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Hophing L, Tse T, Naimer N, Masellis M, Mirza SS, Izenberg A, Khosravani H, Kassardjian CD, Mitchell SB. Virtual Compared With In-Person Neurologic Examination Study. Neurol Clin Pract 2024; 14:e200339. [PMID: 39185101 PMCID: PMC11341002 DOI: 10.1212/cpj.0000000000200339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 04/12/2024] [Indexed: 08/27/2024]
Abstract
Background and Objectives The COVID-19 pandemic forced a shift to virtual care in several neurologic care settings. Little is known about the validity of the virtual neurologic examination (VNE) for clinical decision making when compared with the in-person neurologic examination (IPNE). The objective of this study was to investigate the utility of the VNE in arriving at an accurate localization and diagnosis in comparison with the traditional IPNE in an ambulatory outpatient setting. Methods A retrospective chart review of patients examined virtually and in-person within 4 months at outpatient general neurology and neuromuscular clinics from 2 tertiary academic care centers during the COVID-19 pandemic was conducted. The Cohen kappa coefficient was calculated to test agreement between virtual and in-person assessment results, and descriptive statistical methods were used to compare accuracy, localization, and diagnosis. Results A total of 81 patients met the inclusion criteria. Overall, there was fair agreement between VNE and IPNE (64% agreement, p = 0.003). Substantial agreement between VNE and IPNE was observed for gait abnormalities; moderate agreement for extraocular movements, facial weakness, dysarthria, fasciculation, and lower limb weakness; and fair agreement for bulk, upper limb weakness, and sensation. No agreement between VNE and IPNE was seen for hypokinetic or hyperkinetic movements and cerebellar signs. Compared with the IPNE, specificity of the VNE was 86% and sensitivity was 56%. Some cases demonstrated a consistent localization (44%) and diagnosis (57%) after virtual and in-person assessments. The localization was changed in 15% and refined in 41% of cases between visits. The diagnosis was changed in 14% and refined in 30% of cases. Discussion The high rates of agreement in detecting an abnormality on the VNE and IPNE for some maneuvers and resultant clinical impressions may support the validity of the VNE for initial consultation depending on the clinical scenario. The VNE seems to be a good surrogate evaluation compared with the IPNE for certain chief complaints. The low sensitivity suggests that a normal VNE should warrant further in-person clinical correlation, especially in the context of a highly concerning history. The IPNE is more sensitive in detecting subtle abnormalities on examination, and a low threshold should be used to bring a patient in for an IPNE if the VNE is normal in certain clinical contexts.
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Affiliation(s)
- Lauren Hophing
- Division of Neurology (LH, MM, AI, HK, CDK, SBM), Department of Medicine; Neurology Quality and Innovation Lab (LH, TT, NN, HK, CDK, SBM); Division of Neurology (MM, AI, HK, SBM), Department of Medicine, Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (MM, SSM, HK, SBM), University of Toronto, Ontario, Canada; Division of Neurology (CDK), Department of Medicine; Li Ka Shing Knowledge Institute (CDK), St. Michael's Hospital; Department of Psychiatry (SBM), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; and Azrieli Brian Medicine Fellowship Program (SBM), Toronto, Ontario, Canada
| | - Tiffany Tse
- Division of Neurology (LH, MM, AI, HK, CDK, SBM), Department of Medicine; Neurology Quality and Innovation Lab (LH, TT, NN, HK, CDK, SBM); Division of Neurology (MM, AI, HK, SBM), Department of Medicine, Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (MM, SSM, HK, SBM), University of Toronto, Ontario, Canada; Division of Neurology (CDK), Department of Medicine; Li Ka Shing Knowledge Institute (CDK), St. Michael's Hospital; Department of Psychiatry (SBM), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; and Azrieli Brian Medicine Fellowship Program (SBM), Toronto, Ontario, Canada
| | - Nicole Naimer
- Division of Neurology (LH, MM, AI, HK, CDK, SBM), Department of Medicine; Neurology Quality and Innovation Lab (LH, TT, NN, HK, CDK, SBM); Division of Neurology (MM, AI, HK, SBM), Department of Medicine, Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (MM, SSM, HK, SBM), University of Toronto, Ontario, Canada; Division of Neurology (CDK), Department of Medicine; Li Ka Shing Knowledge Institute (CDK), St. Michael's Hospital; Department of Psychiatry (SBM), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; and Azrieli Brian Medicine Fellowship Program (SBM), Toronto, Ontario, Canada
| | - Mario Masellis
- Division of Neurology (LH, MM, AI, HK, CDK, SBM), Department of Medicine; Neurology Quality and Innovation Lab (LH, TT, NN, HK, CDK, SBM); Division of Neurology (MM, AI, HK, SBM), Department of Medicine, Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (MM, SSM, HK, SBM), University of Toronto, Ontario, Canada; Division of Neurology (CDK), Department of Medicine; Li Ka Shing Knowledge Institute (CDK), St. Michael's Hospital; Department of Psychiatry (SBM), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; and Azrieli Brian Medicine Fellowship Program (SBM), Toronto, Ontario, Canada
| | - Saira S Mirza
- Division of Neurology (LH, MM, AI, HK, CDK, SBM), Department of Medicine; Neurology Quality and Innovation Lab (LH, TT, NN, HK, CDK, SBM); Division of Neurology (MM, AI, HK, SBM), Department of Medicine, Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (MM, SSM, HK, SBM), University of Toronto, Ontario, Canada; Division of Neurology (CDK), Department of Medicine; Li Ka Shing Knowledge Institute (CDK), St. Michael's Hospital; Department of Psychiatry (SBM), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; and Azrieli Brian Medicine Fellowship Program (SBM), Toronto, Ontario, Canada
| | - Aaron Izenberg
- Division of Neurology (LH, MM, AI, HK, CDK, SBM), Department of Medicine; Neurology Quality and Innovation Lab (LH, TT, NN, HK, CDK, SBM); Division of Neurology (MM, AI, HK, SBM), Department of Medicine, Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (MM, SSM, HK, SBM), University of Toronto, Ontario, Canada; Division of Neurology (CDK), Department of Medicine; Li Ka Shing Knowledge Institute (CDK), St. Michael's Hospital; Department of Psychiatry (SBM), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; and Azrieli Brian Medicine Fellowship Program (SBM), Toronto, Ontario, Canada
| | - Houman Khosravani
- Division of Neurology (LH, MM, AI, HK, CDK, SBM), Department of Medicine; Neurology Quality and Innovation Lab (LH, TT, NN, HK, CDK, SBM); Division of Neurology (MM, AI, HK, SBM), Department of Medicine, Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (MM, SSM, HK, SBM), University of Toronto, Ontario, Canada; Division of Neurology (CDK), Department of Medicine; Li Ka Shing Knowledge Institute (CDK), St. Michael's Hospital; Department of Psychiatry (SBM), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; and Azrieli Brian Medicine Fellowship Program (SBM), Toronto, Ontario, Canada
| | - Charles D Kassardjian
- Division of Neurology (LH, MM, AI, HK, CDK, SBM), Department of Medicine; Neurology Quality and Innovation Lab (LH, TT, NN, HK, CDK, SBM); Division of Neurology (MM, AI, HK, SBM), Department of Medicine, Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (MM, SSM, HK, SBM), University of Toronto, Ontario, Canada; Division of Neurology (CDK), Department of Medicine; Li Ka Shing Knowledge Institute (CDK), St. Michael's Hospital; Department of Psychiatry (SBM), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; and Azrieli Brian Medicine Fellowship Program (SBM), Toronto, Ontario, Canada
| | - Sara B Mitchell
- Division of Neurology (LH, MM, AI, HK, CDK, SBM), Department of Medicine; Neurology Quality and Innovation Lab (LH, TT, NN, HK, CDK, SBM); Division of Neurology (MM, AI, HK, SBM), Department of Medicine, Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (MM, SSM, HK, SBM), University of Toronto, Ontario, Canada; Division of Neurology (CDK), Department of Medicine; Li Ka Shing Knowledge Institute (CDK), St. Michael's Hospital; Department of Psychiatry (SBM), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; and Azrieli Brian Medicine Fellowship Program (SBM), Toronto, Ontario, Canada
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Patel AD, Joshi C, Das R, Stern JM, Herman ST, Gidal BE. The Tell on Telehealth. Epilepsy Curr 2024; 24:232-241. [PMID: 39309058 PMCID: PMC11412410 DOI: 10.1177/15357597241255274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 09/25/2024] Open
Abstract
Objective Telehealth in epilepsy care is not new. During the COVID-19 public health emergency, telehealth became more readily used to deliver epilepsy care. However, a summarized guidance of use in caring for people with epilepsy utilizing telehealth is needed. Methods Existing literature was reviewed to provide guidance on various aspects of telehealth. Billing aspects are reviewed. Recommendations and considerations along with benefits and barriers to telehealth are provided. Results Telehealth can be a preferred delivery route of care for people with epilepsy in specific situations. Examples include psychiatric complaints, medication management, and follow-up visits for noncomplicated epilepsy care. In addition, telehealth is useful for patients who need postoperative visits, are not able to travel, or live in residential facilities. In-person care may be more suitable for patients who are medically complex, have language barriers or difficulty with resource access, hearing impaired, or have neurostimulation devices where remote monitoring or programming options are infeasible. Discussion Telehealth care for people with epilepsy can be a useful and important method of care delivery. It should remain an option for providers to use in epilepsy clinical care. It is important for the neurology provider to understand the benefits, billing, and barriers to providing telehealth.
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Affiliation(s)
- Anup D. Patel
- Division of Neurology, Nationwide Children’s Hospital, Columbus, OH, USA
- The Center for Clinical Excellence, Nationwide Children’s Hospital, Columbus, OH, USA
- Partners for Kids, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics and Neurology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Charuta Joshi
- Department of Pediatrics, Children’s Health, University of Texas Southwestern, Dallas, TX, USA
| | - Rohit Das
- Department of Neurology, Oregon Health & Sciences, Portland, OR, USA
| | - John M. Stern
- Department of Neurology, Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Susan T. Herman
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Barry E. Gidal
- Division of Pharmacy Practice and Translational Research, University of Wisconsin School of Pharmacy, Madison, WI, USA
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van Dijl TL, Videler AC, Aben HP, Kop WJ. Anger regulation in patients with functional neurological disorder: A systematic review. Gen Hosp Psychiatry 2024; 88:30-47. [PMID: 38458028 DOI: 10.1016/j.genhosppsych.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/24/2024] [Accepted: 02/27/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Functional neurological disorder (FND) has been associated with predisposing psychological factors, including dysregulation of anger-related processes. This paper provides a systematic review of the literature on anger regulation in FND. We evaluated anger-related research on patient self-report, observational, and laboratory based measures in FND. The review also addresses adverse childhood experiences and their relation with anger regulation, and the effects of therapies targeting anger regulation in FND. METHODS MEDLINE, EMBASE, and PsycINFO were searched for both quantitative and qualitative research, published in a peer-reviewed journal with a sample size of at least 5 (registered under Prospero protocol CRD42022314340). RESULTS A total of 2200 articles were identified. After screening, 54 studies were included in this review (k = 20 questionnaire-based studies, k = 12 laboratory studies, k = 21 using other methods, and k = 1 used both questionnaires and other methods) representing data of 2502 patients with FND. Questionnaire-based studies indicated elevated levels of state anger and trait hostility in patients with FND. Laboratory studies showed a higher tendency to avoid social threat cues, attentional bias towards angry faces, difficulties reliving anger, and preoccupation with frustrating barriers among FND patients versus controls. No specific childhood experiences were identified related to anger regulation in FND, and too few small and uncontrolled studies were available (k = 2) to assess the effects of anger-related interventions in FND. The overall quality of the studies was fair (k = 31) to poor (k = 18). Five studies (k = 5) were rated as having a good quality. CONCLUSIONS This review suggests that patients with FND have maladaptive anger regulation compared to individuals without FND. The findings also highlight the need for further research on the prevalence and consequences of anger-related processes in the development, diagnosis and treatment of FND.
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Affiliation(s)
- T L van Dijl
- Department of Medical and Clinical Psychology, Center for Research on Psychological Disorders and Somatic Diseases, Tilburg University, Tilburg, the Netherlands; Clinical Centre of Excellence for Body, Mind, and Health, GGz Breburg, Tilburg, the Netherlands; Department Tranzo, Tilburg University, Tilburg, the Netherlands; Department of Psychiatry, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands; Department of Child and Adolescent Psychiatry, De Hoop ggz, Dordrecht, the Netherlands.
| | - A C Videler
- Clinical Centre of Excellence for Body, Mind, and Health, GGz Breburg, Tilburg, the Netherlands; Department Tranzo, Tilburg University, Tilburg, the Netherlands
| | - H P Aben
- Department of Neurology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - W J Kop
- Department of Medical and Clinical Psychology, Center for Research on Psychological Disorders and Somatic Diseases, Tilburg University, Tilburg, the Netherlands; Department Tranzo, Tilburg University, Tilburg, the Netherlands
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Perez DL, Nicholson TR, Asadi-Pooya AA, Butler M, Carson AJ, David AS, Deeley Q, Diez I, Edwards MJ, Espay AJ, Gelauff JM, Jungilligens J, Hallett M, Kanaan RAA, Tijssen MAJ, Kozlowska K, LaFrance WC, Marapin RS, Maurer CW, Reinders AATS, Sojka P, Staab JP, Stone J, Szaflarski JP, Aybek S. Response to the Letter Concerning the Publication: Neuroimaging in Functional Neurological Disorder: State of the Field and Research Agenda. Perez DL et al. Neuroimage Clin. 2021;30:102623. Neuroimage Clin 2024; 41:103573. [PMID: 38309187 PMCID: PMC10847796 DOI: 10.1016/j.nicl.2024.103573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/05/2024]
Affiliation(s)
- David L Perez
- Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Timothy R Nicholson
- Neuropsychiatry Research & Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Centre, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Matthew Butler
- Neuropsychiatry Research & Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alan J Carson
- Centre for Clinical Brain Sciences, The University of Edinburgh, EH16 4SB, UK
| | - Anthony S David
- Division of Psychiatry, Institute of Mental Health, University College London, London, UK
| | - Quinton Deeley
- South London and Maudsley NHS Foundation Trust, London UK Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Ibai Diez
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark J Edwards
- Institute of Psychiatry, Psychology and Neuroscience, King's College 16 De Crespigny Park, London, SE5 8AF, UK
| | - Alberto J Espay
- James J. and Joan A. Gardner Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | | | - Johannes Jungilligens
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Germany
| | - Mark Hallett
- National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
| | - Richard A A Kanaan
- Department of Psychiatry, University of Melbourne, Austin Health, Heidelberg, Australia
| | - Marina A J Tijssen
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Groningen, University of Groningen, the Netherlands
| | - Kasia Kozlowska
- The Children's Hospital at Westmead, Westmead Institute of Medical Research, University of Sydney Medical School, Sydney, NSW, Australia
| | - W Curt LaFrance
- Departments of Psychiatry and Neurology, Rhode Island Hospital, Brown University, Providence, RI, USA
| | - Ramesh S Marapin
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Groningen, University of Groningen, the Netherlands
| | - Carine W Maurer
- Department of Neurology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
| | - Antje A T S Reinders
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Petr Sojka
- Department of Neurology and Centre of Clinical Neuroscience, Charles University, 1st Faculty of Medicine and General University Hospital in Prague, Prague, Czech Republic
| | - Jeffrey P Staab
- Departments of Psychiatry and Psychology and Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic Rochester, MN, USA
| | - Jon Stone
- Centre for Clinical Brain Sciences, The University of Edinburgh, EH16 4SB, UK
| | - Jerzy P Szaflarski
- University of Alabama at Birmingham Epilepsy Center, Department of Neurology, University of Alabama at Birmingham, AL, USA
| | - Selma Aybek
- Faculté des Sciences et de Médecine, Université de Fribourg, Chemin du Musée 5, 1700 Fribourg, Suisse
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Ramsay N, Stone J, Fadiloglu K, Baxter M, Hutchison C, Bennett K, Moullaali T, Mathur J, Bridson J, Hoeritzauer I. Functional neurological disorder: A common reason for a neurology inpatient referral. Eur J Neurol 2023; 30:3886-3889. [PMID: 37505203 DOI: 10.1111/ene.16003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/17/2023] [Accepted: 07/23/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND AND PURPOSE In 2021, the European Academy of Neurology's training requirements were updated to include functional neurological disorder (FND) as a core topic for the first time. To reinforce these changes, we aimed to understand the proportion of inpatients (in non-neurology settings) who are diagnosed with FND. METHODS We prospectively collected data on diagnoses made after inpatient ward reviews from neurology trainees at three tertiary neurology centres in Scotland from April to September 2021. We assessed healthcare utilization data for patients with a diagnosis of FND, epilepsy and epileptic seizures, or a neuroinflammatory disorder over the preceding 12 months. RESULTS There were 437 inpatient reviews for 424 patients by 13 trainees. The largest single diagnosis was FND (n = 80, 18%), followed by epilepsy (n = 64, 14%), primary headache disorder (n = 40, 9%) and neuroinflammatory disorders (n = 28, 6%). There was an uncertain diagnosis for 48 reviews (11%). Compared to patients with epilepsy or neuroinflammatory disorders, patients with FND had a similar number of admissions (2 vs. 2 vs. 1) and brain/spine imaging studies (2 vs. 1 vs. 2). CONCLUSIONS In Scotland, FND was the most common diagnosis made after a request for an inpatient review by a neurologist from another department in the hospital. Patients with FND have similar health resource needs to those with other common neurological disorders when they present to hospitals with tertiary neurology centres. This data supports the inclusion of FND as a core curriculum topic in neurology training.
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Affiliation(s)
- Neil Ramsay
- Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Kubra Fadiloglu
- Department of Liaison Psychiatry, Western General Hospital, Edinburgh, UK
| | | | | | - Karina Bennett
- Department of Neurology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Tom Moullaali
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Jai Mathur
- Department of Internal Medicine, University College Hospital, London, UK
| | - James Bridson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Ingrid Hoeritzauer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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