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PubMed2002

Neurological research in Europe, as assessed with a four-year overview of neurological science international journals.

This paper analyses all the peer-reviewed articles published by European authors in 161 neurological journals screened by ISI in accordance with Current Contents/Life Science and Current Contents/Clinical Medicine in the period 1995-1998. Our aim was to report the amount and quality of neurological research in the different countries of the European Union (EU), the USA and the world. The number of papers, the impact factors (IF), the population of the source country and gross domestic product (GDP), were downloaded. Data show that in the EU there is a progressive increase in the number of published papers from 1995 to 1998 and that large countries such as Germany, the United Kingdom, France and Italy rank at the top four places for absolute number of papers. The gap in the number of papers between the USA and the EU significantly diminished in the examined period, from a difference of 14 % to 6 %. However, when the IF is considered, the USA performed better than EU, although excellent results have been obtained by the United Kingdom, Ireland, Netherlands and Sweden. When the number and quality of papers are plotted against the number of inhabitants or GDP, Sweden, the Netherlands and Finland are the leading countries in Europe. The present study demonstrates that neurological research in the EU is active and productive, is steadily increasing and is now a relevant part of all biomedical world research.

Animals↗
PubMed2004

Validation of the Guidelines for the Diagnosis of Dementia and Alzheimer's Disease of the Italian Neurological Society. Study in 72 Italian neurological centres and 1549 patients.

The objective of this study was to verify the adherence of Italian family physicians and neurologists to the Guidelines on Diagnosis of Dementia of the Italian Society of Neurology. A multicentre survey was carried out, in 72 neurological centres. The centres included at least 15 consecutive subjects suspected of having a dementia. The adherence of family physicians to the guidelines was poor. Neurologists performed a complete neuropsychological evaluation in a minority of the cases. Patients who had a decrease of Mini Mental Status Examination scores after six months higher than or equal to 4 were more represented among those patients for whom one or more recommendations were not respected. In Italy the adherence to the Guidelines on Diagnosis of Dementia and AlzheimerValidation studys Disease of the Italian Society of Neurology is very poor for family physicians (GPs) and satisfactory, albeit improvable, on the part of neurologists. Respect for the guidelines might improve the outcome of patients with dementia.

Aged↗
PubMed1989

The Neurological Evaluation Scale (NES): a structured instrument for the assessment of neurological signs in schizophrenia.

The significance of neurological signs in schizophrenia is poorly understood. In part, this may reflect the marked variability in the methods of ascertainment in previous studies. The Neurological Evaluation Scale (NES) is designed to standardize the assessment of neurological impairment in schizophrenia. The battery consists of 26 items. Data on the interrater reliability for total score, functional areas of interest, and individual items are presented. Preliminary validity data demonstrate the ability of the battery to discriminate patients with schizophrenia from nonpsychiatric controls.

Brain Damage, Chronic↗
PubMed1999

Neurology without borders: neurological disease in a shrinking world.

The last half of the twentieth century has seen social, political, economic, and environmental changes which have altered patterns of health care in all parts of the world. International influences are becoming stronger each year, and the practice of medicine in any single country is becoming more and more influenced by events and practices in others. Environmental degradation may involve widespread dissemination of neurological toxins. Newly emerging or drug-resistant infections include those involving the nervous system. Effective neurological practice is more dependent than ever on knowledge of international health. Neurologists can act as effective advocates for appropriate treatment, allocation of resources, and prevention of neurological diseases.

Humans↗
PubMed1993

[Conflict regarding neurology--a study of specialty origin of clinical neurology in Germany].

Although Germany was a center of neurological research during the 19th century institutionalisation of clinical neurology was delayed in comparison to other countries. The establishment of neurology in Germany is characterised by a conflict between internists, psychiatrists and neurologists that lasted nearly a hundred years. The present study describes and analyses the motives and the course of development of this dispute. The conflict could not be solved by means of objective arguments because on the one hand nervous disease were part of internal medicine, while on the other hand the postulated identity of mental and nervous disease was the central paradigm of the academic psychiatrists. As a professional group the entry of the neurologists into the dispute was very late at a time point when the historical development was already in favour of the psychiatrists. By taking into account not only intrascientific but also political and economic factors, the dynamics of the historical process becomes comprehensible.

Conflict, Psychological↗
PubMed1996

A history of the Neurological Institute of New York and its Department of Neurological Surgery.

The neurological institute of New York was founded in 1909 as the first hospital in North America devoted exclusively to the care of patients afflicted with neurological diseases. The Institute amalgamated with Columbia University's College of Physicians and Surgeons and The Presbyterian Hospital in New York City in 1928. The Department of Neurological Surgery developed under the successive leadership of Charles Elsberg, Byron Stookey, J. Lawrence Pool, Lester Mount, Edward Schlesinger, and Bennett Stein, each of whom brought unique qualities to the role of Department Chairman. This article traces the history of the Institute and its affiliates, present activities, and future plans.

Academic Medical Centers↗
PubMed1995

Magnitudes of neurological disorders in a farming town in Kyushu, Japan: frequency of neurological symptoms and signs.

We examined 1,270 elderly residents aged 60 years and over in a cross-sectional study of a standardized clinical examination to determine the frequency of 'abnormal' neurological findings in 27 randomly selected communities in the town of Mifune, Japan. The survey showed one or more neurological symptoms in 89.1%, and one or more signs in 94.4% of the examined elderly. Most of the symptoms and signs increased with age, especially after 70 years, indicating the importance of neurological afflictions in the community health of the elderly.

Age Factors↗
PubMed1993

Neurologists--1991 to 1992. Human Resources in Neurology Subcommittee of the American Academy of Neurology.

The American Academy of Neurology (AAN) membership survey was developed to define and monitor changing trends in the demography and practice profile of US neurologists. All 11,300 AAN members received a Demographic Information Form (DIF) and 2,600 members also received a Practice Profile Form (PPF) to gather this information. Response rates were 75% from the DIF group and 70% from those who received both. For responding members, age (median, 43 years), sex (83% male), race/ethnic origin (85% white), and medical schools (22% international medical graduates) are similar to those for other physicians in the United States. The ratio of neurologists to population ranges from a low of 1.3 per 100,000 in Wyoming to a high of 11.0 per 100,000 in the District of Columbia. One-fourth of neurologists complete at least one residency in addition to neurology and 39% complete a fellowship. Although nearly two-thirds (63%) of neurologists have a full-time or clinical academic appointment, 70% indicate patient care as their primary medical activity. The number of working hours and professional activities of neurologists vary with practice type. Neurologists perform numerous neurodiagnostic tests for reimbursement, particularly neurophysiologic studies and lumbar puncture. One-third of office-based neurologists have an ownership interest in an imaging facility. The most common payment sources for professional fees are commercial insurers (32%) and Medicare (29%), the latter reflecting the large proportion of disabled and elderly treated by neurologists. Office-based neurologists provide 5% charity care and write off an additional 13% of unpaid charges. The practice of neurology is constantly changing.(ABSTRACT TRUNCATED AT 250 WORDS)

Fellowships and Scholarships↗
PubMed1999

Expanding the neurological examination using functional neurologic assessment part I: methodological considerations.

Manual assessment of muscular function, in particular a method known as applied kinesiology (AK), is a clinical measure of neurologic function. A review of the literature reveals methodological problems with previous studies of AK as a form of neurologic assessment. Research designs that do not reflect clinical practice and principles of AK are common in the literature. Additional study is warranted to explore the potential of AK manual muscle testing as a diagnostic tool. We outline principles of AK and recommend that future research reflect more accurately the clinical practice of functional neurologic assessment and applied kinesiology.

Humans↗
PubMed1995

[Does a neurologic clinic need an inhouse cerebrospinal fluid/neurochemical laboratory? Results of a survey of 289 neurological clinics].

In 1993 and 1994 an official inquiry was carried out by the Deutsche Gesellschaft für Neurologie into the existence of neurochemical laboratories in departments of neurology throughout Germany. The following results were obtained. Neurochemical laboratories are more often seen in neurology departments involved in routine or emergency diagnosis than in departments engaged only in rehabilitation. Nearly all departments with an intensive care unit in a university hospital (91%) and nearly half of those outside the university (46%) have their own neurochemical laboratory. Departments with their own neurochemical laboratories are characterized by the use of specialized immunological diagnosis, especially of the cerebrospinal fluid (e.g., immunoglobulins, isoelectric focusing), in contrast to departments that are not working in the field of emergency medicine and are not equipped with their own neurochemical laboratories. The latter mostly carry out screening tests (e.g., antiepileptic drug monitoring, tumor markers). The existence of a neurochemical laboratory in a neurology department does not lead to an undifferentiated increase in the number of laboratory tests, but reflects the need for specialized diagnosis in CSF and neuroimmunology.

Brain Chemistry↗
PubMed1994

Interventional neurology: botulinum toxin as a potent symptomatic treatment in neurology.

Local injections of botulinum toxin is a well-accepted treatment for focal dystonias, hemifacial spasms and strabismus. Its use by skilled neurologists has been reported to be safe and effective. We report our experience with botulinum toxin injections in 108 patients with various central nervous system disorders. Botox was effective in upper face dystonia (86% improvement), spastic dysphonia (92% improvement), platysma muscle spasms and spasmodic torticollis (range of movement 61%, pain and tension 90%). It was also very effective in a few patients with apraxia of eyelid opening, parkinsonian jaw tremor, teeth clenching, palatal myoclonus and adductor leg spasticity. No serious side effects were recorded. Botulinum toxin is a useful symptomatic treatment for many neurological disorders, and one of the leading mode of treatments in the new subspecialty in neurology called "Interventional neurology."

Adolescent↗
PubMed1997

[Analysis of the situation of Valencian neurology by the Commission of Analysis of the Quality of Valencian Neurological Society].

INTRODUCTION: The Comision de Analisis de la Calidad de la Sociedad Valenciana de Neurologia has made a proposal of Neurology care requirements, based on the findings of various studies done in this region. There studies suggest that there should be a proportion of 3 neurologists per 100,000 inhabitants. METHOD: An analysis of requirements was made, based on evaluation of the public health service, private practice and trainee specialists (MIR) regarding this problem. The need for emergency neurological attention, and the place of a hierarchy and a system for referral was also considered. RESULTS: It was calculated that 109 neurologists are required, 11 in Castellon, 63 in Valencia and 35 in Alicante. This would mean a proportion of 2,66 neurologists per 100,000 inhabitants in Castellon, 2,90 in Valencia and 2,70 in Alicante. The total figure for the whole Community would be 2,82 per 100,000 inhabitants. CONCLUSIONS: At the present time neurological care is expensive, since a lack of specialists means waiting lists, poor patient care and high costs due to inappropriate use of technical resources.

Emergency Medical Services↗
PubMed2004

Practice parameter: diagnostic assessment of the child with cerebral palsy [RETIRED]: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society.

OBJECTIVE: The Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society develop practice parameters as strategies for patient management based on analysis of evidence. For this parameter the authors reviewed available evidence on the assessment of a child suspected of having cerebral palsy (CP), a nonprogressive disorder of posture or movement due to a lesion of the developing brain. METHODS: Relevant literature was reviewed, abstracted, and classified. Recommendations were based on a four-tiered scheme of evidence classification. RESULTS: CP is a common problem, occurring in about 2 to 2.5 per 1,000 live births. In order to establish that a brain abnormality exists in children with CP that may, in turn, suggest an etiology and prognosis, neuroimaging is recommended with MRI preferred to CT (Level A). Metabolic and genetic studies should not be routinely obtained in the evaluation of the child with CP (Level B). If the clinical history or findings on neuroimaging do not determine a specific structural abnormality or if there are additional and atypical features in the history or clinical examination, metabolic and genetic testing should be considered (Level C). Detection of a brain malformation in a child with CP warrants consideration of an underlying genetic or metabolic etiology. Because the incidence of cerebral infarction is high in children with hemiplegic CP, diagnostic testing for coagulation disorders should be considered (Level B). However, there is insufficient evidence at present to be precise as to what studies should be ordered. An EEG is not recommended unless there are features suggestive of epilepsy or a specific epileptic syndrome (Level A). Because children with CP may have associated deficits of mental retardation, ophthalmologic and hearing impairments, speech and language disorders, and oral-motor dysfunction, screening for these conditions should be part of the initial assessment (Level A). CONCLUSIONS: Neuroimaging results in children with CP are commonly abnormal and may help determine the etiology. Screening for associated conditions is warranted as part of the initial evaluation.

Algorithms↗
PubMed1990

Complications of gastroesophageal antireflux surgery in neurologically impaired versus neurologically normal children.

Antireflux surgery was performed in 234 children over a 5-year period; 153 were neurologically impaired (NI) and 81 were neurologically normal (NN). Initial presentation, demographic data, and type of antireflux operation were similar in the two groups. Eighty-six percent of the NI group versus 30% of the NN group had gastrostomy tubes placed. The incidence of late postoperative complications was 26% in the NI group and 12% in the NN group (P less than .01). During the late postoperative period, NI children underwent reoperation four times as frequently as NN children (19% v 5%, respectively; P less than .01). Wrap herniation accounted for 38% of complications and 59% of reoperations in the late postoperative period. Mortality due to aspiration occurred in 9% of the NI group versus 1% of the NN group. Combined failure rate (reoperation plus aspiration-induced deaths) was 28% in NI and 6% in NN (P less than .01). We conclude that neurological status is the major predictor of operative success and that wrap herniation due to crural disruption is the most common cause of operative failure.

Adolescent↗
PubMed1990

Anticardiolipin antibodies in patients with rabies vaccination induced neurological complications and other neurological diseases.

We reported the occurrence of anticardiolipin antibodies (ACA) by using an enzyme-linked immunosorbent assay (ELISA) in sera of patients with neurologic complications from Semple rabies vaccination. There was a correlation between the presence of ACA and the disease severity. Sixteen of 25 patients (64%) with major neurological complications, 2 of 21 patients (10%) with minor complications, and non of the normal vaccinees had an ACA response. In comparison to this, ACA was found in 10/43 (24%) of patients with post-infectious encephalitis (PIE), Guillain-Barré syndrome (GBS) and multiple sclerosis (MS), 5/22 (23%) and 4/31 (13%) of patients with degenerative neurological diseases and central nervous system (CNS) infections, respectively. There was no specific restriction to any particular isotype. Frequency difference of ACA responses was unremarkable in systemic lupus erythematosus (SLE) patients with (3/9) and without (3/10) CNS involvement. It is not conclusive about the pathogenetic role of ACA. This remains to be determined.

Antibodies↗
PubMed1979

Psychiatric illness in a neurological out-patient department in North East England. Use of the General Health Questionnaire in the prospective study of neurological out-patients.

342 patients referred to a neurological out-patient department in North East England between November 1975 and November 1976 were studied prospectively using two methods of psychiatric case identification, by clinical interview and by use of the General Health Questionnaire. The population of psychiatric patients identified by clinical techniques is different from that identified by the GHQ and it is concluded that GHQ cannot be used for routine screening in the neurological clinic. Clinical data were compared with a previous retrospective study. Clinical assessment revealed 27% with psychiatric disorders whilst GHQ showed a probable psychiatric morbidity of 48% with a cut off score of 11/12 and 21% with our best cut off score of 26/27. Statistical problems with this method are discussed and the results of this study compared with others using the same questionnaire. Aspects of organic and psychiatric disorder in a neurological clinic are discussed.

Adult↗
PubMed1995

The British Neurological Surveillance Unit: a nation-wide scheme for the ascertainment of rare neurological disorders.

The British Neurological Surveillance Unit was set up in January 1993 with the aim of co-ordinating and improving the ascertainment of rare neurological disorders in the United Kingdom by using a system of nation-wide active surveillance. The unit provides a service for individual investigators who must first submit possible studies to a scientific advisory committee. Once accepted the condition is listed on a report card which is sent to every member of the British neurological community every month. The cards are easy to use, and all the reporting neurologist has to do is tick a box indicating whether a case has (or has not been) seen. At the end of every month the individual investigators then initiate further follow-up by contacting the reporting neurologists. In the first year of operation the scheme has assisted in the surveillance of 6 disorders and the following number of verified cases have so far been ascertained: polio in adults (n = 0); acute psychological disorders in patients with epilepsy (n = 75); Guillain-Barré syndrome in the south of England (n = 32); epilepsia partialis continua (n = 40); amyloid neuropathy (n = 12), and agenesis of the corpus callosum (n = 24). The monthly response rates are between 65 and 75%, with the eventual aim of achieving over 90% after the scheme has become more established.

Amyloid Neuropathies↗
PubMed2003

Fetal and neonatal neurologic case histories: assessment of brain disorders in the context of fetal-maternal-placental disease. Part 2: Neonatal neurologic consultations in the context of adverse antepartum and intrapartum events.

The more conventional role of the pediatric neurologist involves the evaluation of the child after birth. Although the pediatric neurologist rarely attends the delivery of the neonate, consultation by the neurologist should begin immediately following stabilization by the neonatal resuscitation team. Four interrelated aspects of the neurologist's clinical assessment will be discussed in the context of reaching a consultative opinion, which must incorporate knowledge of chronologic events before as well as during labor and delivery. This evaluation encompasses an assessment of levels of arousal, increased or decreased muscle tone, presence of seizures, and effects of systemic diseases on the central nervous system, which are the essential elements of a complete neurologic examination. Documentation of the neonate's neurologic condition, together with knowledge of maternal, fetal, and placental diseases, will help anticipate neuroresuscitative decisions, as well as subsequent neurologic deficits.

Arousal↗