[Child neurology. Introduction. What is child neurology and what is the child neurologic disease panorama].
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Disabling neurological syndromes: prevalence amongst hospitalized neurological patients.
Neurological patient populations are usually described by diagnosis or in terms of functional disability measures but rarely by their clinical syndromes. A point-prevalence study was conducted assessing 349 neurological inpatients to determine the frequency and co-occurrence of disabling neurological syndromes, considering a wider spectrum including pain, emotional, neuropsychological, vegetative and sensorimotor syndromes. Of the study patients, 61% (n = 224) had sensorimotor syndromes, 53% (n = 185) had neuropsychological disorders, 40% (n = 139) of the patients suffered from pain, emotional disorders were found in 36% (n = 122) and vegetative disorders in 33% (n = 113). Although frequency varied by neurological diagnosis, these disabling conditions were found across all inpatient groups of diagnosis. Similarly, disorders outside the motor domains grouped according to their Barthel Index showed a striking frequency in patients considered as activities of daily living independent, reflecting a wider spectrum of disability that functional measures are not able to capture. Of the study population, 68% (n = 237) suffered from co-occurring disorders from different categories (pain, emotional, neuropsychological, vegetative and sensorimotor syndromes). There is a high prevalence and co-occurrence of disabling syndromes in neurological inpatients. These proportions reflect the neurological workload in a patient population and should be considered in future rehabilitation research and allocation of resources.
Activities of Daily Living↗
[Urgent neurologic states: experience at the Neurology Clinic in Sarajevo].
There is a quite good definition of medical care for patients suffering from chronicle neurological diseases. However the neurologist role in taking care of urgent cases is substantially less determined. This paper is analyzing one year efforts of the on duty neurological team in the Out Patient Department and Emergency Division of the Neurology Department in Sarajevo. During this period the on duty neurological team examined the total of 3939 patients, out of which 1022 patients where kept for treatment. The patients where most frequently assigned to the Emergency unit for following reasons: vascular incident of the Central Nervous System(1955 patients or 50%), cerebrovascular accident represented with 1290 or 33%, and TIA of the carotid and vertebrobasilar area 544 or 14% along with hypertensive encephalopathia, 118 or 3%. This is followed by the group of the short-term disturbance of consciousness (472 or 125), out of which the consciousness crises represented 257 or 7%, and epileptic crises 215 or 5%. Following are the lower percentages of the headaches (287 or 7%), radicular painful syndrome of cervical and lumbal area (209 or 5%), vertigo (183 or 5%), neurophatia (167 or 4%), etc. The more extensive number of patients admitted at the Emergency Division where suffering from brain stroke (800 or 78%), TIA was represented by a lower number (172 or 17%). Only 50 patients had other diagnosis. The ischemic stroke represented 674 or 81% with patients suffering from the brain stroke and the hemorrhagic stroke 153 or 19%. Today, the urgent neurological conditions represent a particular area of Neurology, not only neurologists need to know but also other medical doctors, to enable the patients to be forwarded on time to the appropriate care institution.
Central Nervous System Diseases↗
[Psychosomatic aspects of neurologic diseases. Experiences with clinical neurology from the viewpoint of the psychoanalyst].
The great relevance of psychoanalytic-psychosomatic aspects for a more profound understanding of neurological diseases is the topic of this article. In terms of medical history, the development of the discipline of neurology especially in Germany is outlined, whereby neurology and psychosomatic medicine share the fate of a handicapped individuation. On the background of this delayed establishment as branches of their own, the mutual denial of neurology and psychosomatic medicine up to the present is discussed. By means of a survey of literature and case examples of several neurological disorders (hysterical conversion symptoms, selected diseases of the extrapyramidal motor system, lumbago, sciatica, cephalgia, epilepsy) the great importance of psychosomatic medicine and psychoanalysis for neurology is pointed out.
Conversion Disorder↗
Human neuro-specimen banking 1961-1992. The National Neurological Research Specimen Bank (a donor program of pre- and post-mortem tissues and cerebrospinal fluid/blood; and a collection of cryopreserved human neurological specimens for neuroscientists).
The National Neurological Research Specimen Bank (The Bank) was established in 1961 to provide a vital service to neuroscientists. Our purpose is to support medical research which seeks the etiopathogenesis for devastating neurological disorders with no known cause, treatment or precise animal model. It serves as a bridge between the neurology clinician who diagnoses and cares for patients with incurable disease and the basic scientist who has need for specimens to find their etiopathogenesis. In the long run this service should advance neurologic diagnoses and serve as the basis for designing treatment. The Bank has grown to be the largest, most diverse neurological specimen bank of its kind in the world. It is a type of "tissue bank" where donor members "will" their central nervous system tissues to science. Then we collect, photograph, seal in air tight bags, quick freeze, cryogenically store and distribute on request the donated tissue to research scientists around the world. All tissue diagnoses are confirmed by clinical records and neuropathologic examination; further histology is conducted on request. In addition to brain and spinal cord tissues, the Bank has samples of other tissues. There are also samples of pre- and post-mortem CSF and sera from normal individuals and patients with various neurological disorders, especially serial specimens on multiple sclerosis patients and HIV-1 seropositive and at risk individuals. This paper outlines the global operations of our human brain bank, based on protocols developed and used by the authors. These operations include donor solicitation, tissue acquisition and documentation, tissue processing and storage, specimen dissemination to users, outcome assessment of banking, quality control, cost of our operation, table of organization and the future.
Blood Donors↗
The Health Care Financing Administration's new examination documentation criteria: minimum auditing standards for the neurologic examination to be used by Medicare and other payors. Report from the American Academy of Neurology Medical Economics and Management Subcommittee.
Medicare recently announced the adoption of minimum documentation criteria for the neurologic examination. These criteria are added to existing standards for the history and medical decision-making. These criteria will be used in compliance audits by Medicare and other payors. Given the current federal initiative to eliminate fraud in the Medicare program, all neurologists need to comply with these standards. These criteria are for documentation only. Neurologic standards of care require a more complex and diverse examination pertinent to the problem(s) under consideration. Further guidance as to the content of a neurologic evaluation is outlined in the article "Practice guidelines: Neurologic evaluation" (Neurology 1990; 40: 871). The level of history and examination required for specific services is defined in the American Medical Association current procedural terminology book. Documentation standards for examination of children are not yet defined.
Aged↗
Executive summary of the National Institute of Neurological Disorders and Stroke conference on Emergency Neurologic Clinical Trials Network.
On March 17 and 18, 2004, the National Institute of Neurological Disorders and Stroke sponsored a conference to explore the advisability of establishing a multicenter network designed to perform clinical trials in emergency neurologic conditions. The Emergency Neurology Clinical Trials Network concept was discussed by 25 clinicians and scientists from multiple disciplines. The goal was to improve the overall functional outcome for patients with acute neurologic emergencies. The participants discussed various aspects necessary in evaluating the potential of such a network, including the organization structure, funding, cost-effectiveness, and clinical conditions to be studied. A neurologic emergencies network that is not disease specific would open opportunities for clinical research that would facilitate rapid effective treatment of emergency conditions and lead to improved patient outcomes. In addition, the cost savings realized through economies of scale of such a network would allow more research to be performed at a lower cost.
Clinical Trials as Topic↗
Neurological disease, emotional disorder, and disability: they are related: a study of 300 consecutive new referrals to a neurology outpatient department.
OBJECTIVES: To determine the prevalence of anxiety and depressive disorders in patients referred to general neurology outpatient clinics, to compare disability and number of somatic symptoms in patients with and without emotional disorder, the relation to neurological disease, and assess the need for psychiatric treatment as perceived by patients and doctors. METHODS: A prospective cohort study set in a regional neurology service in Edinburgh, Scotland. The subjects were 300 newly referred consecutive outpatients who were assessed for DSM IV anxiety and depressive disorders (PRIME-MD, and HAD), health status, and disability (SF-36), and patients', GPs' and neurologists' ratings of the need for patient to receive psychiatric or psychological treatment. RESULTS: Of 300 new patients, 140 (47%) met criteria for one or more DSM IV anxiety or depressive diagnosis. Major depression was the most common (27%). A comparison of patients with and without emotional disorder showed that physical function, physical role functioning, bodily pain, and social functioning were worse in patients with emotional disorders (p<0. 0005). The median number of somatic symptoms was greater in patients with emotional disorders (p<0.0005). These differences were independent of the presence of neurological disease. Few patients wished to receive psychiatric or psychological treatments. Both general practitioners and neurologists were more likely to recommend psychiatric treatment when the patients' symptoms were medically unexplained. CONCLUSIONS: Almost half of new referrals to general neurology clinics met criteria for a DSM IV psychiatric diagnosis. These patients were more disabled, and had more somatic symptoms. They expressed little enthusiasm for receiving psychiatric treatment.
Adolescent↗
Delay in neurological attention and stroke outcome. Cerebrovascular Diseases Study Group of the Spanish Society of Neurology.
BACKGROUND AND PURPOSE: Despite efforts to reduce the delay between stroke onset and new interventional treatments, no studies have analyzed the repercussions of early neurological attention on the clinical outcome of stroke patients. METHODS: Data were obtained from 721 patients admitted consecutively for a transient ischemic attack or stroke to the neurology departments of 18 Spanish hospitals that followed the same diagnostic and therapeutic guidelines in the acute phase. Factors assessed were age, sex, Canadian Stroke Scale score on admission, previous Barthel Index, and delay before attention by the first physician, by emergency services, by a neurologist, and before hospitalization. Patients' outcomes were classified as good (Barthel Index > 60) or poor (Barthel Index < or = 60 or in-hospital death) depending on patient's functional capacity on discharge. The individual contribution of each of these variables on clinical outcome was estimated with logistic regression analysis. RESULTS: Patients in worse neurological condition on admission presented earlier to the first physician, emergency department, and neurologist. The mortality rate was not significantly modified by early or late presentation at the different medical stages. Logistic regression analysis revealed that the relative risk of poor outcome in patients seen by the neurologist after the first 6 hours from symptom onset was 5.6 (95% confidence interval, 3.4 to 9.2) (P < .0001). Multiple linear regression analysis showed that the delay before the patient received neurological attention correlated positively with the duration of hospitalization (P < .0001). The delays before the patient was seen by the first physician or the emergency department and before hospitalization were not independently related to clinical outcome or length of hospitalization. CONCLUSIONS: Early neurological attention in acute stroke is related to better functional outcome and shorter hospitalization.
Age Factors↗
Board certification in child neurology and neurology: cohort study.
This study followed the progress of a cohort of child neurology and neurology graduates who sought certification by the American Board of Psychiatry and Neurology (ABPN). The 211 candidates were recent graduates when they initiated the certification process in October 1994, and 92% of them have achieved certification. First-attempt performances on the Part I and Part II examinations were related; 62% of those certified passed both on their first attempts. Of those who were certified, 24% also achieved certification in at least one additional ABPN specialty (psychiatry) or subspecialty (clinical neurophysiology, neurodevelopmental disabilities, and pain medicine). Overall, it was estimated that 82% of the 1994 child neurology and neurology graduates sought ABPN certification, and of these, 82% were successful.
Adult↗
Access to health care in the United States: barriers for neurologic patients, challenges for neurologic physicians.
Approximately 34 million people in the United States have no health insurance. Up to 80 million people have insurance inadequate to provide care for severe or long-term illness (the underinsured). In 1986, an estimated 1 million persons in the US could not obtain needed health care for financial reasons, and another 18.8 million had difficulty obtaining care. There probably are 3.2 million people with neurologic disorders among the 34 million uninsured, and more among the underinsured. Those patients probably have difficulty obtaining health care, including neurologic consultations, laboratory tests, and radiologic procedures. Congress and many state legislatures are considering various proposals to address the problems of the un- and underinsured. Several national medical professional societies have developed programs to improve access to care for their patients. The American Academy of Neurology Task Force on Access to Health Care is studying access to care for neurologic patients and will recommend a course of action to the Academy. The Task Force welcomes suggestions concerning appropriate steps to improve access to health care for patients with neurologic disorders.
Delivery of Health Care↗
[Iberoamerican Academy of Pediatric Neurology: its history and importance in the development of Iberoamerican child neurology].
The Iberoamerican Academy of Pediatric Neurology (AINP) started in 1992, in Avila (Spain) and was foundated by a group of pediatrics neurologists who organized three post graduate courses in pediatrics neurology, Miami, Margarita and Cancun, with excelents results, because these reason the AINP has growing, fasted its dramatic success has been mostly due to that group of people who love and build unconditionally with their only goal being the satisfaction of knowing that children with neurological disorders will eventually benefit from their work. In this article we wrote about the history of AINP since 1992, and the reason to foundated. The AINP has growing fasted, and we think that it will be very important in the development of pediatrics neurology in Iberoamerica in different ways like neurology education and the training of the young physician.
Academies and Institutes↗
[Cross-sectional multicenter study of outpatient neurological care in the autonomous region of Valencia. Commission on Analysis of Quality of the Neurological Society of Valencia].
INTRODUCTION: Studies of the use of resources is a method recommended for the determination of health care requirements in order to improve planning for this. OBJECTIVE: To analyze outpatient neurological care in the Autonomous Region of Valencia (CR). PATIENTS AND METHODS: A transverse multicentric study was done in different Neurology Clinics in the CV. For three days, chosen randomly, forms were filled in. RESULTS: Twenty neurologists participated. Analysis was done of 954 consultations. In 30% of these cases the neurologist was satisfied and in 30% he was not. Consultation took 9.5% more time than anticipated. Urgent unscheduled consultations made up 8.6%. Women made up 52% and were of an average age of 52 years. Delay was 29 days. Primary care services referred 42% of the patients. The commonest diagnoses were: cerebral infarct, migraine and parkinsonism. The conditions referred from Primary Care Services were similar to those from non-neurological specialists. First visits took 17.6 minutes and following visits 11.7 minutes. The most usual 'destination' was follow-up (75.2%), followed by AP (24%). CONCLUSIONS: Neurological care in the Neurology Clinics of the CV is easily accessible and of good quality. However, it is overloaded by the large demand, due to ambiguity of the health care system available. The different degrees of professional satisfaction felt by neurologists are probably due to the quality of health care available to patients depending on where they live and the type of centre they attend.
Ambulatory Care↗
Neurological diagnoses in psychiatric patients. The uncertain boundaries between neurology and psychiatry.
The study highlights the high prevalence of neurological diagnoses in a population of psychiatric in-patients admitted to 16 private clinics and 6 private institutes because of their mental and behavioral disorders. Neurological diseases affected 13.05% of acute and 68.09% of chronic psychiatric patients. These results emphasize the need for specific neurological competence in the treatment of many psychiatric patients and better integration between neurological and psychiatric departments. The close relationship between neurology and psychiatry, as well as the renaissance of neuropsychiatry are discussed.
Chronic Disease↗
A review of neurological disorders seen at the Paediatric Neurology Clinic of the University of Nigeria Teaching Hospital, Enugu.
A review of 965 children with neurological disorders, seen at the Paediatric Neurology Clinic of the University of Nigeria Teaching Hospital (UNTH), Enugu, over a 3-year period (1985-1987), revealed that epilepsy was the most common neurological problem affecting 60% of the children, followed by cerebral palsy (16%), speech disorders (8.3%), mental retardation (7.2%), behaviour disorders (2.2%), paralytic poliomyelitis (1.55%), premature craniosynostosis (1.0%), visual and auditory impairment (1.0%) and muscle disorders (0.72%). Perinatal problems such as birth asphyxia, severe neonatal jaundice and infections were the most common aetiological factors identified. Facilities for rehabilitation of the children were inadequate and this, together with the people's ignorance of the natural history of some of the neurological disorders, may account for the high rate of default from follow-up observed in this study. The need for improved maternal and perinatal health services and vigorous health education strategies is emphasized by this review. The positive effect of the Expanded Programme on Immunization (EPI) is reflected in the sharp decline in the proportion of children with neurological disorders owing to paralytic poliomyelitis, from 9.2% in the period 1978-1980, to 1.55% in the present study.
Child↗
Neurologically deviant newborns: neurological and behavioural development at the age of six years.
Of 1655 newborns examined neurologically at term, 80 were found to be abnormal. 76 were traced at six years of age, together with a control group of 77 neonatally normal children. In the study group five children had died, six were severely handicapped and 21 had minor neurological dysfunction (MND). In the control group two had died and four had MND. Obstetrical and neonatal paediatric effects, as well as complications in the intervening years, appeared to have a cumulative effect on the relationship between the neonatal neurological condition and the neurological findings at six years. There were no large differences in behaviour between the study group and the controls, but the study-group MND children showed a stronger tendency for undesirable behaviour and poor school achievements. Although environmental influences are preponderant for the development of behaviour and school performance, a contribution of both neonatal and later neurological conditions seems likely.
Child↗
Comparative analysis of cytokine gene expression in cerebrospinal fluid of horses without neurologic signs or with selected neurologic disorders.
OBJECTIVE: To determine gene transcription for cytokines in nucleated cells in CSF of horses without neurologic signs or with cervical stenotic myelopathy (CSM), West Nile virus (WNV) encephalitis, equine protozoal myeloencephalitis (EPM), or spinal cord trauma. ANIMALS: 41 horses (no neurologic signs [n = 12], CSM [8], WNV encephalitis [9], EPM [6], and spinal cord trauma [6]). PROCEDURES: Total RNA was extracted from nucleated cells and converted into cDNA. Gene expression was measured by use of real-time PCR assay and final quantitation via the comparative threshold cycle method. RESULTS: Cytokine genes expressed by nucleated cells of horses without neurologic signs comprised a balance between proinflammatory tumor necrosis factor-alpha (TNF-alpha), anti-inflammatory cytokines (interleukin [IL]-10 and transforming growth factor [TGF]-beta), and Th1 mediators (interferon [IFN]-gamma). Cells of horses with CSM mainly expressed genes for TNF-alpha, TGF-beta, and IL-10. Cells of horses with WNV encephalitis mainly expressed genes for IL-6 and TGF-beta. Cells of horses with EPM mainly had expression of genes for IL-6, IL-8, IL-10, TNF-alpha, IFN-gamma, and TGF-beta. Cells from horses with spinal cord trauma had expression mainly for IL-6; IFN-gamma; TGF-beta; and less frequently, IL-2, IL-10, and TNF-alpha. Interleukin-8 gene expression was only detected in CSF of horses with infectious diseases. CONCLUSIONS AND CLINICAL RELEVANCE: Despite the small number of CSF samples for each group, results suggest distinct gene signatures expressed by nucleated cells in the CSF of horses without neurologic signs versus horses with inflammatory or traumatic neurologic disorders.
Animals↗
Vertebral artery injury in C1-2 transarticular screw fixation: results of a survey of the AANS/CNS section on disorders of the spine and peripheral nerves. American Association of Neurological Surgeons/Congress of Neurological Surgeons.
OBJECT: The 847 active members of the American Association of Neurological Surgeons/Congress of Neurological Surgeons (AANS/CNS) Section on Disorders of the Spine and Peripheral Nerves were surveyed to quantitate the risk of vertebral artery (VA) injury during C1-2 transarticular screw placement. METHODS: This retrospective study elicited the number of patients treated with transarticular screws, the number of screws placed, the incidence of VA injury and subsequent neurological deficit, and the management of known or suspected VA injury. Two hundred thirteen (25.1%) of the 847 surgeons responded. One hundred one respondents (47.4%) had placed a total of 2492 C1-2 transarticular screws in 1318 patients. Thirty-one patients (2.4%) had known VA injuries and an additional 23 patients (1.7%) were suspected of having injuries. However, only two (3.7%) of the 54 patients with known or suspected VA injuries exhibited subsequent neurological deficits and only one (1.9%) died of bilateral VA injury. Other iatrogenic complications included dural tears, screw fractures, screw breakout, fusion failure, infection, and suboccipital numbness. CONCLUSIONS: Including both known and suspected cases, the risk of VA injury was 4.1% per patient or 2.2% per screw inserted. The risk of neurological deficit from VA injury was 0.2% per patient or 0.1% per screw, and the mortality rate was 0.1%. The choice of management of intraoperative VA injuries was evenly divided between placing the patient under observation and initiating immediate postoperative angiography with possible balloon occlusion.
Association↗