Teleneurology clinics for polyneuropathy: a pilot study Abstract Introduction Polyneuropathy (PN) is a common condition with significant morbidity. We developed tele-polyneuropathy (tele-PN) clinics to improve access to neurology and increase guideline-concordant PN care. This article describes the mixed-methods evaluation of pilot tele-PN clinics at three community sites within the Greater Los Angeles VA Healthcare System. Methods For the first 25 patients (48 scheduled visits), we recorded the duration of the tele-PN visit and exam; the performance on three guideline-concordant care indicators (PN screening labs, opiate reduction, physical therapy for falls); and patient-satisfaction scores. We elicited comments about the tele-PN clinic from patients and the clinical team. We combined descriptive statistics with qualitative themes to determine the feasibility and acceptability of the tele-PN clinics. Results The average tele-PN encounter and exam times were 28.5 and 9.1 min, respectively. PN screening lab completion increased from 80 to 100%. Opiate freedom improved from 68 to 88%. Physical therapy for patients with recent falls increased from 58 to 100%. The tele-PN clinic was preferred for follow-up over in-person clinics in 86% of cases. Convenience was paramount to the clinic’s success, saving an average of 231 min per patient in round-trip travel. The medical team’s caring and collaborative spirit received high praise. While the clinic’s efficiency was equal or superior to in-person care, the limited treatment options for PN and the small clinical exam space are areas for improvement. Conclusion In this pilot, we were able to efficiently see and examine patients remotely, promote guideline-concordant PN care, and provide a high-satisfaction encounter.

Correction to: Switching from natalizumab to fingolimod treatment in multiple sclerosis: real life data from the Austrian MS Treatment Registry The original version of this article unfortunately contained a mistake. First and last names of the authors were interchanged. The correct author names are given below.

Legionella infection associated with dimethyl fumarate used for treatment of multiple sclerosis

Aperiodic alternating nystagmus in isolated vestibular nucleus infarction

RCVS and TGA: a common pathophysiology?

Christiaan Eijkman (1856–1930)

Cluster headache: an overview of established and emerging treatments

Cerebral blood flow in a case of typical aura without headache

Brachial multisegmental amyotrophy caused by cervical anterior horn cell disorder associated with a spinal CSF leak: a report of five cases Abstract Objective Common symptoms in patients with a spinal CSF leak include orthostatic headaches, neck stiffness, and hearing difficulties. The main outcome of this report was to introduce and characterize brachial multisegmental amyotrophy, a rare, but treatable symptom associated with a spinal CSF leak. Methods Between 2013 and 2017, five patients who developed progressive amyotrophy were referred to our hospital. A retrospective and prospective analysis of clinical, electrophysiological, and neuroimaging findings is presented. Data were analyzed between August 2013 and April 2019. Results Amyotrophy was observed in the C5–C8 myotomes and was more prominent in the proximal muscles than in the distal muscles. Amyotrophy was unilateral in three patients and asymmetric bilateral in two. Electromyography revealed active and chronic denervation in the C5–C8 myotomes, particularly C5–6, of all patients. Although the clinical manifestations of these cases were similar to amyotrophic lateral sclerosis, unusual neuroimaging findings were observed: spinal T2-weighted MRI revealed high-signal-intensity lesions in the bilateral anterior horns at the C2–C4 spinal levels in all five cases; ventral epidural fluid collection was also observed. Thin-cut MRI or digital subtraction myelography showed ventral dural defects associated with CSF leaks at high thoracic levels in four patients; four underwent surgical dural repair, which attenuated or stabilized neurological symptoms, while upper limb weakness worsened in the other patient who did not undergo surgery. Conclusions A spinal dural defect may be the essential cause of brachial multisegmental amyotrophy. Surgical dural repair may alter the progressive course of this rare condition.

Deep brain stimulation for Meige syndrome: a meta-analysis with individual patient data Abstract Background Deep brain stimulation (DBS) is an effective intervention for Meige syndrome, a type of dystonia characterized by blepharospasm, facial, and oromandibular dystonia. This individual patient-level data meta-analysis was to identify the potential outcome predictors, compare the stimulation targets and summarize the efficacy of DBS for Meige syndrome. Methods Three electronic databases (PubMed, Web of Science and Embase) were searched with no publication data restriction to identify studies regarding DBS for Meige syndrome. The primary outcome was the improvement in BFMDRS-M score. Pearson’s correlation coefficients and a stepwise multivariate regression analysis were used to identify the potential prognostic factors. Results Twenty-three studies (115 patients, 94 with pallidal stimulation and 21 with subthalamic stimulation) were eligible. Patients showed significant improvement in Burke–Fahn–Marsden Dystonia Rating Scale movement (BFMDRS-M) (21.5 ± 11.0 vs 8.6 ± 6.9, P < 0.001) and disability (BFMDRS-D) (6.4 ± 5.1 vs 2.9 ± 2.4, P < 0.001) scores at the last follow-up visit (31.9 ± 30.7 months), compared with scores at baseline. Preoperative BFMDRS-M and BFMDRS-D scores were positively correlated with the relative changes in BFMDRS-M score at the last follow-up visit. On the stepwise multivariate regression, only the preoperative BFMDRS remained significant in the best predictive model. Conclusions Based on the existing evidence, pallidal/subthalamic stimulation is an effective therapy for even the refractory Meige syndrome. Higher preoperative scores probably indicate larger improvement. Stimulation targets or other clinical factors do not constitute the outcome predictive factors.