Neurology. Clinical practice最新文献

{"title":"Quality Improvement Initiative Using Predictive Swallowing Score to Guide Nutritional Support for Patients With Post-Stroke Dysphagia.","authors":"Amr Jijakli, Katelyn Skeels, Devin Zebelean, Krista Swanson, Ashley LaChance, Brigid Dwyer, Ariel Savitz, Emiliya Melkumova, Lester Y Leung","doi":"10.1212/CPJ.0000000000200352","DOIUrl":"10.1212/CPJ.0000000000200352","url":null,"abstract":"<p><strong>Background and objectives: </strong>Decisions on enteral nutrition for patients with dysphagia after acute ischemic stroke (AIS) are often not evidence based. We sought to determine whether development of a nutritional support algorithm leveraging the Predictive Swallowing Score (PRESS) could improve process times without placement of unnecessary gastrostomies.</p><p><strong>Methods: </strong>This is a quality improvement study conducted at an academic medical center comparing a 6-month cohort of adults with AIS and dysphagia prepathway (PRE, July 1, 2019-December 31, 2019) and a 6-month cohort postpathway (POST, January 1, 2020-June 30, 2020). Gastrostomy recommendation, time to gastrostomy decision (TTD), discharge with gastrostomy, discharge with a nasogastric tube (NGT), and length of stay (LOS) were compared between groups.</p><p><strong>Results: </strong>Among 121 patients with AIS and dysphagia, 58 (48%) were hospitalized prealgorithm and 63 (52%) postalgorithm. PRE TTD was longer than POST TTD (4.5 vs 1.5 days, <i>p</i> = 0.004). Frequency of gastrostomy was similar between PRE and POST (12% vs 8%, <i>p</i> = 0.58). LOS for patients recommended gastrostomy was longer in PRE (14.5 vs 6.5 days, <i>p</i> = 0.03). Frequency of discharge with NGT was numerically higher in POST but not significantly different (0.7% vs 6%, <i>p</i> = 0.4). Overall, LOS was the same in both groups (5 days).</p><p><strong>Discussion: </strong>Development of a structured nutritional support algorithm incorporating PRESS may help facilitate sooner gastrostomy placement without increasing gastrostomy placement frequency and encourage more discharges to inpatient rehabilitation facilities with NGTs.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11341003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Access to Care and Health-Related Quality of Life in Multiple Sclerosis.","authors":"Ruth Ann Marrie, Samantha Lancia, Gary R Cutter, Robert J Fox, Amber Salter","doi":"10.1212/CPJ.0000000000200338","DOIUrl":"10.1212/CPJ.0000000000200338","url":null,"abstract":"<p><strong>Background and objectives: </strong>Despite their high health care use, it is unclear whether the health care needs of people with MS are being met and what their priorities are. We assessed priorities for access to, and affordability of care, by people living with MS in the United States. We also tested the association between perceived inadequate access to care and health-related quality of life (HRQoL).</p><p><strong>Methods: </strong>In Fall 2022, we conducted a cross-sectional survey of participants in the North American Research Committee on Multiple Sclerosis Registry about access to care and HRQoL (Health Utilities Index Mark III). We used multivariable polytomous logistic regression to test sociodemographic and clinical factors associated with access to care. We used multivariable linear regression analysis to test the association between access to care and HRQoL.</p><p><strong>Results: </strong>We included 4,914 respondents in the analysis, of whom 3,974 (80.9%) were women, with a mean (SD) age 64.4 (9.9) years. The providers who were most reported as needed but inaccessible were complementary providers (35.5%), followed by allied health providers (24.2%), occupational therapists (22.7%), and mental health providers (20.7%). Over 80% of participants reported that it was important or very important to be able to get an appointment with their primary MS health care provider when needed, to have sufficient time in their appointments to explain their concerns, to see their neurologist if their status changed, and that their health care providers communicated to coordinate their care. Participants who reported needing to see the provider but not having access or seeing the provider but would like to see them more often had lower HRQOL (ranging from -0.059 to -0.176) than participants who saw the provider as much as needed.</p><p><strong>Discussion: </strong>Gaps in access to care persist for people with MS in the United States and substantially affect HRQoL. Improving access to care for people with MS should be a health system priority.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11341006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ten Reasons Why Neurologists Should Refer Patients With Alzheimer Dementia to Music Therapy.","authors":"Shauna H Yuan, Michael J Silverman, Andrea M Cevasco-Trotter, Sonya G Wang","doi":"10.1212/CPJ.0000000000200357","DOIUrl":"10.1212/CPJ.0000000000200357","url":null,"abstract":"<p><strong>Background: </strong>Alzheimer dementia (AD) constitutes a major societal problem with devastating neuropsychiatric involvement. Pharmaceutical interventions carry a heightened risk of side effects; thus, nonpharmacological interventions such as music-based interventions (MBIs), including music therapy, are recommended.</p><p><strong>Recent findings: </strong>The 2023 Neurology release of the Music Based Intervention Toolkit for Brain Disorders of Aging showcased music's emerging role as an intervention to manage symptoms of various brain disorders while defining the building blocks of MBIs to guide research in the exploration of music's therapeutic potential.</p><p><strong>Implications for practice: </strong>This study extends beyond the research aspects of the MBI Toolkit to clinical applications by providing neurologists with a summary of MBIs, the MBI Toolkit, how board-certified music therapists (MT-BCs) administered music therapy is a unique MBI, and 10 reasons why they should make referrals to music therapy for their patients with AD.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11341083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Recovery of Consciousness via Evidence-Based Medicine and Research (RECOVER) Program: A Paradigm for Advancing Neuroprognostication.","authors":"David Fischer, Benjamin S Abella, Geoffrey D Bass, Jeremy Charles, Stephen Hampton, Catherine V Kulick-Soper, Matthew T Mendlik, Oscar J Mitchell, Aliza M Narva, William Pino, Morgan L Sikandar, Saurabh R Sinha, Genna J Waldman, Jeffrey B Ware, Joshua M Levine","doi":"10.1212/CPJ.0000000000200351","DOIUrl":"10.1212/CPJ.0000000000200351","url":null,"abstract":"<p><strong>Background: </strong>Neuroprognostication for disorders of consciousness (DoC) after severe acute brain injury is a major challenge, and the conventional clinical approach struggles to keep pace with a rapidly evolving literature. Lacking specialization, and fragmented between providers, conventional neuroprognostication is variable, frequently incongruent with guidelines, and prone to error, contributing to avoidable mortality and morbidity.</p><p><strong>Recent findings: </strong>We review the limitations of the conventional approach to neuroprognostication and DoC care, and propose a paradigm entitled the Recovery of Consciousness Via Evidence-Based Medicine and Research (RECOVER) program to address them. The aim of the RECOVER program is to provide specialized, comprehensive, and longitudinal care that synthesizes interdisciplinary perspectives, provides continuity to patients and families, and improves the future of DoC care through research and education.</p><p><strong>Implications for practice: </strong>This model, if broadly adopted, may help establish neuroprognostication as a new subspecialty that improves the care of this vulnerable patient population.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11341005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Seizure Outcome With or Without Vagal Nerve Stimulation Therapy.","authors":"Sonia Gill, Kathryn N Devlin, Hsiangkuo Yuan, Scott Mintzer, Christopher Skidmore, Chengyuan Wu, Michael R Sperling, Maromi Nei","doi":"10.1212/CPJ.0000000000200358","DOIUrl":"10.1212/CPJ.0000000000200358","url":null,"abstract":"<p><strong>Background and objectives: </strong>To compare long-term seizure control in patients with long-term VNS (vagal nerve stimulator) stimulation (VNS-on) with those who discontinued VNS after >3 years (VNS-off).</p><p><strong>Methods: </strong>Patients with refractory epilepsy with VNS therapy for >3 years (and follow-up for >2 years after VNS discontinuation for VNS-off patients) were included. Patients with brain surgery <3 years after VNS were excluded. We compared the percentage of patients with ≥50% seizure reduction (50% responder rate) and change in seizure frequency within and between groups in follow-up.</p><p><strong>Results: </strong>Thirty-three VNS-on and 16 VNS-off patients were evaluated. VNS-on patients underwent stimulation for 9.7 years (mean). VNS-off patients had VNS treatment for 6.5 years (mean), discontinued treatment, then had additional 8.0 years (mean) follow-up. 50% responder rates were similar between groups (VNS-on: 54.5% vs VNS-off at last-on: 37.5%, <i>p</i> = 0.26; vs VNS-off at the last follow-up: 62.5%, <i>p</i> = 0.60). VNS-on patients had a significant reduction in seizure frequency at the last follow-up compared with baseline (median [Mdn] = -4.5 seizures/month, interquartile range [IQR] = 14.0, 56% reduction, <i>p</i> = 0.013). VNS-off patients also showed significant seizure reduction while still continuing VNS therapy (Mdn = -1.0 seizures/month, IQR = 13.0, 35% reduction, <i>p</i> = 0.020) and, after discontinuing therapy, at the last follow-up compared with baseline (Mdn = -3.2, IQR = 11.0, 52% reduction, <i>p</i> = 0.020). The 2 groups were comparable in seizure frequency change both at the last-on visit (absolute change, <i>p</i> = 0.62; relative change, <i>p</i> = 0.50) at the last follow-up (absolute change, <i>p</i> = 0.67; relative change, <i>p</i> = 0.76).</p><p><strong>Discussion: </strong>Patients who discontinued VNS therapy and those who continued therapy had similar response during active treatment and similar long-term outcomes, suggesting that factors such as the natural disease course and/or medication treatment strongly affect long-term outcomes.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11341084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antiseizure Medication Withdrawal, Risk of Epilepsy, and Longterm EEG Trends in Acute Symptomatic Seizures or Epileptic EEG Patterns.","authors":"Adithya Sivaraju, Alice Tao, Rakesh Jadav, Karen N Kirunda, Nishi Rampal, Jennifer A Kim, Emily J Gilmore, Lawrence J Hirsch","doi":"10.1212/CPJ.0000000000200342","DOIUrl":"10.1212/CPJ.0000000000200342","url":null,"abstract":"<p><strong>Background and objectives: </strong>Patients with acute symptomatic seizures (ASyS) and acute epileptiform findings on EEG are common. They are often prescribed long-term antiseizure medications (ASMs); it is unknown whether or when this is necessary. Primary outcome was late unprovoked seizure occurrence and association with ASM taper. The secondary outcome was EEG pattern evolution over time.</p><p><strong>Methods: </strong>This is a retrospective cohort study of patients from 2015 to 2021 with ASyS (clinical or electrographic) and/or epileptiform findings on index hospitalization EEGs who were discharged on ASMs and had subsequent follow-up including an outpatient EEG at Yale New Haven Hospital. All patients were seen in our postacute symptomatic seizure (PASS) clinic after hospital discharge. We also developed a simple predictive score, Epilepsy-PASS (EPI-PASS), using variables independently associated with seizure recurrence based on stepwise regression; each of the 3 identified variables was assigned a score of 0 (absent) or 1 (present), for a total score of 0-3.</p><p><strong>Results: </strong>Of 190 patients screened, 58 were excluded, leaving a final cohort of 112 patients. Twenty-four percent (27/112) patients developed a late unprovoked seizure (i.e., epilepsy). Independent predictors of epilepsy were persistence of epileptiform abnormalities on follow-up EEGs [56% developed epilepsy vs 19% without, 0.002, OR 7.18 (1.36-37.88)], clinical ASyS [32% vs 13%, <i>p</i> = 0.002, OR 7.45 (2.31-54.36)], and cortical involvement on imaging [40% vs 11%, <i>p</i> = 0.003, OR 7.63 (1.96-29.58)]. None of the 23 patients with none of these predictors (0 points on EPI-PASS) developed epilepsy, vs 13% with 1 predictor (EPI-PASS = 1) and 46% with 2 or 3 predictors (EPI-PASS = 2-3) at 1-year follow-up. ASM taper was not associated with seizure recurrence. Abnormal EEG findings in the index hospitalization usually resolved [54/69 (78%) patients] on subsequent EEGs.</p><p><strong>Discussion: </strong>Most patients with clinical ASyS or acute epileptiform EEG findings do not require long-term ASMs. Index hospitalization EEG findings usually resolve, but if they do not, there is a >50% chance of developing epilepsy. Other predictors of epilepsy are cortical involvement on imaging and clinical ASyS. A simple 4-point scale using these 3 predictors (EPI-PASS) may help predict the risk of developing epilepsy but requires independent validation.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11341085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilization, Workflow, and Outcomes of Endovascular Thrombectomy in Patients With vs Without Premorbid Disability in a National Registry.","authors":"Aravind Ganesh, Ondrej Volny, Ingrid Kovacova, Aleš Tomek, Michal Bar, Radek Pádr, Filip Cihlar, Miroslava Nevsimalova, Lubomir Jurak, Roman Havlicek, Martin Kovar, Petr Sevcik, Vladimír Rohan, Jan Fiksa, David Cerník, Rene Jura, Daniel Vaclavik, Michael D Hill, Robert Mikulík","doi":"10.1212/CPJ.0000000000200341","DOIUrl":"10.1212/CPJ.0000000000200341","url":null,"abstract":"<p><strong>Background and objectives: </strong>Given the paucity of high-quality safety/efficacy data on acute stroke therapies in patients with premorbid disability, they risk being routinely excluded from such therapies. We examined utilization of endovascular thrombectomy (EVT), associated workflow, and poststroke outcomes among patients with vs without premorbid disability.</p><p><strong>Methods: </strong>We used national registry data on thrombolysis/EVT for the Czech Republic from 1 January 2016 to 31 December 2020. Premorbid disability was defined as prestroke modified Rankin Scale score (mRS) ≥3. We compared proportions of patients with vs without premorbid disability who received EVT and examined workflow times. We compared ΔmRS-change in mRS from prestroke to 3 months-in patients with vs without premorbid disability, in addition to intracerebral hemorrhage (ICH), mortality, and discharge NIHSS (National Institutes of Health Stroke Scale score), adjusting for age, sex, baseline NIHSS, and comorbidities, and verified using propensity score weighting (PSW) and matching for differences in treatment assignment. We stratified by age group (<65, 65-74, 75-84, ≥85 years) to explore outcome heterogeneity with vs without premorbid disability.</p><p><strong>Results: </strong>Among 22,405 patients with ischemic stroke who received thrombolysis/EVT/both, 1,712 (7.6%) had prestroke mRS ≥ 3. Patients with prestroke disability were less likely to receive EVT vs those without (10.1% vs 20.7%, aOR: 0.30, 95% CI 0.24-0.36). When treated, they had longer door-to-arterial puncture times (median: 75 minutes, IQR: 58-100 vs 54, IQR: 27-77, adjusted difference: 12.5, 95% CI 2.68-22.3). Patients with prestroke disability receiving thrombolysis/EVT/both had worse ΔmRS (adjusted rate ratio, aIRR on PSW: 1.57, 95% CI 1.43-1.72), rates of 3-month mRS 5-6, discharge NIHSS, and mortality (aOR-PSW [mortality]: 2.54, 95% CI 1.92-3.34), while ICH did not significantly differ. 32.1% of patients with prestroke disability receiving thrombolysis/EVT/both successfully returned to prestroke state, but this proportion ranged from 19.6% for those older than 85 years to 66.0% for those younger than 65 years. Regardless of premorbid disability, EVT was associated with better outcomes including lower ΔmRS (aIRR-PSW: 0.87, 95% CI 0.83-0.91) and mortality, with no interaction of treatment effect by premorbid disability status (e.g., mortality p_interaction = 0.73). EVT recipients with premorbid disability did not differ significantly for several outcomes including ΔmRS (aIRR: 0.99, 95% CI 0.84-1.17) but were more likely to have 3-month mRS 5-6 (70.1% vs 39.5% without premorbid disability, aOR: 1.85, 95% CI 1.12-3.04).</p><p><strong>Discussion: </strong>Patients with premorbid disability were less likely to receive EVT, had slower treatment times, and had worse outcomes compared with patients without premorbid disability. However, regardless of premorbid disability, patient","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11341008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lecanemab Planning: Blueprint for Safe and Effective Management of Complex Therapies.","authors":"Rita Shane, Sarah Kremen, Zaldy S Tan, Hai Tran, Thanh G Tu, Nancy L Sicotte","doi":"10.1212/CPJ.0000000000200361","DOIUrl":"10.1212/CPJ.0000000000200361","url":null,"abstract":"<p><strong>Background: </strong>Approximately 6.9 million American individuals have Alzheimer dementia and 50% have mild disease. Lecanemab, an approved antiamyloid antibody, is associated with modest reduction in functional decline in patients with mild dementia or mild cognitive impairment. In Clarity-AD, 239 (26.6%) of patients experienced amyloid-related imaging abnormalities (ARIAs) overall (i.e., ARIAs associated with hemorrhages or edema). The complexity of treatment and risks of adverse events necessitate a multidisciplinary collaborative approach.</p><p><strong>Recent findings: </strong>With limited treatment options, lecanemab approval generated significant interest among clinicians, patients, and families. Lecanemab treatment requires biweekly infusions along with ongoing imaging tests, laboratory monitoring, patient assessment, drug interaction screening, and cognitive function monitoring. Processes to support patient selection, access, and safety are important given the monitoring requirements and total cost of care.</p><p><strong>Implications for practice: </strong>The planning process for lecanemab can serve as a blueprint to support safe and effective management of therapeutic innovation in neurology and other areas.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11368232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Testing the Validity and Reliability of a Standardized Virtual Examination for Concussion.","authors":"Alani I Jack, Helena T Digney, Carter A Bell, Scott N Grossman, Jacob I McPherson, Ghazala T Saleem, Mohammad N Haider, John J Leddy, Barry S Willer, Laura J Balcer, Steven L Galetta, Neil A Busis, Daniel M Torres","doi":"10.1212/CPJ.0000000000200328","DOIUrl":"10.1212/CPJ.0000000000200328","url":null,"abstract":"<p><strong>Background and objectives: </strong>We determined inter-modality (in-person vs telemedicine examination) and inter-rater agreement for telemedicine assessments (2 different examiners) using the Telemedicine Buffalo Concussion Physical Examination (Tele-BCPE), a standardized concussion examination designed for remote use.</p><p><strong>Methods: </strong>Patients referred for an initial evaluation for concussion were invited to participate. Participants had a brief initial assessment by the treating neurologist. After a patient granted informed consent to participate in the study, the treating neurologist obtained a concussion-related history before leaving the examination room. Using the Tele-BCPE, 2 virtual examinations in no specific sequence were then performed from nearby rooms by the treating neurologist and another neurologist. After the 2 telemedicine examinations, the treating physician returned to the examination room to perform the in-person examination. Intraclass correlation coefficients (ICC) determined inter-modality validity (in-person vs remote examination by the same examiner) and inter-rater reliability (between remote examinations done by 2 examiners) of overall scores of the Tele-BCPE within the comparison datasets. Cohen's kappa, κ, measured levels of agreement of dichotomous ratings (abnormality present vs absent) on individual components of the Tele-BCPE to determine inter-modality and inter-rater agreement.</p><p><strong>Results: </strong>For total scores of the Tele-BCPE, both inter-modality agreement (ICC = 0.95 [95% CI 0.86-0.98, <i>p</i> < 0.001]) and inter-rater agreement (ICC = 0.88 [95% CI 0.71-0.95, <i>p</i> < 0.001]) were reliable (ICC >0.70). There was at least substantial inter-modality agreement (κ ≥ 0.61) for 25 of 29 examination elements. For inter-rater agreement (2 telemedicine examinations), there was at least substantial agreement for 8 of 29 examination elements.</p><p><strong>Discussion: </strong>Our study demonstrates that the Tele-BCPE yielded consistent clinical results, whether conducted in-person or virtually by the same examiner, or when performed virtually by 2 different examiners. The Tele-BCPE is a valid indicator of neurologic examination findings as determined by an in-person concussion assessment. The Tele-BCPE may also be performed with excellent levels of reliability by neurologists with different training and backgrounds in the virtual setting. These findings suggest that a combination of in-person and telemedicine modalities, or involvement of 2 telemedicine examiners for the same patient, can provide consistent concussion assessments across the continuum of care.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11182663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141420073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Mechanical Thrombectomy for Acute Ischemic Stroke in Cancer Patients: A Single-Center Experience and Meta-Analysis.","authors":"Mohamed N Elmarawany, Islam El Malky, Sebastian Winklhofer, Mira Katan, Souvik Kar, Gerasimos Baltsavias","doi":"10.1212/CPJ.0000000000200320","DOIUrl":"10.1212/CPJ.0000000000200320","url":null,"abstract":"<p><strong>Background and objectives: </strong>The published data about mechanical thrombectomy (MT) in cancer patients is sparse. We present our institutional experience in this clinical scenario, and a meta-analysis.</p><p><strong>Methods: </strong>The baseline data, procedural data, clinical and radiological outcomes of MT were analyzed and compared among three groups of stroke patients: controls, patients with active malignancy (AM), and patients with history of malignancy (HOM). A meta-analysis of 12 studies was conducted to address the differences between controls and AM patients regarding selected outcomes.</p><p><strong>Results: </strong>The 3 groups (controls, AM, HOM) showed significant differences regarding previous history of stroke or TIA (7.8% vs 10.5% vs 38.5%, <i>p</i> = 0.006), alcohol consumption (0.9% vs 10.5% vs 0.0%, <i>p</i> = 0.04), thrombophilia (1.7% vs 15.8% vs 7.7%, <i>p</i> = 0.009), deep venous thrombosis (0.4 vs 26.3% vs 7.7%, <i>p</i> = 0.005). The AM group had significantly higher rates of sICH (3.5% [controls] vs 21.1% [AM] vs 0.0% [HOM], <i>p</i> = 0.007), and mortality at 3 months (27.5% [controls] vs 61.5% [AM] vs 40.0% [HOM] vs, <i>p</i> = 0.032). The control and HOM groups had significantly better functional independence at 3 months (52.1% [controls] vs 15.4% [AM] vs 60.0% [HOM], <i>p</i> = 0.032).In the meta-analysis, the AM arm showed significantly higher mortality during hospitalization (n = 6, OR 95% CI = 3.03 [1.62, 5.64]), and at 3 months (n = 10, OR 95% CI = 4.33 [2.80, 6.68]), and significantly lower rates of 3 months functional independence (mRS = 0-2) (n = 10, OR 95% CI = 0.47 [0.32, 0.70]). No significant difference was found in sICH rates (n = 6, pooled OR 95% CI = 2.03 [0.83, 4.95]).</p><p><strong>Discussion: </strong>Endovascular MT is technically successful and reasonably safe in treating AIS from LVO in active malignancy patients. However, the causes and implications of sICH require further investigation. Despite technical success, these patients experience poor clinical outcomes, and the long-term benefits of MT remain uncertain.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11165561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141311275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}