关键词： Headache   Migraine   Neurology   Outpatient   Referral  

摘要： Background Headache is the most common reason for referral to neurology outpatient clinics in Ireland and represents approximately 30% of all new appointments. Aim To evaluate diagnoses and outcomes of all patients newly referred with headache to a consultant neurologist at an Irish university teaching hospital over a 2-year period. Design A retrospective analysis and audit. Methods Data including patient demographics, red flags, investigations, diagnosis, and outcome were collected on consecutive patients newly referred with headache to a consultant neurologist's outpatient clinic over a 2-year period. Results Two hundred and seventy patients with headache were seen;75% were women with mean age of 39 years. 89.26% (241/270) were diagnosed with a primary headache disorder alone;4.44% (12/270) with a secondary headache disorder alone;3.33% (9/270) with both a primary and secondary headache disorders;and 2.96% (8/270) with a painful cranial neuropathy. Migraine was the most common diagnosis, frequently associated with medication overuse. Non-attendance rates were high. Although imaging abnormalities were frequently found, on no occasion was it thought to be the cause of the headache. Conclusions Most patients referred to a neurology outpatient clinic with headache have a primary headache disorder. Alternate pathways should be considered to reduce the burden on Ireland's limited neurology resources without compromising patient safety.

关键词： Electroencephalography   Wireless EEG headset   Intensive care   Bedside monitoring  

摘要： A novel wireless eight-channel electroencephalography (EEG) headset specially developed for ICUs was tested in regard of comparability with standard 10/20 EEG systems. The continuous EEG (cEEG) derivations via CerebAir EEG headset (Nihon Kohden Europe, Rosbach, Germany) and internationally standardized 10/20 reference EEGs as the diagnostic standard were performed in a mixed collective on a neurointensive care unit (neuro-ICU). The derivations were verified for comparability in detection of EEG background activity, epileptiform discharges, and seizure patterns. Fifty-two patients with vigilance reduction following serious neurological or metabolic diseases were included, and both methods were applied and further analyzed in 47. EEG background activity matched in 24 of 45 patients (53%;p = 0.126), epileptiform discharges matched in 32 (68%) patients (p = 0.162), and seizure activity matched in 98%. Overall, in 89% of the patients, cEEG detected the same or additional ICU-relevant EEG patterns. The tested wireless cEEG headset is a useful monitoring tool in patients with consciousness disorders. The present study indicates that long-term measurements with the wireless eight-channel cEEG lead to a higher seizure and epileptiform discharge detection compared to intermittent 10/20 EEG derivations in the ICU setting.

关键词： Programming Languages   Compilers   Interpreters   Processor Architectures   Computer Science   general  

摘要： The purpose of this study is to investigate gait in patients with neurological disorders using accelerometers. Accelerometers were placed on both ankles of participants undergoing gait analysis. Data were collected during the 10-min walk test from healthy participants (n = 20) and patients with neurological deficits (n = 22) scheduled for surgery. Additional data were obtained after surgery for comparison. Both the time and frequency domain features were compared between healthy participants and patients. The interval between successive heel-strikes differed significantly, as did that between successive toe-offs. These features were correlated in healthy participants but not in patients, for whom the correlation coefficients tended to increase after surgery, indicating that the correlations can be used to monitor gait recovery and ankle-worn accelerometers were effective in collecting data for gait monitoring.

关键词： ACE2 receptors   COVID-19   MERS   Neurological signs   SARS-CoV-2  

摘要： Coronavirus disease 2019 (COVID-19) has become a challenging public health catastrophe worldwide. The newly emerged disease spread in almost all countries and infected 100 million persons worldwide. The infection is not limited to the respiratory system but involves various body systems and may lead to multiple organ failure. Tissue degenerative changes result from direct viral invasion, indirect consequences, or through an uncontrolled immune response. (SARS-CoV-2) spreads to the brain via hematogenous and neural routes accompanied with dysfunction of the blood-brain barrier. The involvement of the central nervous system is now suspected to be among the main causes of death. The present review discusses the historical background of coronaviruses, their role in previous and ongoing pandemics, the way they escape the immune system, why they are able to spread despite all undertaken measures, in addition to the neurological manifestations, long-term consequences of the disease, and various routes of viral introduction to the CNS.

关键词： COVID-19   Neuro-COVID-19   NF-kappa B   Cognitive impairment   Oxidative stress  

摘要： The coronavirus disease that presumably began in 2019 (COVID-19) is a highly infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has resulted in a pandemic. Initially, COVID-19 was thought to only affect respiration. However, accumulating evidence shows a wide range of neurological symptoms are also associated with COVID-19, such as anosmia/ageusia, headaches, seizures, demyelination, mental confusion, delirium, and coma. Neurological symptoms in COVID-19 patients may arise due to a cytokine storm and a heighten state of inflammation. The nuclear factor kappa-light-chain enhancer of activated B cells (NF-kappa B) is a central pathway involved with inflammation and is shown to be elevated in a dose-dependent matter in response to coronaviruses. NF-kappa B has a role in cytokine storm syndrome, which is associated with greater severity in COVID-19-related symptoms. Therefore, therapeutics that reduce the NF-kappa B pathway should be considered in the treatment of COVID-19. Neuro-COVID-19 units have been established across the world to examine the neurological symptoms associated with COVID-19. Neuro-COVID-19 is increasingly becoming an accepted term among scientists and clinicians, and interdisciplinary teams should be created to implement strategies for treating the wide range of neurological symptoms observed in COVID-19 patients.

关键词： Transcranial magnetic stimulation   Degenerative cervical myelopathy   Neuromodulation   Spinal cord injuries   Spinal cord diseases   rTMS  

摘要： Degenerative Cervical Myelopathy (DCM) is one of the commonest causes of non-traumatic Spinal Cord Injury (SCI) leading to significant neurological impairments and reduced health-related quality of life. Guidelines recommend surgical intervention to halt disease progression in moderate-to-severe cases, and whilst many do experience neurological recovery, this is incomplete leading to lifelong disability. A James Lind Alliance (JLA) research priority setting partnership for DCM highlighted novel therapies and rehabilitation as top 10 research priority in DCM. Neurological recovery following decompressive surgery in DCM has been attributed neuroplasticity, and therapies influencing neuroplasticity are of interest. Electrical neuromodulation interventions such as repetitive Transcranial Magnetic Stimulation (rTMS), are being increasingly explored in related fields such as spinal cord injury to improve recovery and symptoms. The aim of this systematic review was to determine the role and efficacy of rTMS as a therapeutic tool in managing neurological dysfunction in DCM. We searched the databases of Medline, EMBASE, CINAHIL and Cochrane Central Register of Controlled Trials (CENTRAL). No studies were identified that had investigated the therapeutic use of rTMS in DCM. A significant number of studies had explored TMS based neurophysiological assessments indicating its role as a screening and prognostication tool in DCM. Post-operative rehabilitation interventions including TMS and non-operative management of DCM is a field which requires further investigation, as required in the AO Spine JLA DCM research priorities. rTMS is a safe neuromodulatory intervention and may have a role in enhancing recovery in DCM. Further research in these fields are required. (c) 2021 Elsevier Ltd. All rights reserved.

关键词： Comparative effectiveness research   Dissemination   Framework   Brain   Neuroscience   Quality  

摘要： Neurological disorders are the leading cause of disability and the second leading cause of death globally. To challenge this enormous disease burden, scientists are pursuing innovative solutions to maintain and improve the quality of neurological care. Despite the availability of many effective evidence-based practices, many patients with neurological disorders cannot access these (or receive them inefficiently after a long delay) and may be exposed to unnecessary, expensive, and potentially harmful treatments. To promote the systematic uptake of evidence-based practices into the real world, a new scientific study of methods has been developed: implementation science. In implementation science research, trans disciplinary research teams systematically (using theory, model, and framework) assess local barriers to facilitate the adoption of evidence-based practices and examine potential solutions using implementation strategies (interventions that help adoption of intended practices) targeting multiple levels in the health care system, including patient, provider, clinic, facility, organization, or broader community and policy environment. The success of these strategies (implementation outcomes) is measured by the extent and quality of the implementation. Implementation studies can be either observational or interventional but are distinct from traditional efficacy or effectiveness studies. Traditional neuroscience research and clinical trials, conducted in controlled settings, focus on discovering new insights with little consideration of translating those insights into the everyday practice of a resource-constrained and dynamic health care system. Thus, neurologists should become familiar with implementation science to reduce the knowledge-practice gap, maximize health care value, and improve management of brain disorders affecting public health. (c) 2021 Elsevier Inc. All rights reserved.

关键词： Sleep   Pediatric   Childhood   Sleep development   Sleep problems   Insomnia  

摘要： Healthy sleep, including proper amounts in the 24-hour day/night period, is crucial for developing children. Sleep development in infants and children is characterized by increased amounts of sleep, including rapid eye movement and non–rapid eye movement (NREM) slow-wave sleep. Expected changes as well as deviations may contribute to sleep problems, which are common in typically developing children and very common in those with neurodevelopmental disorders and often are chronic. Periodic screening of children for sleep problems is important for timely and effective management of these.