Neurology. Clinical practice最新文献

{"title":"Disparate Use of Diagnostic Modalities for Patients With Limited English Proficiency and Neurologic Disorders.","authors":"Altaf Saadi, Redwan Bin Abdul Baten, Margarita Alegría, David Himmelstein, Steffie Woolhandler","doi":"10.1212/CPJ.0000000000200417","DOIUrl":"10.1212/CPJ.0000000000200417","url":null,"abstract":"<p><strong>Background and objectives: </strong>Limited English proficiency (LEP) impairs health access-including outpatient specialty care-and quality care, i.e., inappropriate use of diagnostic tests. At least in some cases, studies have suggested that clinicians may substitute testing for time-consuming clinical evaluation involving medical interpreters. This study (1) examines disparities in receipt of diagnostic testing among patients with LEP and neurologic illness, in both the ambulatory and emergency department (ED) settings, including (2) whether better patient-provider communication is associated with reduced testing disparities and (3) how testing disparities vary according to insurance.</p><p><strong>Methods: </strong>We analyzed nationally representative data from the 2003-2018 Medical Expenditure Panel Survey and identified adults with neurologic illness using diagnostic codes. To assess the association between LEP status and diagnostic testing (CT/MRI, laboratory tests, and any diagnostic tests), we estimated logistic regression models that included year-fixed effects. We constructed separate models for ambulatory and ED settings, including models with a patient-provider communication measure to see how that influenced the LEP-diagnostic testing association. Finally, we conducted stratified analyses by sources of health insurance.</p><p><strong>Results: </strong>LEP status was associated with greater receipt of laboratory tests (OR = 1.46, <i>p</i> < 0.05) but less CT/MRI in the ambulatory setting (0.86, <i>p</i> < 0.05), patterns that persisted in analyses stratified by insurance status. Factoring in patient-provider communication attenuated but did not eliminate these disparities, with attenuation most notable in rates of CT/MRI. We found fewer testing disparities for patients with LEP in the ED than in ambulatory settings.</p><p><strong>Discussion: </strong>In this nationwide study of patients with neurologic illness, we observed both greater and less use of diagnostic tests for patients with LEP and neurologic illness. The greater use of laboratory tests may reflect the overuse of easily obtainable tests for patients with LEP. Conversely, the less use of CT/MRI may be due to time and transportation challenges in scheduling follow-up visits, alongside other barriers to patient follow-up. The population of patients with LEP is growing, making it critical to study not only disparities in their care but also nuances and determinants of these disparities beyond patient-provider communication and across clinical settings.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 2","pages":"e200417"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11727602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984294","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":"Improving the Clinical Diagnostic Criteria for Genetically Confirmed Adult-Onset Huntington Disease: Considering Nonmotor Presentations.","authors":"Ciaran M Considine, Clare M Eddy, Samuel A Frank, Sandra K Kostyk, Mayke Oosterloo, Annie Killoran, Erin Furr Stimming, Matthias Dose, Travis Cruickshank, Thomas D Bird, Louise Vetter, Astri Arnesen, James Valvano, Herwig W Lange, Daniel O Claassen","doi":"10.1212/CPJ.0000000000200427","DOIUrl":"10.1212/CPJ.0000000000200427","url":null,"abstract":"<p><strong>Background: </strong>Huntington disease (HD) is a genetic neurodegenerative disorder. Given the focus on motor manifestations, nonmotor symptoms are frequently underappreciated in clinical evaluations, despite frequently contributing to primary functional impairment.</p><p><strong>Recent findings: </strong>A diagnosis of motor-onset as the definition of manifest symptoms misrepresents the complex nature of HD presentation. Despite recent attempt to integrate nonmotor diagnostic criteria, practical guidelines are necessary to inform clinical diagnosis. We propose an HD diagnostic framework and staging system that prioritizes genetic testing, integrates motor and nonmotor symptom considerations in the determination of clinical disease onset and severity, and acknowledges the secondary role of clinically indicated diagnostic assessments, incorporating the broad symptom profiles observed in clinical practice.</p><p><strong>Implications for practice: </strong>The proposed diagnostic criteria more accurately reflect the presentation of HD and provide greater opportunities for health care professionals to provide appropriate clinical care guidelines for adults with gene-expanded HD.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 2","pages":"e200427"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11741291/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008876","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":"A Real-World Prospective Multiple Sclerosis Pregnancy Registry in the United States: PREG-MS.","authors":"Maria K Houtchens, Maria Claudia Manieri, Tatenda Dawn Mahlanza, Jeta Pol-Patil, Eric C Klawiter, Andrew J Solomon, Ellen Lathi, Joshua Katz, Carolina Ionete, Idanis Berrios Morales, Christopher Severson, Jonathan Zurawski, James M Stankiewicz, Ann Cabot, Adele Dessa Sadovnick","doi":"10.1212/CPJ.0000000000200425","DOIUrl":"10.1212/CPJ.0000000000200425","url":null,"abstract":"<p><strong>Background and objectives: </strong>Multiple sclerosis (MS) affects more than 1 million people in the United States, including reproductive-age women. There has been a paucity of prospective, pregnancy registries based on MS disease rather than medication exposures. A prospective MS pregnancy registry (PREG-MS) was established in 2017 as a prospective, single-cohort, real-world MS pregnancy registry in New England States of the United States, with goals to evaluate (1) course of MS and disease-modifying therapies (DMT) use during conception attempts and in the peripartum period, (2) pregnancy outcomes in women with MS (WwMS), and (3) longer-term developmental outcomes in offspring of WwMS.</p><p><strong>Methods: </strong>Between 2017 and 2020, PREG-MS recruited from 11 preselected academic and community MS centers and followed WwMS and their children from conception attempts and any pregnancy trimester, up to 3 years of postpartum. Comprehensive neurologic, obstetric, and pediatric development information was collected through telephone interviews and medical records.</p><p><strong>Results: </strong>One hundred forty-six patients were enrolled between 2017 and 2020; there were 122 pregnancies from 135 participants, and 105 infants were born on study. 24.6% pregnancies were unplanned; 14.1% had an infertility diagnosis. Assisted reproductive technologies were used by 12.6%. 54% of pregnancies were designated as \"high-risk\", and ∼40% had peripartum obstetrical complications with 17% adverse pregnancy outcomes. Mean baseline Expanded Disability Status Scale was 1.09 ± 0.84. ∼85% were treated with DMTs up to the time of conception. 19.7% had 1 or more relapses within prepregnancy year, correlating with increased duration of conception attempts (<i>p</i> < 0.0001). 12% had intrapartum, and 24.5% had postpartum relapses. Any fertility treatments predicted intrapartum relapses independent of DMT status (OR 5.18, 95% CI 1.58-17.02, <i>p</i> = 0.007). 33.6% were exposed to DMTs in pregnancy. Intrapartum relapses (<i>p</i> = 0.008) and high-risk pregnancy (<i>p</i> = 0.036) were associated with postpartum exacerbations.</p><p><strong>Discussion: </strong>Our real-world, prospective, nondisabled MS pregnancy cohort had a sizable proportion of participants with clinical disease activity in the prepartum and intrapartum period, despite high-DMT utilization prepartum. A greater-than-expected number of participants were considered to have high-risk pregnancies and reported peripartum complications. The use of any fertility treatments was independently predictive of intrapartum relapses, supporting hormonal-immune interactions as disease modulators in MS. Larger prospective, longitudinal registries are needed to confirm our findings.</p><p><strong>Trial registration information: </strong>Clinical trial registration number: NCT03368157.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 2","pages":"e200425"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11727603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984287","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":"Erratum: Patient- and Caregiver-Reported Impact of Symptoms in Alzheimer Disease, Mild Cognitive Impairment, and Dementia.","authors":"Jamison Seabury, Jennifer Weinstein, Anika Varma, Spencer James Rosero, Charlotte Engebrecht, Abigail Arky, Christine Zizzi, Nuran Dilek, Abigail Mathewson, Susan Salem-Spencer, Elizabeth J Santos, Chad Rydel Heatwole","doi":"10.1212/CPJ.0000000000200444","DOIUrl":"10.1212/CPJ.0000000000200444","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1212/CPJ.0000000000200418.].</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 2","pages":"e200444"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11839228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458703","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":"Financial Concerns Are Common Among Family Surrogate Decision-Makers of Patients With Stroke: A Mixed Methods Study.","authors":"Christopher J Becker, Jessica E Baker, Guanghao Zhang, F Garrett Conyers, Xu Shi, Madeline Kwicklis, Rebecca Lank, Carmen Ortiz, Erin Case, Mellanie V Springer, Lewis B Morgenstern, Darin B Zahuranec","doi":"10.1212/CPJ.0000000000200451","DOIUrl":"10.1212/CPJ.0000000000200451","url":null,"abstract":"<p><strong>Background and objectives: </strong>Stroke has a large aggregate financial effect, but the prevalence and predictors of cost concerns among family surrogate decision-makers of patients with stroke are unknown. The aim of this study was to explore the prevalence, predictors, and nature of cost concerns among family surrogate decision-makers of patients with stroke.</p><p><strong>Methods: </strong>Family surrogate decision-makers of patients with stroke were recruited from a largely biethnic population-based study in Nueces County, TX. The primary outcome was the presence of cost concerns, defined as being \"very worried\" or \"moderately worried\" about being able to pay stroke-related medical costs, assessed through surveys conducted at baseline (shortly after stroke) and 3-, 6-, and 12-month poststroke. Potential predictors included clinical and sociodemographic factors for patients and family members, obtained from surveys and medical charts. Exploratory multivariable logistic regression models identified factors associated with cost concerns, adjusting for covariates. We also explored the nature of cost concerns in semistructured interviews with a subset of participants.</p><p><strong>Results: </strong>Of 465 eligible stroke cases, 318 family members of 256 patients with stroke participated. Patients were 52% female, 58% Mexican American (MA), 38% non-Hispanic White (NHW), and 8% other race/ethnicity, mean age 75 (SD 14), and median NIH Stroke Scale score of 12.5 (IQR 5-22). Family members were 76% female, 63% MA, 32% NHW, and 5% other race/ethnicity, mean age 56 (SD 13). Of 256 patients, 118 (46%) had a family member with cost concerns. After adjustment for all covariates, MA ethnicity and lack of insurance were associated with greater cost concerns. Cost concerns decreased over time and were less common among family members who were neither a spouse nor a child of the patient. In semistructured interviews, cost concerns related to postacute care were most frequently mentioned, but concerns regarding hospital costs and nonmedical costs were also common.</p><p><strong>Discussion: </strong>Nearly half of family surrogate decision-makers of patients with stroke had at least moderate concerns about being able to afford stroke-related medical costs. Lack of adequate insurance and membership in a historically marginalized ethnic group were the strongest predictors of cost concerns.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 2","pages":"e200451"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975301/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811950","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":"Validation of a Machine-Learning Clinical Decision Aid for the Differential Diagnosis of Transient Loss of Consciousness.","authors":"Alistair Wardrope, Melloney Ferrar, Steve Goodacre, Daniel Habershon, Timothy J Heaton, Stephen J Howell, Markus Reuber","doi":"10.1212/CPJ.0000000000200448","DOIUrl":"10.1212/CPJ.0000000000200448","url":null,"abstract":"<p><strong>Background and objectives: </strong>The aim of this study was to develop and validate a machine-learning classifier based on patient and witness questionnaires to support differential diagnosis of transient loss of consciousness (TLOC) at first presentation.</p><p><strong>Methods: </strong>We prospectively recruited patients newly presenting with TLOC to an emergency department, an acute medical unit, and a first seizure or syncope clinic. We invited participants to complete an online questionnaire, either at home or at time of initial assessment. Two expert raters determined the cause of participants' TLOC after 6-month follow-up. We used independent development and validation samples to train a random forest classifier to predict diagnosis from participants' questionnaire responses and validate classifier performance. We compared classifier performance against penalized linear regression and referrer diagnosis.</p><p><strong>Results: </strong>We included 178 participants in the final analysis, of whom 46 identified a witness able to complete an additional witness questionnaire. Given low witness recruitment, we developed a classifier based on patient answers only. A classifier trained on 9 items correctly identified 63 of 78 diagnoses (80.8%) (95% CI 70.0-88.5), an increase over the accuracy of initial assessing clinicians who were only able to diagnose 70.5% correctly. Within this, 96% (87.0%-99.4%) of those expertly rated as having syncope were correctly classified by the classifier (classifier sensitivity); 40% (20%-63.6%) of those expertly rated after follow-up as having either epilepsy or functional/dissociative seizures were similarly classified as being nonsyncope (classifier specificity).</p><p><strong>Discussion: </strong>A machine-learning classifier for differential diagnosis of TLOC has comparable performance in differentiating between 3 main causes of primary TLOC as the current standard of care but is insufficiently accurate in its current form to warrant incorporation into routine care. A system including information from witnesses might improve classification performance.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 2","pages":"e200448"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803923","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":"ALS Motor Observational Telemedicine Objective Rasch-Built Assessment: A Quantitative Scale for the Era of Teleneurology.","authors":"Christina N Fournier, Mark Levine, Karon Simmons, Rocío Carolina García-Santibáñez, Anne Rowland, Colin C Quinn, Doreen T Ho, Richard S Bedlack, Jonathan D Glass","doi":"10.1212/CPJ.0000000000200432","DOIUrl":"10.1212/CPJ.0000000000200432","url":null,"abstract":"<p><strong>Background and objectives: </strong>Telemedicine has become a mainstay of ALS clinical care, but there is currently no standardized approach for assessing and tracking changes to the neurologic examination in this format. The goal of this study was to create a standardized telemedicine-based motor examination scale to objectively and reliably track ALS progression and use Rasch methodology to validate the scale and improve its psychometric properties.</p><p><strong>Methods: </strong>A draft telemedicine examination scale with 25 items assessing movement in the bulbar muscles, neck, trunk, and extremities was created by an ALS expert panel, incorporating input from patient advisors. This prospective, observational study was approved by the Emory IRB, and participants provided informed consent. Adults with a diagnosis of ALS who were able to undergo a video telemedicine evaluation by an Emory clinician were eligible for participation. Rasch analyses were performed to determine the final item responses and optimize the scoring structure. Test-retest reliability was assessed in a subset of participants through 2 separate examinations by 2 different examiners within a 7-day period. Construct validity was assessed by calculating correlations with simultaneously administered Rasch-built Overall ALS Disability Scale (ROADS) and revised ALS Functional Rating Scale (ALSFRS-R).</p><p><strong>Results: </strong>The ALS Motor Observational Telemedicine Objective Rasch-built assessment was administered to a total of 258 PALS representing the full spectrum of a typical ALS clinic population. After performing Rasch analyses, 3 items were removed and item response categories were consolidated for 8 items. The final 22-item ALS MOTOR scale conformed to Rasch model criteria. The inter-rater reliability was 95%. The ALS MOTOR had a 0.78 (95% CI 0.72-0.83) correlation with ALSFRS-R and 0.81 (95% CI 0.76-0.85) correlation with ROADS.</p><p><strong>Discussion: </strong>The ALS MOTOR is a novel, accessible tool for remotely and objectively tracking ALS progression for both clinical care and research studies. Use of Rasch methodology for scale validation allowed for optimization of scale psychometric properties, which is particularly important when using the sum score as an overall outcome measure. Longitudinal and external validation studies are ongoing.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 2","pages":"e200432"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059625","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":"Approach to Managing the Initial Presentation of Multiple Sclerosis: A Worldwide Practice Survey.","authors":"Jodie I Roberts, Aravind Ganesh, Luca Bartolini, Tomas Kalincik","doi":"10.1212/CPJ.0000000000200376","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200376","url":null,"abstract":"<p><strong>Background and objectives: </strong>Available disease-modifying therapies (DMTs) for multiple sclerosis (MS) are rapidly expanding; although escalation approaches aim to balance safety and efficacy, emerging evidence suggests superior outcomes for people with MS who are exposed to early high-efficacy therapies. We aimed to explore practice differences in prevailing management strategies for relapsing-remitting MS.</p><p><strong>Methods: </strong>We used a worldwide electronic survey launched by the Practice Current section of <i>Neurology® Clinical Practice</i>. Questions pertained to a case of a 37-year-old woman presenting with optic neuritis. Respondents were asked to indicate their initial investigations, relapse management strategy, choice of disease-modifying therapy, and plan for follow-up imaging (contrast/noncontrast). Survey responses were stratified by key demographic variables along with 95% confidence intervals (95% CIs).</p><p><strong>Results: </strong>We received 153 responses from 42 countries; 32.3% responders identified as MS specialists. There was a strong preference for intravenous delivery of high-dose corticosteroids (87.7%, 95% CI 80.7-92.5), and most of the responders (61.3%, 95% CI 52.6-69.4) indicated they would treat a nondisabling (mild sensory) MS relapse. When asked to select a single initial DMT, 56.6% (95% CI 47.6-65.1) selected a high-efficacy therapy (67.5% MS specialists vs 53.7% non-MS specialists). The most selected agents overall were fingolimod (14.7%), natalizumab (15.5%), and dimethyl fumarate (20.9%). Two-thirds of respondents indicated they would request contrast-enhanced surveillance MRI.</p><p><strong>Discussion: </strong>Although there is a slight preference for initiating high-efficacy DMT at the time of initial MS diagnosis, opinions regarding the most appropriate treatment paradigm remain divided.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200376"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470862","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":"Coprophenomena Associated With Worse Individual and Family Function for Youth With Tourette Syndrome: A Cross-Sectional Study.","authors":"Samantha P Myers, Kathleen D Meeks, Heather Adams, Amy E Vierhile, Erika Augustine, Alyssa Collins, Adam B Lewin, Tanya K Murphy, Jonathan W Mink, Jennifer Vermilion","doi":"10.1212/CPJ.0000000000200369","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200369","url":null,"abstract":"<p><strong>Background and objectives: </strong>Tourette syndrome (TS) is defined by multiple motor tics and one or more phonic tics with a symptom duration of >1 year. Coprophenomena are uncommon tics characterized by obscene sounds, words, or gestures. Youth with TS commonly have psychiatric co-occurring conditions such as attention-deficit hyperactivity disorder or obsessive-compulsive disorder and have reported lower scores on measures of individual and family functioning than youth without TS. This study aimed to determine associations among co-occurring condition symptoms, tic severity, and function in youth with TS and coprophenomena compared with those with TS without coprophenomena.</p><p><strong>Methods: </strong>Data were collected through a multicenter, cross-sectional study. Youth with TS were recruited from 2 referral centers, and data were collected from youth and their parents or caregivers. Tic severity was assessed using the Yale Global Tic Severity Scale, and individual function was measured with the Children's Global Assessment Scale. Family impact was measured using the Family Impact Module in domains of parent health-related quality of life (HRQOL), family functioning, and total family impact. We compared individual and family function in youth with TS with coprophenomena (TS+copro) and without coprophenomena (TS-copro). Wilcoxon rank-sum tests were used to compare scores on individual function and family function measures.</p><p><strong>Results: </strong>Of 169 participants, 17 (10.1%) reported coprophenomena. Participants with TS and coprophenomena had higher tic severity scores than those without coprophenomena (TS+copro mean = 36.9, TS-copro = 20.8). Youth with coprophenomena had lower scores for global function (TS+copro median = 51, TS-copro = 60), family functioning (TS+copro = 43.8, TS-copro = 59.4), parent HRQOL (TS+copro = 57, TS-copro = 72), and total family QOL (TS+copro = 50.7, TS-copro = 65.3).</p><p><strong>Discussion: </strong>Youth with TS and coprophenomena had lower individual function, family function, and parent HRQOL than youth without coprophenomena. Coprophenomena presence may indicate that youth have a more severe phenotype of TS, and youth with copropheneomena may benefit from additional caregiver or family supports.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200369"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470865","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":"Functional Movement Disorders and Deep Brain Stimulation: A Review.","authors":"Alexandra Boogers, Alfonso Fasano","doi":"10.1212/CPJ.0000000000200367","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200367","url":null,"abstract":"<p><strong>Purpose of the review: </strong>The aim of this narrative review was to explore the interplay between functional movement disorders (FMDs) and deep brain stimulation (DBS).</p><p><strong>Recent findings: </strong>Patients with unrecognized FMD who are referred for DBS usually present with functional dystonia. By contrast, patients who present with FMD after DBS are mostly presenting with functional tremor, in keeping with non-DBS FMD cohorts. Comorbid presentation of FMD in established DBS indications makes the decision to opt for surgery challenging. Many contributing factors can play a role in the development of FMD, including the trauma caused by awake neurosurgery and/or extensive DBS programming.</p><p><strong>Summary: </strong>FMDs in the context of DBS are often overlooked and should be diagnosed promptly because they determine surgical outcome. The approach to DBS candidates with comorbid FMD and the risk factors of FMD after DBS should be further explored.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200367"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470873","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}