BMJ Neurology Open最新文献

{"title":"Improving cognition in people with multiple sclerosis: study protocol for a multiarm, randomised, blinded trial of multidomain cognitive rehabilitation using a video-serious game (E-SEP cognition).","authors":"Bruno Lenne, Béatrice Degraeve, Jessy Davroux, Laurène Norberciak, Arnaud Kwiatkowski, Cécile Donze","doi":"10.1136/bmjno-2023-000488","DOIUrl":"10.1136/bmjno-2023-000488","url":null,"abstract":"<p><strong>Introduction: </strong>Multiple sclerosis (MS) is a prevalent neurological disease characterised by disseminated areas of demyelination and atrophy within the central nervous system, inducing cognitive disorders in 45%-65% of persons with MS (PwMS). Neuropsychology and neuroimaging studies provide evidence of the effectiveness of cognitive rehabilitation interventions, including memory and attention. Recently, serious game therapy (SGT) has been used in rehabilitation to improve cognitive processing speed. The aim of this study is to describe the protocol of a randomised controlled trial (RCT) to test the efficacy of a tablet-based cognitive home intervention among ambulatory PwMS, in comparison to a standardised neuropsychological rehabilitation.</p><p><strong>Methods and analysis: </strong>This will be a parallel-assignment, double-blinded, RCT. One hundred and fifty (75 per arm) PwMS will be randomly assigned to receive cognitive rehabilitation session over 4 months (four 20-min sessions/week) of either: (1) tablet-based SGT or (2) conventional cognitive exercises. The same assessor will evaluate outcome measures at three points: at baseline (T0), after the 16 therapy sessions weeks (T1), and 6 months after the end of treatment (T2). The primary outcomes were the scores from the <i>Brief International Cognitive Assessment for Multiple Sclerosis</i> (BICAMS). Data analysis will be performed to compare the efficacy of the two treatments. We expect superior efficiency of tablet-based SGT in contrast to conventional cognitive exercises, based on BICAMS measures of speed processing information and episodic memory.</p><p><strong>Ethics and dissemination: </strong>The trial protocol is registered on ClinicalTrials.Gov (NCT04694534) and benefits from a favourable opinion from an ethics committee (RC-P0066-2018-A00411-54).</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10685921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138464311","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":"Ambroxol as a disease-modifying treatment to reduce the risk of cognitive impairment in <i>GBA</i>-associated Parkinson's disease: a multicentre, randomised, double-blind, placebo-controlled, phase II trial. The AMBITIOUS study protocol.","authors":"Fabiana Colucci, Micol Avenali, Rosita De Micco, Marco Fusar Poli, Silvia Cerri, Mario Stanziano, Ana Bacila, Giada Cuconato, Valentina Franco, Diego Franciotta, Cristina Ghezzi, Matteo Gastaldi, Antonio Emanuele Elia, Luigi Romito, Grazia Devigili, Valentina Leta, Barbara Garavaglia, Nico Golfrè Andreasi, Federico Cazzaniga, Chiara Reale, Caterina Galandra, Giancarlo Germani, Pierfrancesco Mitrotti, Gerardo Ongari, Ilaria Palmieri, Marta Picascia, Anna Pichiecchio, Mattia Verri, Fabrizio Esposito, Mario Cirillo, Federica Di Nardo, Simone Aloisio, Mattia Siciliano, Sara Prioni, Paolo Amami, Sylvie Piacentini, Maria Grazia Bruzzone, Marina Grisoli, Fabio Moda, Roberto Eleopra, Alessandro Tessitore, Enza Maria Valente, Roberto Cilia","doi":"10.1136/bmjno-2023-000535","DOIUrl":"https://doi.org/10.1136/bmjno-2023-000535","url":null,"abstract":"<p><strong>Background: </strong>Heterozygous mutations in the <i>GBA</i> gene, encoding the lysosomal enzyme β-glucocerebrosidase (GCase), are the most frequent genetic risk factor for Parkinson's disease (PD). <i>GBA</i>-related PD (GBA-PD) patients have higher risk of dementia and reduced survival than non-carriers. Preclinical studies and one open-label trial in humans demonstrated that the chaperone ambroxol (ABX) increases GCase levels and modulates α-synuclein levels in the blood and cerebrospinal fluid (CSF).</p><p><strong>Methods and analysis: </strong>In this multicentre, double-blind, placebo-controlled, phase II clinical trial, we randomise patients with GBA-PD in a 1:1 ratio to either oral ABX 1.2 g/day or placebo. The duration of treatment is 52 weeks. Each participant is assessed at baseline and weeks 12, 26, 38, 52 and 78. Changes in the Montreal Cognitive Assessment score and the frequency of mild cognitive impairment and dementia between baseline and weeks 52 are the primary outcome measures. Secondary outcome measures include changes in validated scales/questionnaires assessing motor and non-motor symptoms. Neuroimaging features and CSF neurodegeneration markers are used as surrogate markers of disease progression. GCase activity, ABX and α-synuclein levels are also analysed in blood and CSF. A repeated-measures analysis of variance will be used for elaborating results. The primary analysis will be by intention to treat.</p><p><strong>Ethics and dissemination: </strong>The study and protocols have been approved by the ethics committee of centres. The study is conducted according to good clinical practice and the Declaration of Helsinki. The trial findings will be published in peer-reviewed journals and presented at conferences.</p><p><strong>Trial registration numbers: </strong>NCT05287503, EudraCT 2021-004565-13.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10679992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138464310","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":"Cerebral venous sinus thrombosis secondary to acute cytomegalovirus infection.","authors":"Andrew J Martin","doi":"10.1136/bmjno-2023-000460","DOIUrl":"10.1136/bmjno-2023-000460","url":null,"abstract":"<p><strong>Background: </strong>Cerebral venous sinus thrombosis (CVST) is a potentially life-threatening disorder with a number of causes, including viral infections.</p><p><strong>Case presentation: </strong>A 25-year-old female patient presented with a non-specific febrile illness, headache and hepatitis. She was found to have right transverse sinus and cortical venous thrombosis in addition to acute systemic Cytomegalovirus (CMV) infection. She responded well to anticoagulation with warfarin for 6 months. CMV infection was treated conservatively.</p><p><strong>Conclusion: </strong>CVST is an increasingly prevalent condition often presenting with headache, focal neurological deficits and seizures. Despite extensive investigations, often no specific cause is found. CMV is a ubiquitous virus that can present with a non-specific febrile illness or a variety of organ dysfunction. CMV has been shown to be associated with predominantly venous thrombosis, most commonly lower limb deep venous thrombosis, pulmonary embolism and splanchnic vein thrombosis. The risk is highest in immunocompromised patients, though most patients are immunocompetent. There have been few reports of CVST related to CMV and all of these with a more tenuous link to acute CMV infection. Clinicians should be aware of this link, particularly in those who have CVST in the context of a febrile illness, or immunocompromised patients.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10626861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71488834","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":"Assessment of ChatGPT's performance on neurology written board examination questions.","authors":"Tse Chian Chen, Evan Multala, Patrick Kearns, Johnny Delashaw, Aaron Dumont, Demetrius Maraganore, Arthur Wang","doi":"10.1136/bmjno-2023-000530","DOIUrl":"10.1136/bmjno-2023-000530","url":null,"abstract":"<p><strong>Background and objectives: </strong>ChatGPT has shown promise in healthcare. To assess the utility of this novel tool in healthcare education, we evaluated ChatGPT's performance in answering neurology board exam questions.</p><p><strong>Methods: </strong>Neurology board-style examination questions were accessed from BoardVitals, a commercial neurology question bank. ChatGPT was provided a full question prompt and multiple answer choices. First attempts and additional attempts up to three tries were given to ChatGPT to select the correct answer. A total of 560 questions (14 blocks of 40 questions) were used, although any image-based questions were disregarded due to ChatGPT's inability to process visual input. The artificial intelligence (AI) answers were then compared with human user data provided by the question bank to gauge its performance.</p><p><strong>Results: </strong>Out of 509 eligible questions over 14 question blocks, ChatGPT correctly answered 335 questions (65.8%) on the first attempt/iteration and 383 (75.3%) over three attempts/iterations, scoring at approximately the 26th and 50th percentiles, respectively. The highest performing subjects were pain (100%), epilepsy & seizures (85%) and genetic (82%) while the lowest performing subjects were imaging/diagnostic studies (27%), critical care (41%) and cranial nerves (48%).</p><p><strong>Discussion: </strong>This study found that ChatGPT performed similarly to its human counterparts. The accuracy of the AI increased with multiple attempts and performance fell within the expected range of neurology resident learners. This study demonstrates ChatGPT's potential in processing specialised medical information. Future studies would better define the scope to which AI would be able to integrate into medical decision making.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10626870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71488833","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":"Efficacy of exercises in early-stage Parkinson’s disease (PARK-EASE trial): single-blind, randomised, controlled trial","authors":"Raktim Swarnakar, Sanjay Wadhwa, Srikumar Venkataraman, Vinay Goyal, Sreenivas Vishnubhatla","doi":"10.1136/bmjno-2023-000499","DOIUrl":"https://doi.org/10.1136/bmjno-2023-000499","url":null,"abstract":"Objectives To assess the efficacy of exercises in early-stage Parkinson’s disease (PD). Design Single-blind, randomised controlled trial. Setting Tertiary rehabilitation care centre. Participants Forty individuals (≥18 years, either gender) with newly diagnosed PD (Hoehn and Yahr stage ≤2) on a stable dose of PD medications were randomised (1:1) to the intervention group (IG) and control group (CG). Interventions The IG received strengthening (30 min/day, 2 days/week), aerobic (30 min/day, 3 days/week) and agility (30 min/day, 2 days/week) exercises in a structured format for 12 weeks. CG received stretching exercises for 12 weeks. Main outcome measures Unified PD Rating Scale (UPDRS) III (motor) at week 12 (primary), UPDRS I (mentation, behaviour and mood), UPDRS II and VI (Schwab and England Activities of daily living Scale) and Parkinson’s Disease Quality of Life (PDQL) at week 12 (secondary). Results 36 participants completed 12-week study period. UPDRS III (lesser scores reflect improvement) at 12 weeks showed a significant between-group difference (−5.05 points (95% CI: −9.38 to −0.71), p=0.02). At 4 and 8 weeks, UPDRS III did not show a statistically significant between-group difference (−2.15 points (95% CI: −6.77 to 2.47) and −4.1 points (95% CI: −8.54 to 0.34), respectively). From baseline to 12 weeks, UPDRS III in the IG showed a 6.5-point (95% CI (4.85 to 8.14)) reduction, and the CG showed a 0.8-point increase (95% CI (−3.06 to 1.46)), PDQL (higher scores reflect improvement) in the IG showed a 8.45-point (95% CI (–12.78 to –4.11)) increase and CG showed a 2.75-point (95% CI (0.16 to 5.33)) reduction. Conclusions Structured exercises improve motor symptoms and quality of life in early-stage PD. Consistent adherence for at least 12 weeks is crucial for clinical improvement. Early initiation of exercises as neurorehabilitation is recommended. Further research on specific types, dosing and intensity of exercises with a larger sample size is warranted in early-stage PD. Trial registration number CTRI/2018/05/014241.","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135764920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"STAREE-Mind Imaging Study: a randomised placebo-controlled trial of atorvastatin for prevention of cerebrovascular decline and neurodegeneration in older individuals.","authors":"Ian H Harding,&nbsp;Joanne Ryan,&nbsp;Stephane Heritier,&nbsp;Simone Spark,&nbsp;Zachary Flanagan,&nbsp;Richard McIntyre,&nbsp;Craig S Anderson,&nbsp;Sharon L Naismith,&nbsp;Trevor T-J Chong,&nbsp;Michael O'Sullivan,&nbsp;Gary Egan,&nbsp;Meng Law,&nbsp;Sophia Zoungas","doi":"10.1136/bmjno-2023-000541","DOIUrl":"10.1136/bmjno-2023-000541","url":null,"abstract":"<p><strong>Introduction: </strong>Cerebrovascular disease and neurodegeneration are causes of cognitive decline and dementia, for which primary prevention options are currently lacking. Statins are well-tolerated and widely available medications that potentially have neuroprotective effects. The STAREE-Mind Imaging Study is a randomised, double-blind, placebo-controlled clinical trial that will investigate the impact of atorvastatin on markers of neurovascular health and brain atrophy in a healthy, older population using MRI. This is a nested substudy of the 'Statins for Reducing Events in the Elderly' (STAREE) primary prevention trial.</p><p><strong>Methods: </strong>Participants aged 70 years or older (n=340) will be randomised to atorvastatin or placebo. Comprehensive brain MRI assessment will be undertaken at baseline and up to 4 years follow-up, including structural, diffusion, perfusion and susceptibility imaging. The primary outcome measures will be change in brain free water fraction (a composite marker of vascular leakage, neuroinflammation and neurodegeneration) and white matter hyperintensity volume (small vessel disease). Secondary outcomes will include change in perivascular space volume (glymphatic drainage), cortical thickness, hippocampal volume, microbleeds and lacunae, prefrontal cerebral perfusion and white matter microstructure.</p><p><strong>Ethics and dissemination: </strong>Academic publications from this work will address the current uncertainty regarding the impact of statins on brain structure and vascular integrity. This study will inform the utility of repurposing these well-tolerated, inexpensive and widely available drugs for primary prevention of neurological outcomes in older individuals. Ethics approval was given by Monash University Human Research Ethics Committee, Protocol 12206.</p><p><strong>Trial registration number: </strong>ClinicalTrials.gov Identifier: NCT05586750.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10619122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71429077","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":"Evaluation of the efficacy and safety of MRI-guided focused ultrasound (MRgFUS) for focal hand dystonia: study protocol for an open-label non-randomised clinical trial.","authors":"Joel Maamary, James Peters, Kain Kyle, Diane Ruge, Benjamin Jonker, Yael Barnett, Stephen Tisch","doi":"10.1136/bmjno-2023-000522","DOIUrl":"10.1136/bmjno-2023-000522","url":null,"abstract":"<p><strong>Introduction: </strong>MRI-guided focused ultrasound (MRgFUS) thalamotomy provides an exciting development in the field of minimally invasive stereotactic neurosurgery. Current treatment options for focal hand dystonia are limited, with potentially more effective invasive stereotactic interventions, such as deep brain stimulation or lesional therapies, rarely used. The advent of minimally invasive brain lesioning provides a potentially safe and effective treatment approach with a recent pilot study establishing MRgFUS Vo-complex thalamotomy as an effective treatment option for focal hand dystonia. In this study, we undertake an open-label clinical trial to further establish MRgFUS Vo-complex thalamotomy as an effective treatment for focal hand dystonia with greater attention paid to potential motor costs associated with this treatment. To elucidate pathophysiology of dystonia and treatment mechanisms, neurophysiological and MRI analysis will be performed longitudinally to explore the hypothesis that neuroplastic and structural changes that may underlie this treatment benefit.</p><p><strong>Methods and analysis: </strong>A total of 10 participants will be recruited into this open-label clinical trial. All participants will undergo clinical, kinemetric, neurophysiological and radiological testing at baseline, followed by repeated measures at predesignated time points post MRgFUS Vo-complex thalamotomy. Further, to identify any underlying structural or neurophysiological abnormalities present in individuals with focal hand dystonia, 10 age and gender matched control participants will be recruited to undergo comparative investigation. These results will be compared with the intervention participants both at baseline and at 12 months to assess for normalisation of these abnormalities, if present.</p><p><strong>Ethics and dissemination: </strong>This trial was reviewed and approved by the St Vincent's Health Network Sydney Human Research Ethics Committee (2022/ETH00778). Study results will be published in peer-reviewed journals and presented at both national and international conferences.</p><p><strong>Trial registration number: </strong>CTRN12622000775718.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10603452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71415184","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":"Oculomotor palsy and drowsiness due to post-thrombectomy subarachnoid haemorrhage falsely suggesting transtentorial herniation.","authors":"Logesh Palanikumar,&nbsp;Joshua Mahadevan,&nbsp;Timothy Kleinig","doi":"10.1136/bmjno-2023-000500","DOIUrl":"10.1136/bmjno-2023-000500","url":null,"abstract":"<p><strong>Introduction: </strong>Post-thrombectomy subarachnoid haemorrhage (SAH) can result in oculomotor palsy and drowsiness, which may falsely suggest transtentorial herniation.</p><p><strong>Case presentation: </strong>We present a case of right oculomotor nerve palsy presenting after endovascular thrombectomy (EVT) for a right middle cerebral artery (MCA) stroke. The patient presented with a significant right MCA syndrome and a National Institutes of Health Stroke Scale (NIHSS) score of 10 with CT perfusion demonstrating a large penumbral lesion and a CT angiogram confirming a right MCA M1 occlusion. After thrombectomy, the patient developed a 9mm dilated non-reactive right pupil, and a new ipsilateral near-complete oculomotor nerve palsy. Repeat code stroke imaging demonstrated perimesencephalic SAH). The patient was managed expectantly and her conscious state and oculomotor palsy gradually resolved with an excellent neurological recovery.</p><p><strong>Conclusion: </strong>This case underscores the potential for post-thrombectomy perimesencephalic SAH as a rare mimic of symptomatic intracranial haemorrhage with mass effect manifesting as sudden-onset oculomotor nerve palsy.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5a/36/bmjno-2023-000500.PMC10551951.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41155375","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":"Physical exercise for treating non-motor symptoms assessed by general Parkinson's disease scales: systematic review and meta-analysis of clinical trials.","authors":"Valton Costa,&nbsp;Alice de Oliveira Barreto Suassuna,&nbsp;Thanielle Souza Silva Brito,&nbsp;Thalita Frigo da Rocha,&nbsp;Anna Carolyna Gianlorenco","doi":"10.1136/bmjno-2023-000469","DOIUrl":"10.1136/bmjno-2023-000469","url":null,"abstract":"<p><strong>Introduction: </strong>Parkinson's disease is a movement disorder that also manifests non-motor symptoms (NMS). Physical exercise is a prominent strategy that can have an impact on NMS; however, the evidence is limited. Our aim was to verify the effects of exercise on NMS, as assessed using general NMS scales.</p><p><strong>Methods: </strong>This study is a systematic review and meta-analysis. Two searches were conducted on the PubMed, Cochrane Library, Scopus, Web of Science, Embase, Science Direct and PEDro databases from September to December 2022. The PEDro scale was used to assess the methodological quality of the studies.</p><p><strong>Results: </strong>Twenty-three studies were included. The interventions were classified as multimodal, aerobic, resistance, dance, conventional physical therapy and other types. Five studies had high risk of bias. Eight studies were included in the meta-analyses. According to the criteria, four studies compared exercise with non-exercise (n=159), two compared multimodal exercise with cognitive/leisure approaches (n=128), and two compared aerobic with conventional exercise (n=40). No statistical differences were observed between exercise and non-exercise (-0.26 (-0.58 to 0.05)) and between multimodal and cognitive approaches (0.21 (-0.14 to 0.55)). However, trends were observed in the direction of exercise and cognitive approaches. A significant difference was observed favouring aerobic over conventional exercise (-0.72 (-1.36 to -0.08)).</p><p><strong>Conclusions: </strong>Our findings suggest that exercise may have an effect on general NMS compared with non-exercise, although only a trend was observed. It was also observed for cognitive approaches over multimodal exercises. Aerobic exercise showed near-large effects compared with conventional exercise.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cb/6b/bmjno-2023-000469.PMC10551973.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41172010","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":"Myths and facts about functional neurological disorders: a cross-sectional study of knowledge and awareness among medical students and healthcare professionals in Iraq.","authors":"Essam M Al-Sibahee,&nbsp;Ahmed Hashim,&nbsp;Sajjad Al-Badri,&nbsp;Nabeel Al-Fatlawi","doi":"10.1136/bmjno-2023-000470","DOIUrl":"https://doi.org/10.1136/bmjno-2023-000470","url":null,"abstract":"<p><strong>Background: </strong>Functional neurological disorder (FND) is a complex condition with neurological symptoms but no clear structural or biochemical explanation. Myths and misconceptions about FND can lead to misdiagnosis and inappropriate treatment. This study aimed to assess knowledge and common myths about FND among medical students and practitioners.</p><p><strong>Methods: </strong>Data were collected from 324 participants using a structured questionnaire. The questionnaire included demographics, general information about FND and myths about FND. Data were analysed using non-parametric tests and Spearman's r for correlations.</p><p><strong>Results: </strong>The majority of participants were clinical-years medical students (65.1%) and female (59.6%). Overall, knowledge about FND was limited, with a mean score of 42.3% of correct answers. Common myths included the belief that FND is a psychological disorder and that patients feign symptoms. Knowledge scores differed significantly among different grades/experience levels, with postgraduate practitioners having the highest scores. There was a positive correlation between knowledge scores and confidence in managing FND.</p><p><strong>Conclusion: </strong>This study highlights the prevalence of myths and misconceptions about FND among medical students and practitioners, emphasising the need for accurate education to improve diagnosis and management. Healthcare professionals should take a biopsychosocial approach to FND, considering the complex interplay between biological, psychological and social factors. Efforts to increase awareness and reduce stigma associated with FND are crucial for promoting better care. Targeted educational interventions may be beneficial to improve the understanding and management of FND among medical professionals.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/24/80/bmjno-2023-000470.PMC10546105.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41136418","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}