关键词： Accidental falls   decision support techniques   Trail Making test   executive function   attention  

摘要： Objective: To determine whether tests of cognitive function and patient-reported outcome measures of motor function can be used to create a machine learning-based predictive tool for falls. Design: Prospective cohort study. Setting: Tertiary neurological and neurosurgical center. Subjects: In all, 337 in-patients receiving neurosurgical, neurological, or neurorehabilitation-based care. Main Measures: Binary (Y/N) for falling during the in-patient episode, the Trail Making Test (a measure of attention and executive function) and the Walk-12 (a patient-reported measure of physical function). Results: The principal outcome was a fall during the in-patient stay (n=54). The Trail test was identified as the best predictor of falls. Moreover, addition of other variables, did not improve the prediction (Wilcoxon signed-rank P < 0.001). Classical linear statistical modeling methods were then compared with more recent machine learning based strategies, for example, random forests, neural networks, support vector machines. The random forest was the best modeling strategy when utilizing just the Trail Making Test data (Wilcoxon signed-rank P < 0.001) with 68% (+/- 7.7) sensitivity, and 90% (+/- 2.3) specificity. Conclusion: This study identifies a simple yet powerful machine learning (Random Forest) based predictive model for an in-patient neurological population, utilizing a single neuropsychological test of cognitive function, the Trail Making test.

关键词： quality improvement   quality measures   neurotology   vertigo   benign paroxysmal positional vertigo (BPPV)   Meniere's disease   vestibular migraine   unilateral vestibular hypofunction  

关键词： India   neuroepidemiology   neurological disorders   prevalence   tribal  

摘要： Background: There are few community-based neuroepidemiological studies based in tribal communities. This cross-sectional community-based study explored the prevalence rates of neurological disorders in the tribal region of Kaparada in Gujarat. Methodology: A two-stage methodology was used. Door-to-door surveys were conducted in the villages of Moti Vahiyal, Arnai, and Chavshala in Kaparada taluka in the Valsad district. Trained volunteers administered a questionnaire that assessed demographic details and common neurological symptoms in children and adults. Data were obtained from 8217 individuals from 1464 households using the questionnaire in stage 1. A number of 615 individuals reported at least one symptom. In stage 2, a team of neurologists conducted a medical camp to assess those "screened in" for neurological disorders. Results: The crude prevalence rate for neurological disorders in general was found to be 2592.19/100,000. The prevalence rates for lower motor neuron diseases were highest (1010.1), and the rates of epilepsy, movement disorders, stroke, vertigo, headaches, upper motor neuron diseases, and mental and behavioral disorders were found to be 255.6, 133.9, 109.53, 170.38, 511.4, 109.53, and 292.08/100,000, respectively. Age- and sex-specific rates and patterns varied for different disorders. Conclusion: The prevalence rates of most disorders were found to be lower than those reported elsewhere, but age and sex prevalence patterns were similar to existing research. Challenges in conducting such a study in a remote population are discussed.

关键词： Multiple sclerosis   immunology   neuromyelitis optica (NMO)  

摘要： The article comments on the article 'Late-onset neutropenia and neurological relapse during long-term rituximab therapy in MOG antibody spectrum disorder.' It mentions that the cases present in the study highlight two important clinical issues that include, neurologists treating patients with neuroinflammatory disorders with B-cell-depleting agents need to be aware of late-onset neutropenia, and relapses in MOG antibody disease patients treated with rituximab.

关键词： Baicalin   Hemorrhagic transformation   Ischemic stroke   Natural compound   Peroxynitrite   Tissue plasminogen activator  

摘要： Tissue plasminogen activator (t-PA) has a restrictive therapeutic window within 4.5h after ischemic stroke with the risk of hemorrhagic transformation (HT) and neurotoxicity when it is used beyond the time window. In the present study, we tested the hypothesis that baicalin, an active compound of medicinal plant, could attenuate HT in cerebral ischemia stroke with delayed t-PA treatment. Male Sprague-Dawley rats were subjected to middle cerebral artery occlusion (MCAO) for 4.5h and then continuously received t-PA infusion (10mg/kg) for 0.5h and followed by 19-h reperfusion. Baicalin (50, 100, 150mg/kg) was administrated via femoral vein at 4.5h after MCAO cerebral ischemia. Delayed t-PA infusion significantly increased the mortality rate, induced HT, blood-brain barrier (BBB) damage, and apoptotic cell death in the ischemic brains and exacerbated neurological outcomes in cerebral ischemia-reperfusion rats at 24h after MCAO cerebral ischemia. Co-treatment of baicalin significantly reduced the mortality rates, ameliorated the t-PA-mediated BBB disruption and HT. Furthermore, baicalin showed to directly scavenge peroxynitrite and inhibit MMP-9 expression and activity in the ischemic brains with the delayed t-PA treatment. Baicalin had no effect on the t-PA fibrinolytic function indicated by t-PA activity assay. Taken together, baicalin could attenuate t-PA-mediated HT and improve the outcomes of ischemic stroke treatment possibly via inhibiting peroxynitrite-mediated MMP-9 activation.

关键词： neuroethics   neurophilosophy   virtual reality   agency   embodiment   trust   neurology   psychiatry  

摘要： Highly immersive virtual reality (VR) systems have been introduced into the consumer market in recent years. The improved technological capabilities of these systems as well as the combination with biometric sensors, for example electroencephalography (EEG), in a closed-loop hybrid VR-EEG, opens up a range of new potential medical applications. This article first provides an overview of the past and current clinical applications of VR systems in neurology and psychiatry and introduces core concepts in neurophilosophy and VR research (such as agency, trust, presence, and others). Then, important adverse effects of highly immersive VR simulations and the ethical implications of standalone and hybrid VR systems for therapy in neurology and psychiatry are highlighted. These new forms of VR-based therapy may strengthen patients in exercising their autonomy. At the same time, however, these emerging systems present ethical challenges, for example in terms of moral and legal accountability in interactions involving "intelligent" hybrid VR systems. A user-centered approach that is informed by the target patients' needs and capabilities could help to build beneficial systems for VR therapy.

关键词： ataxia   chorea   dystonia   gait disorders in childhood   myoclonus   spasticity  

摘要： There are an enormous number of neurological illnesses that can manifest with gait disturbance in childhood. Whilst experience and clinical acumen are helpful in diagnosing these disorders, some basic principles in assessment and diagnosis are helpful in determining the phenomenology, time course, and neuro-anatomical localisation. In this review we focus on some of the more common movement disorders resulting in inserted postures (including spasticity and dystonia), inserted movements (including chorea and myoclonus), and impairment of motor control (including ataxia and neuro-muscular disorders). A number of case studies are included to illustrate the factual descriptions. © 2018 Elsevier Ltd

关键词： Clinical Study   Data Quality   National Institute of Neurological Disorders and Stroke   Cerebral Palsy   Neurologic Disorders  

摘要： To increase the efficiency and effectiveness of clinical research studies, cerebral palsy (CP) specific Common Data Elements (CDEs) were developed through a partnership between the National Institute of Neurological Disorders and Stroke (NINDS) and the American Academy of Cerebral Palsy and Developmental Medicine (AACPDM). International experts reviewed existing NINDS CDEs and tools used in studies of children and young people with CP. CDEs were compiled, subjected to internal review, and posted online for external public comment in September 2016. Guided by the International Classification of Functioning, Disability and Health framework, CDEs were categorized into six domains: (1) participant characteristics;(2) health, growth, and genetics;(3) neuroimaging;(4) neuromotor skills and functional assessments;(5) neurocognitive, social, and emotional assessments;and (6) engagement and quality of life. Version 1.0 of the NINDS/AACPDM CDEs for CP is publicly available on the NINDS CDE and AACPDM websites. Global use of CDEs for CP will standardize data collection, improve data quality, and facilitate comparisons across studies. Ongoing collaboration with international colleagues, industry, and people with CP and their families will provide meaningful feedback and updates as additional evidence is obtained. These CDEs are recommended for NINDS-funded research for CP.

摘要： Background X-linked recessive ichthyosis (XLI) is a relatively common type of ichthyosis caused by a deficiency in the steroid sulfatase (STS) enzyme. It is the only type of ichthyosis that can be both syndromic and nonsyndromic. Typical clinical features include dark-brown scale of variable size favouring the extensor surfaces of the extremities. ObjectivesMethodsTo characterize clinically nonsyndromic XLI, with a particular focus on extracutaneous manifestations. This was a multicentre retrospective review of clinical findings from a case series of patients with a clinical and genetic diagnosis of XLI. ResultsConclusionsWe identified 30 patients with XLI belonging to 25 different families carrying a deletion in the STS locus. All patients had dark scales of variable size on the extensor surfaces of the extremities. Lack of flexural involvement and pruritus were common but inconsistent findings, whereas palmoplantar hyperlinearity was absent in all but one patient. A history of orchiopexy was present in 10% and thus was more common than expected vs. the general population (3%). Neurological disorders including epilepsy (13%) and attention deficit hyperactivity disorder (ADHD;30%) were over-represented in patients with XLI. This was a retrospective study with a limited number of patients. In the absence of confirmatory genetic testing and family history of the disease, dark-brown scale of the extensor surfaces and the absence of palmoplantar hyperlinearity appear to be the most reliable clinical findings supporting a diagnosis of XLI. Dermatologists should be aware of the high prevalence of ADHD and epilepsy in patients with nonsyndromic XLI.