1
|
Cheng C, Perkins B, Keith M, Bryden A, Chepla KJ. Preoperative evaluation of nerve transfer recipients after spinal cord injury using stimulated manual muscle testing. J Hand Surg Eur Vol 2024; 49:873-877. [PMID: 37987690 DOI: 10.1177/17531934231214105] [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] [Indexed: 11/22/2023]
Abstract
Nerve transfer after spinal cord injury has become increasingly popular. Accurate preoperative identification of lower motor neuron involvement in potential recipient nerves is critical. Electrodiagnostic testing has been shown to correlate with intraoperative findings; however, it is time-consuming, costly and may not be readily available. Stimulated manual muscle testing is an alternative diagnostic approach. It is inexpensive and easily done by the surgeon or therapist in the office; however, correlation with intraoperative stimulation has not been reported. A retrospective review was conducted for patients who underwent nerve transfer for tetraplegia with recorded preoperative stimulated manual muscle testing and intraoperative stimulation results. Nine patients including 37 nerve transfers were included. Of the 37 nerve transfers, 36 were accurately graded preoperatively by stimulated manual muscle testing. Stimulated manual muscle testing had a sensitivity of 89%, specificity of 100%, positive predictive value of 100% and a negative predictive value of 97%. This study supports stimulated manual muscle testing for preoperative distinction between upper versus lower motor neuron injuries.Level of evidence: IV.
Collapse
Affiliation(s)
- Christopher Cheng
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Cleveland, OH, USA
| | - Blake Perkins
- Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Cleveland, OH, USA
| | - Michael Keith
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Cleveland, OH, USA
| | - Anne Bryden
- Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Cleveland, OH, USA
- Institute of Functional Restoration, Case Western Reserve University, Cleveland, OH, USA
| | - Kyle J Chepla
- Division of Plastic Surgery, MetroHealth Medical Center, Cleveland, OH, USA
| |
Collapse
|
2
|
Rakusa M, Moro E, Akhvlediani T, Bereczki D, Bodini B, Cavallieri F, Fanciulli A, Filipović SR, Guekht A, Helbok R, Hochmeister S, Martinelli Boneschi F, Özturk S, Priori A, Romoli M, Willekens B, Zedde M, Sellner J. The COVID-19 pandemic and neurology: A survey on previous and continued restrictions for clinical practice, curricular training, and health economics. Eur J Neurol 2024; 31:e16168. [PMID: 38038262 PMCID: PMC11235678 DOI: 10.1111/ene.16168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/03/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND AND PURPOSE The COVID-19 pandemic has significantly impacted health systems worldwide. Here, we assessed the pandemic's impact on clinical service, curricular training, and financial burden from a neurological viewpoint during the enforced lockdown periods and the assumed recovery by 2023. METHODS An online 18-item survey was conducted by the European Academy of Neurology (EAN) NeuroCOVID-19 Task Force among the EAN community. The survey was online between February and March 2023. Questions related to general, demographic, clinical, work, education, and economic aspects. RESULTS We collected 430 responses from 79 countries. Most health care professionals were aged 35-44 years, with >15 years of work experience. The key findings of their observations were as follows. (i) Clinical services were cut back in all neurological subspecialties during the most restrictive COVID-19 lockdown period. The most affected neurological subspecialties were services for patients with dementia, and neuromuscular and movement disorders. The levels of reduction and the pace of recovery were distinct for acute emergencies and in- and outpatient care. Recovery was slow for sleep medicine, autonomic nervous system disorders, neurorehabilitation, and dementia care. (ii) Student and residency rotations and grand rounds were reorganized, and congresses were converted into a virtual format. Conferences are partly maintained in a hybrid format. (iii) Affordability of neurological care and medication shortage are emerging issues. CONCLUSIONS Recovery of neurological services up to spring 2023 has been incomplete following substantial disruption of neurological care, medical education, and health economics in the wake of the COVID-19 pandemic. The continued limitations for the delivery of neurological care threaten brain health and call for action on a global scale.
Collapse
Affiliation(s)
- Martin Rakusa
- Division of NeurologyUniversity Medical Centre MariborMariborSlovenia
| | - Elena Moro
- Division of Neurology, CHU of Grenoble, Grenoble Institute of Neurosciences, INSERM U1216Grenoble Alpes UniversityGrenobleFrance
| | | | | | - Benedetta Bodini
- Neurology DepartmentSt. Antoine Hospital, APHPParisFrance
- Paris Brain Institute, ICM, CNRS, INSERMSorbonne UniversitéParisFrance
| | - Francesco Cavallieri
- Neurology Unit, Neuromotor and Rehabilitation DepartmentAzienda USL‐IRCCS di Reggio EmiliaReggio EmiliaItaly
| | | | | | - Alla Guekht
- Research and Clinical Center for NeuropsychiatryMoscowRussian Federation
- Pirogov Russian National Research Medical UniversityMoscowRussian Federation
| | - Raimund Helbok
- Department of NeurologyJohannes Kepler UniversityLinzAustria
| | | | | | - Serefnur Özturk
- Department of Neurology, Faculty of MedicineSelcuk UniversityKonyaTurkey
| | - Alberto Priori
- Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health SciencesUniversity of MilanMilanItaly
- Clinical Neurology Unit, Azienda Socio‐Sanitaria Territoriale Santi Paolo e Carlo and Department of Health SciencesUniversity of MilanMilanItaly
| | - Michele Romoli
- Neurology and Stroke Unit, Department of NeuroscienceBufalini HospitalCesenaItaly
| | - Barbara Willekens
- Department of NeurologyAntwerp University HospitalEdegemBelgium
- Translational Neurosciences Research GroupUniversity of AntwerpWilrijkBelgium
| | - Marialuisa Zedde
- Neurology Unit, Stroke UnitAzienda Unità Sanitaria Locale, IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Johann Sellner
- Department of NeurologyLandesklinkum Mistelbach‐GänserndorfMistelbachAustria
| | | |
Collapse
|
3
|
Carroll TJ, Chirokikh A, Thon J, Jones CMC, Logigian E, Ketonis C. Diagnosis of Ulnar Neuropathy at the Elbow Using Ultrasound - A Comparison to Electrophysiologic Studies. J Hand Surg Am 2023; 48:1229-1235. [PMID: 37877916 DOI: 10.1016/j.jhsa.2023.08.014] [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: 01/14/2023] [Revised: 08/16/2023] [Accepted: 08/30/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE Given the relatively high false negative rate of electrodiagnostic studies (EDX) in patients with clinically diagnosed ulnar neuropathy at the elbow (UNE), we sought to determine whether an alternative objective test could more effectively detect UNE. Additionally, we proposed to determine the relationship between the cross-sectional area (CSA) of the ulnar nerve on ultrasound (US), EDX, and clinical symptoms. METHODS This was a retrospective study of patients presenting with symptomatic UNE. The performance characteristics of EDX versus ultrasound were calculated using the clinical diagnosis of UNE as the reference standard. Standard EDX studies and US of the ulnar nerve were analyzed. Maximal CSA of the ulnar nerve and EDX severity were analyzed for patients with each combination of US-positive/negative and EDX-positive/negative findings. RESULTS Analysis was performed on 89 patients and 115 nerves with signs and symptoms of cubital tunnel syndrome. In total, 56 (49%) nerves were diagnosed as mild UNE, 32 (28%) nerves were diagnosed as moderate UNE, 17 (15%) nerves were diagnosed as severe UNE, and 10 (8%) nerves were negative for UNE by EDX. Maximal-maximal CSA was highly correlated with disease severity as determined by nerve conduction studies/electromyography. Compared with EDX+/US+, patients with EDX-/US+ showed higher rates of ulnar sensory loss and elbow tenderness with similar rates of positive Tinel and intrinsic muscle atrophy. In this sample of patients with clinically diagnosed UNE, 91.3% of the patients demonstrated positive EDX studies, whereas 94.8% had a positive US. CONCLUSIONS Ultrasound is an alternative to EDX that could be incorporated clinically in the diagnosis and management of UNE. Ultrasound was able to consistently detect clinically positive cubital tunnel syndrome demonstrating its utility as a confirmatory or supplemental test to the clinical assessment if one is required. Ultrasound additionally may be able to better identify patients with early stages of UNE with negative EDX findings. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic IV.
Collapse
Affiliation(s)
- Thomas John Carroll
- University of Rochester Department of Orthopaedic Surgery, University of Rochester School, Rochester, NY.
| | - Alexander Chirokikh
- University of Rochester Department of Orthopaedic Surgery, University of Rochester School, Rochester, NY
| | - Julie Thon
- University of Rochester Department of Orthopaedic Surgery, University of Rochester School, Rochester, NY
| | - Courtney Marie Cora Jones
- University of Rochester Department of Orthopaedic Surgery, University of Rochester School, Rochester, NY
| | - Eric Logigian
- University of Rochester Department of Neurology, University of Rochester School, Rochester, NY
| | - Constantinos Ketonis
- University of Rochester Department of Orthopaedic Surgery, University of Rochester School, Rochester, NY
| |
Collapse
|
4
|
Tranter MM, Aggarwal S, Young JW, Dillon DG, Barnes SA. Reinforcement learning deficits exhibited by postnatal PCP-treated rats enable deep neural network classification. Neuropsychopharmacology 2023; 48:1377-1385. [PMID: 36509858 PMCID: PMC10354061 DOI: 10.1038/s41386-022-01514-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/21/2022] [Accepted: 11/26/2022] [Indexed: 12/14/2022]
Abstract
The ability to appropriately update the value of a given action is a critical component of flexible decision making. Several psychiatric disorders, including schizophrenia, are associated with impairments in flexible decision making that can be evaluated using the probabilistic reversal learning (PRL) task. The PRL task has been reverse-translated for use in rodents. Disrupting glutamate neurotransmission during early postnatal neurodevelopment in rodents has induced behavioral, cognitive, and neuropathophysiological abnormalities relevant to schizophrenia. Here, we tested the hypothesis that using the NMDA receptor antagonist phencyclidine (PCP) to disrupt postnatal glutamatergic transmission in rats would lead to impaired decision making in the PRL. Consistent with this hypothesis, compared to controls the postnatal PCP-treated rats completed fewer reversals and exhibited disruptions in reward and punishment sensitivity (i.e., win-stay and lose-shift responding, respectively). Moreover, computational analysis of behavior revealed that postnatal PCP-treatment resulted in a pronounced impairment in the learning rate throughout PRL testing. Finally, a deep neural network (DNN) trained on the rodent behavior could accurately predict the treatment group of subjects. These data demonstrate that disrupting early postnatal glutamatergic neurotransmission impairs flexible decision making and provides evidence that DNNs can be trained on behavioral datasets to accurately predict the treatment group of new subjects, highlighting the potential for DNNs to aid in the diagnosis of schizophrenia.
Collapse
Affiliation(s)
- Michael M Tranter
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, USA
- Department of Mental Health, VA San Diego Healthcare System, La Jolla, CA, 92093, USA
| | - Samarth Aggarwal
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, USA
| | - Jared W Young
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, USA
- Department of Mental Health, VA San Diego Healthcare System, La Jolla, CA, 92093, USA
| | - Daniel G Dillon
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, 02478, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Samuel A Barnes
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, USA.
- Department of Mental Health, VA San Diego Healthcare System, La Jolla, CA, 92093, USA.
| |
Collapse
|
5
|
Jones LK, McClean JC, Avitzur O. US Health Care System in 2035: The Neurology Future Forecasting Series. Neurology 2022; 98:402-408. [PMID: 35256518 DOI: 10.1212/wnl.0000000000200057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/28/2021] [Indexed: 11/15/2022] Open
Abstract
Evolution of the US health care system has been punctuated by periods of rapid change. In the coming decades there will be meaningful and potentially disruptive developments in health care delivery mechanisms, the policy environment, and the populations for whom we provide care. Neurologists will need to adapt to changing patient expectations, market dynamics, and regulatory structures to thrive in the future health care environment. This article describes a forecast of potential changes in the US health care system by 2035, an assessment of the implications for the field of neurology, and a rationale for long-term strategic planning to prepare.
Collapse
Affiliation(s)
- Lyell K Jones
- From the Mayo Clinic (L.K.J.), Rochester, MN; San Antonio Military Medical Center (J.C.M.), TX; and American Academy of Neurology (O.A.), Tarrytown, NY.
| | - Jeffrey C McClean
- From the Mayo Clinic (L.K.J.), Rochester, MN; San Antonio Military Medical Center (J.C.M.), TX; and American Academy of Neurology (O.A.), Tarrytown, NY
| | - Orly Avitzur
- From the Mayo Clinic (L.K.J.), Rochester, MN; San Antonio Military Medical Center (J.C.M.), TX; and American Academy of Neurology (O.A.), Tarrytown, NY
| |
Collapse
|
6
|
What's Happening in Innovations in Care Delivery. Neurology 2021. [DOI: 10.1212/wnl.0000000000011559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
7
|
Jones LK, Schwarz HB. Elasticity in Health Care: How Much Can We Stretch the System, and Our Patients? Neurology 2020; 96:87-88. [PMID: 33361252 DOI: 10.1212/wnl.0000000000011313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Lyell K Jones
- From the Mayo Clinic (L.K.J.), Rochester, MN; and University of Rochester (H.B.S.), NY.
| | - Heidi B Schwarz
- From the Mayo Clinic (L.K.J.), Rochester, MN; and University of Rochester (H.B.S.), NY
| |
Collapse
|