treatment-related effects were maintained at 3-month follow-up. Findings were achieved with minimal clinician time (average of 95.7 min [s.d. = 59.3] per participant), highlighting the public health potential of this approach to care. No adverse treatment events were reported.
Conclusions
Internet-delivered psychological interventions could be a suitable model of accessible supportive care for patients with neurological disorders.
Dr. Sharpe was a leading eye movement researcher who had also been the editor of this journal. We wish to mark the 10th anniversary of his death by providing a sense of what he had achieved through some examples of his research.
Conversion disorder (a term that describes what was previously called hysteria) refers to motor or sensory symptoms, or both, that resemble a neurological disease, but that do not originate from or cannot be explained by a known physical disease.
Objectives
To find reliable tools that can guide the difficult diagnosis of conversion disorder.
Methods
Bibliographic review
Results
The exact prevalence of the disorder is unknown. It is estimated that approximately 5% of referrals to neurology are for this disorder. Approximately one third of patients referred to the neurologist have symptoms that cannot be explained by an organic disease. Involuntary movements are the most common motor manifestations of the conversive syndrome, being tremor one of the most frequent manifestations. The first differential diagnosis of conversion disorder is neurological disease. It is currently not necessary for the diagnosis to assess whether or not the symptoms are produced intentionally, as the assessment of conscious intentionality is unreliable. The neurological examination is the fundamental tool for the diagnostic approach, being even more enlightening than the complementary tests. Hoover’s sign, Babinski’s combined leg flexion, plantar flexion of the ankle, tremor and its distraction and synchronisation manoeuvres, as well as the clinical differences between epileptic seizures and non-epileptic seizures of psychogenic origin, are some of the reliable tools for a correct diagnosis.
Conclusions
The diagnosis of the disease should be one of exclusion. There must be clinical data showing clear evidence of incompatibility with a neurological disease and conversion symptoms do not correspond to known physiological mechanisms and anatomical pathways.