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A computerized version of the Trail Making Test, an adaptation of the classical paper-and-pencil form, was compared with the paper-and-pencil form. The testee must connect targets on the screen with the cursor using the mouse instead of a sheet of paper and a pen. The participants were 68 healthy adolescents and young adults. The comparison of scores on the two versions showed that they cannot be considered equivalent; the difference between the two parts of the test (Parts A and B) was greater in the paper-and-pencil version; correlations between the two versions of Part A and of Part B were significant, but too low to consider the two versions parallel. Both versions were accepted by participants. As expected, mean scores were different in Parts A and B in both versions and magnitude of differences was large. [ABSTRACT FROM AUTHOR]

Coronavirus 2019 (COVID-19) has profoundly impacted the well-being of society and the practice of medicine across health care systems worldwide. As with many other subspecialties, the clinical paradigm in behavioral neurology and neuropsychiatry (BN-NP) was transformed abruptly, transitioning to real-time telemedicine for the assessment and management of the vast majorities of patient populations served by our subspecialty. In this commentary, we outline themes from the BN-NP perspective that reflect the emerging lessons we learned using telemedicine during the COVID-19 pandemic. Positive developments include the ability to extend consultations and management to patients in our high-demand field, maintenance of continuity of care, enhanced ecological validity, greater access to a variety of well-reimbursed telemedicine options (telephone and video) that help bridge the digital divide, and educational and research opportunities. Challenges include the need to adapt the mental state examination to the telemedicine environment, the ability to perform detailed motor neurologic examinations in patients where motor features are important diagnostic considerations, appreciating nonverbal cues, managing acute safety and behavioral concerns in less controlled environments, and navigating intervention-based (neuromodulation) clinics requiring in-person contact. We hope that our reflections help to catalyze discussions that should take place within the Society for Behavioral and Cognitive Neurology, the American Neuropsychiatric Association, and allied organizations regarding how to optimize real-time telemedicine practices for our subspecialty now and into the future.

Background Existing tools for rapid cognitive assessment in HIV-positive individuals with mild cognitive deficits lack sensitivity or do not meet psychometric requirements for tracking changes in cognitive ability over time. Methods Seventy-five nondemented HIV-positive patients were evaluated with the Montreal Cognitive Assessment (MoCA), a brief battery of standardized neuropsychological tests, and computerized tasks evaluating frontal-executive function and processing speed. Rasch analyses were applied to the MoCA data set and subsequently to the full set of data from all tests. Results The MoCA was found to adequately measure cognitive ability as a single, global construct in this HIV-positive cohort, although it showed poorer precision for measuring patients of higher ability. Combining the additional tests with the MoCA resulted in a battery with better psychometric properties that also better targeted the range of abilities in this cohort. Conclusion This application of modern test development techniques shows a path towards a quick, quantitative, global approach to cognitive assessment with promise both for initial detection and for longitudinal follow-up of cognitive impairment in patients with HIV infection. [ABSTRACT FROM AUTHOR]

Heart problems are common in newborn babies, affecting approximately 5-10 in 1000 babies. Some are more serious than others, but most babies born with heart problems do not have other health issues. Of those babies who have a serious heart problem, almost 1 in 4 will have heart surgery in their first year. In the UK, pregnant women are offered a scan at around 20 weeks to try and spot any heart problems. In most cases there is not a clear reason for the problem, but sometimes other issues, such as genetic conditions, are discovered. In recent years the care given to these babies after they are born has improved their chances of surviving. However, it is recognised that babies born with heart problems have a risk of delays in their learning and development. This may be due to their medical condition, or as a result of surgery and complications after birth. In babies with heart problems, there is a need for more research on ultrasound and magnetic resonance imaging (MRI) to understand how the brain develops and why these babies are more likely to have delays in learning and development. This paper discusses the way ultrasound and MRI are used in assessing the baby's brain. Ultrasound is often used to spot any problems, looking at how the baby's brain develops in pregnancy. Advances in ultrasound technologies have made this easier. MRI is well-established and safe in pregnancy, and if problems in the brain have been seen on ultrasound, MRI may be used to look at these problems in more detail. While it is not always clear what unusual MRI findings can mean for the baby in the long term, increased understanding may mean parents can be given more information about possible outcomes for the baby and may help to improve the counselling they are offered before their baby's birth. [ABSTRACT FROM AUTHOR]

Discusses the development and use of the Mini-Mental State (MMS) Examination in diagnosing cognitive disorders. Method used in assessing the validity of MMS results; Background on different versions of MMS tests; Applications of MMS.

Background statement: Accurate completion of a Neurological Assessment including the Glasgow Coma Scale (GCS) is of the upmost importance in identifying and escalating neurological deterioration. This assessment must be standardised to ensure patient safety and quality care. Aim: This paper aims to review the standardisation of the GCS inclusive of a comprehensive Neurological Assessment in metropolitan hospitals in Australia. Existing literature on this tool in clinical practice, will be further explored in this review. It will primarily focus on efficacy, standardisation and accuracy of completing a Neurological Assessment on an Adult. Methods: A comprehensive review of the topic was undertaken, to reveal literature that supports the aim of this paper. Medline and Embase were accessed, with the use of Boolean operators to ensure literature met the inclusion and exclusion criteria. Results: Five articles were selected as appropriate and relevant to meet the needs and expectations of this review. Research suggests inconsistency and validity of the tool, which may affect patient safety. [ABSTRACT FROM AUTHOR]

Superficial temporal artery (STA) to middle cerebral artery (MCA) bypass, also referred to as STA-MCA bypass, is a direct revascularisation treatment for moyamoya disease. Moyamoya disease is a rare cerebrovascular condition characterised by progressive narrowing of the distal segments of the internal carotid arteries. Untreated, this may cause varied and progressive symptoms for patients, with a significantly increased risk of stroke annually. STA-MCA bypass is performed several times a year at Royal North Shore Hospital by specialist cerebrovascular neurosurgeons. This is a quaternary service with patient referrals received from throughout Australia. This paper will provide an overview of moyamoya, the surgical treatment and nursing care. The pre- and post-procedure nursing care for these patients is paramount, including perioperative blood pressure management, neurological assessment and wound care. The paper will also explore a case study of a patient who underwent a STA-MCA bypass, highlighting the value of specialised neuroscience nursing care, and additional considerations when managing patients living at a distance from the local health district. [ABSTRACT FROM AUTHOR]

Background/Objectives: The Early Identification and Intervention for Infants (Ei3) Network is an interdisciplinary team dedicated to improving early detection and intervention of cerebral palsy (CP) in California. This paper describes the key (1) awareness-building and (2) capacity-building strategies utilized by the Ei3 Network in the first two years. Methods: Awareness-building methods included interactive conference discussions, resource deliverable creation, and the creation of a framework for dissemination. Capacity-building methods were hosting assessment training, gathering stakeholder feedback, and implementation training. All deliverables were created with a minimum of 3 review and revision cycles. We planned, hosted, and provided scholarships for training, including the Hammersmith Infant Neurological Examination (HINE), Prechtl's GMA, and an implementation conference. Preliminary descriptive statistics and paired samples t-tests were performed on HINE training surveys. Results: Seven resource deliverables were created and distributed. A professional website, @steps2home.org, was launched. Online channels gained followers (146, Instagram; 198, X; 298, Mailchimp). Providers participated in various trainings: the Sykes Symposium on early detection and intervention (70), HINE (211), GMA Basic or Advanced (46), and Implementation Conference (six facilities from April 2023 to June 2024). HINE training participants reported increased ability to identify CP (p = 0.001), knowledge of (p = 0.004) early detection, ability to implement early detection guidelines (p < 0.001), and confidence in performing the HINE on the post-test (79.87%). Conclusions: The first two years of Ei3 resulted in increased awareness of the early detection guidelines through resources to help providers and families navigate complex care systems and dissemination through online and in-person strategies. We built capacity by training an increased number of providers to identify infants at risk of CP and implement the early detection guidelines. Engagement of stakeholders in focus groups, reviewing documents, and including a parent panel throughout the process increased the value of this work and should support the expansion of the network in the next year. [ABSTRACT FROM AUTHOR]

The cognitive neuroscience of language aims at revealing how linguistic information is represented and manipulated in the brain to enable communication and meaningful behaviour. An important aspect of the underlying brain processes is the integration and transformation of information across multiple brain systems. In order to understand these processes, a detailed characterisation of brain connectivity is key. For the most accurate characterisation of brain connectivity, connectivity methods should make use of the full multivariate and multidimensional information available from neuroimaging data. This should include a characterisation of transformations between patterns of activation across brain regions, and in particular their dependence on stimulus features, task and context. Methods for this type of analysis in event-related experimental designs have only recently begun to emerge. This paper describes these novel developments and their potential to transform the neuroscience of language, with a focus on fMRI and EEG/MEG research. [ABSTRACT FROM AUTHOR]

Neurologic examination of the comatose patient has gradually matured. Less than 50 years ago, neurological examination in coma became a regular part of textbooks with separate chapters devoted to the topic but many were deficient in detail. In 1969, C.M. Fisher published an extraordinary 56-page paper on the examination of the comatose patient. The paper-one of Fisher's gems-is not well known and infrequently cited. The many new observations collected in this comprehensive paper are reviewed in this vignette, which highlights not only how these contributions shaped our thinking on coma but also questioned shaky concepts. [ABSTRACT FROM AUTHOR]

Simple Summary: Neurofibromatosis Type 1 is an inherited tumour predisposition syndrome with a varied clinical phenotype. Long-term monitoring through imaging is inconsistent and varies in high- and low-income countries. Implementation of a clinical practice guideline through a multidisciplinary clinic is instrumental to the care of adult Neurofibromatosis Type 1 patients. This systematic review aims to evaluate the association between a country's socioeconomic status and diagnostic modalities and strategies used for adult Neurofibromatosis Type 1 patients. Our results show multiple imaging modalities are used in high-income countries; however, there is limited use in low-income countries. The two most common diagnostic modalities used in developed countries are WB MRI and FDG PET/CT. Background: Neurofibromatosis Type 1 is an autosomal dominant tumour-predisposition condition commonly diagnosed in childhood and fully penetrant by adulthood. Long-term monitoring through imaging is inconsistent and varies between high- and low-income countries. Implementation of a clinical practice guideline through a multidisciplinary clinic is instrumental to the care of adult Neurofibromatosis Type 1 patients. We aim to systematically review international diagnostic modalities and strategies to evaluate any association between a country's socioeconomic status and diagnostic modalities or strategies used for Neurofibromatosis Type 1 patients. Methods: We searched PubMed, Embase, Web of Science, and Cochrane. Relevant clinical information on the surveillance of adult Neurofibromatosis Type 1 patients worldwide was reviewed, extracted, and synthesised. Results: We identified 51 papers reporting on 7724 individuals. Multiple imaging modalities are actively employed in high-income and upper-middle-income countries for surveying adult Neurofibromatosis Type 1 patients. We did not find any relevant papers from low- and middle-income countries. Conclusions: This systematic review suggests that there is robust data on diagnostic modalities for adult Neurofibromatosis Type 1 patients in high-income countries, but not for low- and middle-income countries. There is a lack of data on consolidated diagnostic strategies from both high- and low-income countries. Efforts should be made to publish data on usual clinical practice in low- and middle-income countries to develop clinical practice guidelines describing best medical practice to fit a local context. [ABSTRACT FROM AUTHOR]

The objective structured clinical examination (OSCE) is a commonly used assessment of clinical skill. Ensuring the quality and reliability of OSCEs is a complex and ongoing process. This paper discusses scoring schemas and reviews checklists and global rating scales (GRS) for marking. Also detailed are post-examination quality assurance metrics tailored to smaller cohorts, with an illustrative dataset. A deidentified OSCE dataset, from stations with a checklist and GRS, of 24 examinees from a 2021 cohort was assessed using the following metrics: Cut scores or pass rates, number of failures, R2, intergrade discrimination, and between-group variation. The results were used to inform a set of implementable recommendations to improve future OSCEs. For most stations, the cut score calculated was higher than the traditional pass of 50% (58.9.8%–68.4%). The number of failures was low for traditional pass rates and cut scores (0.00–16.7%), except lab analysis where number of failures was 50.0%. R2 values ranged from 0.67–0.97, but the proportion of total variance was high (67.3–95.9). These data suggest there were potential missed teaching concepts, that station marking was open to examiner interpretation, and there were inconsistencies in examiner marking. Recommendations included increasing examiner training, using GRSs specific to each station, and reviewing all future OSCEs with the metrics described to guide refinements. The analysis used revealed several potential issues with the OSCE assessment. These findings informed recommendations to improve the quality of our future examinations. [ABSTRACT FROM AUTHOR]

The information contained in this article is suitable for clinicians practicing in the United States desiring a general overview of the assessment and management of spinal cord injury (SCI), focusing on initial care, assessment, acute management, complications, prognostication, and future research directions. SCI presents significant challenges, affecting patients physically, emotionally, and financially, with variable recovery outcomes ranging from full functionality to lifelong dependence on caregivers. Initial care aims to minimize secondary injury through thorough neurological evaluations and imaging studies to assess the severity of the injury. Acute management prioritizes stabilizing respiratory and cardiovascular functions and maintaining proper spinal cord perfusion. Patients with unstable or progressive neurological decline benefit from timely surgical intervention to optimize neurological recovery. Subacute management focuses on addressing common complications affecting the respiratory, gastrointestinal, and genitourinary systems, emphasizing a holistic, multidisciplinary approach. Prognostication is currently based on neurological assessments and imaging findings, but emerging biomarkers offer the potential to refine outcome predictions further. Additionally, novel therapeutic interventions, such as hypothermia therapy and neuroprotective medications are being explored to mitigate secondary damage and enhance recovery. This paper serves as a high-yield refresher for clinicians for the assessment and management of acute spinal cord injury during index admission. [ABSTRACT FROM AUTHOR]

Multiple sclerosis (MS) is a chronic and progressive neurological disease that affects the central nervous system, resulting in a wide spectrum of cognitive, emotional, and physical deficits. The progressive course of MS poses significant challenges to patients and has a profound impact on health-related quality of life (HRQoL). The style of coping adopted plays a critical role in determining how individuals with MS adapt to and face the challenges of the disease and their overall well-being. This paper aims to examine the impact of coping strategies on HRQoL in young adults un-/minimally impaired (<5 years, EDSS ≤ 2.5) by MS (age 18–35 years). This retrospective cross-sectional cohort study included 98 young adults (33 males and 65 females) with relapsing–remitting MS who underwent neurological assessment using the Expanded Disability Status Scale. Participants completed the Italian version of the Multiple Sclerosis QoL-54 (MSQoL-54), which provides a physical and mental health score, and the Coping Orientation to Problems Experienced Inventory (Brief-COPE). The results showed a significant relationship between COPE scores and physical and mental health. Subjects affected by MS who tend to use more frequent coping strategies such as active planning, personal growth, and acceptance showed a better overall well-being and quality of life. These findings are relevant to clinical practice given the need to understand the coping variable to improve HRQoL. Understanding these relationships is crucial for developing effective interventions to enhance the well-being of MS subjects. [ABSTRACT FROM AUTHOR]

Parnia et al. recently published suggestions for the study of death and experiences recalled in a near‐death context. We have serious reservations about the authors' statements. In this commentary, we discuss the omissions and knowledge gaps inherent to the authors' paper, which among others include incorrect neurological claims about brain death and misunderstandings regarding the terminology of consciousness. Although we believe that (near‐)death research deserves a framework guideline, the paper by Parnia and colleagues is misleading and, contrary to the authors' intention, hinders the scientific understanding of near‐death experiences and the neural mechanisms occurring in the dying brain. [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented in which the editor discusses the various articles published within the issue on topics like foot plantar pressure system, proprioceptive training, and body symmetry assessment during neurological examination.

Simple Summary: This paper reports a case of suppurative meningoencephalitis by Pseudomonas aeruginosa from the direct extension of chronic otitis in a Gir cow. The direct extension of otitis media/interna results in secondary pyogranulomatous intracranial lesions occasionally. Clinical signs included forebrain, cerebellum, cranial nerve VII, VIII, and XII impairment. Pure cultures of P. aeruginosa were obtained and identified in the suppurative central nervous system (CNS) lesions, meninges, and inner ear samples. The paucity of case reports of middle or inner ear infections evolving to suppurative processes in the CNS of adult cattle suggests underreporting or lack of diagnosis. This paper aims to report clinical, laboratory and pathological features in a case of suppurative meningoencephalitis by P. aeruginosa from the direct extension of chronic otitis in a Gir cow. The cow was recumbent during physical examination, and neurological examination revealed depression, absence of left eyelid and auricular motor reflex, and hypotonic tongue. Hematology revealed hemoconcentration, leukocytosis by neutrophilia, and hyperfibrinogenemia. Cerebrospinal fluid was slightly turbid, and presented polymorphonuclear pleocytosis, and hyperproteinorrachia. Grossly, the skull floor showed a purulent green–yellow exudate that drained from the left inner ear to the cisterna magna. There was diffuse congestion of the telencephalon, and meninges showed severe hyperemia, moderate thickening, and opacity with the deposition of fibrinosuppurative material ventrally, extending to the cerebellum and brainstem. The left cerebellar hemisphere showed an approximately 1.5 cm in diameter liquefaction area surrounded by a hemorrhagic halo. Histologically, cerebellar, mesencephalic, thalamic, and brain base meninges were intensely thickened and showed severe suppurative inflammation and fibrin deposition. Small multifocal suppurative areas were observed in the cerebellum and brainstem, characterized by a necrotic core, a number of neutrophils, and Gram-negative intralesional bacillary myriads. Pure cultures of P. aeruginosa were obtained and identified in the suppurative CNS lesions, meninges, and inner ear samples. This report highlights an uncommon clinical evolution of secondary P. aeruginosa suppurative meningoencephalitis, probably triggered by recurrent parasitic otitis in an adult Gir cow. Veterinarians, practitioners, and farmers must be aware of the risk of CNS infections after unresolved media and inner otitis, especially in cattle breeds more prone to developing parasitic otitis, such as the Gir and Indubrasil breeds. [ABSTRACT FROM AUTHOR]

Ataxic gait monitoring and assessment of neurological disorders belong to important areas that are supported by digital signal processing methods and artificial intelligence (AI) techniques such as machine learning (ML) and deep learning (DL) techniques. This paper uses spatio-temporal data from Kinect sensor to optimize machine learning model to distinguish between ataxic and normal gait. Existing ML-based methodologies fails to establish feature correlation between different gait parameters; thus, exhibit very poor performance. Further, when data is imbalanced in nature the existing ML-based methodologies induces higher false positive. In addressing the research issues this paper introduces an extreme gradient boost (XGBoost)-based classifier and enhanced feature optimization (EFO) by modifying the standard cross validation (SCV) mechanism. Experiment outcome shows the proposed ataxic person identification model achieves very good result in comparison with existing ML-based and DL-based ataxic person identification methodologies. [ABSTRACT FROM AUTHOR]

The Glasgow Coma Scale (GCS) is a widely used clinical tool for assessing impaired consciousness, but concerns arise when applied to intubated patients or those receiving analgesics, sedatives, and paralytics because verbal scores are not evaluable. Furthermore, the GCS does not differentiate the neurological status of the patient once intubated, resulting in poor reliability in neurological assessment, and clinical indicators that may reflect the severity of the coma are not included in the GCS. This study explores alternative tools for neurological assessment in Intensive Care Units (ICUs) when GCS is impractical. Conducting an integrative review of studies from 2018 to 2022, we identified seven relevant papers. Results indicate the FOUR score as a promising GCS alternative, particularly in cases where the GCS is unavailable. Automated pupillometry also demonstrated the potential for monitoring neurologically impaired ICU patients. These tools, independent of verbal responses and applicable to sedated patients, offer improved accuracy in assessing consciousness. The study emphasizes the importance of adopting such alternatives, and addressing GCS limitations, and highlights the need for further research and implementation to enhance patient care in ICU settings. [ABSTRACT FROM AUTHOR]

This paper reviews translational research in psychiatry, focusing on those programs addressing the problem of the validity of psychiatric diagnoses. In medicine in general, and in psychiatry in particular, the term "translational" is used with different meanings. A conceptual analysis suggests that there are at least seven different types of translational research in psychiatry: T1 ("bench-to-bedside" development of tools and treatments), T2 (application of animal models to human psychiatry), T3 (papers focusing on the mind-brain gap, studying biological, neurobiological and cognitive dysfunctions), T4 (personalised therapies and prediction of treatment responses), T5 ("bedside-to-bench" translation of population data for laboratories), T6 (implementation of treatments at the population level, including accessibility and quality of services), and T7 (improving translational knowledge in residents' trainings and researchers' careers). Concerning the problem of validity of psychiatric diagnoses, new neurocognitive models like the Research Domain Criteria project are considered, in particular the translational program of cross-validation aimed at reducing the gap between neuroimaging data and psychopathological scores derived from rating-scales. It is shown that these programs are useful, filling some of the current research gaps, but it is also stressed that they carry implicit realist and reductionist assumptions. It is finally suggested that the formation of mental symptoms is a complex process involving both neurocognitive and semantic factors, which raises doubts about the possibility of complete translations, without residuals. [ABSTRACT FROM AUTHOR]

Brain activity recognition based on electroencephalography (EEG) marks a major research orientation in intelligent medicine, especially in human intention prediction, human–computer control and neurological diagnosis. The literature research mainly focuses on the recognition of single-person binary brain activity, which is limited in the more extensive and complex scenarios. Therefore, brain activity recognition in multiperson and multi-objective scenarios has aroused increasingly more attention. Another challenge is the reduction of recognition accuracy caused by the interface of external noise as well as EEG's low signal-to-noise ratio. In addition, traditional EEG feature analysis proves to be time-intensive and it relies heavily on mature experience. The paper proposes a novel EEG recognition method to address the above issues. The basic feature of EEG is first analyzed according to the band of EEG. The attention-based RNN model is then adopted to eliminate the interference to achieve the purpose of automatic recognition of the original EEG signal. Finally, we evaluate the proposed method with public and local data sets of EEG and perform lots of tests to investigate how factors affect the results of recognition. As shown by the test results, compared with some typical EEG recognition methods, the proposed method owns better recognition accuracy and suitability in multi-objective task scenarios. [ABSTRACT FROM AUTHOR]

Simple Summary: Crisdesalazine is a multi-targeted drug with antioxidant and anti-inflammatory action to prevent amyloid plaque, neurofibrillary tangle, and neurodegeneration that cause dementia. We tried this drug on meningoencephalitis of unknown origin in dogs, expecting the improvement of their neurologic signs. In Case 1, the dog was tentatively diagnosed with meningoencephalitis of unknown origin by MRI and has started treatment with prednisolone and cytarabine. However, recurrent severe bacterial cystitis has occurred, suspected as the side effect of immunosuppressants. After adding crisdesalazine in ongoing therapy, the patient could reduce the dosage of the drugs successfully. In Case 2, the dog was tentatively diagnosed with meningoencephalitis of unknown origin through its history using clinical signs, blood analysis, neurologic examination, magnetic resonance imaging, and cerebrospinal fluid analysis. The dog has started treatment with cytarabine, prednisolone, and levetiracetam and the alleviation of the clinical signs was inadequate. However, after adding crisdesalazine in ongoing treatment, the neurologic signs of the dog were markedly improved. To the best of our knowledge, no previous report has documented clinical cases of reduced neurological signs in dogs with meningoencephalitis of unknown origin after adding crisdesalazine as an adjunct to ongoing immunosuppressive treatment. An 8-year-old, castrated male Shih-tzu dog (Case 1) showing ataxia and gait disorder was referred for neurological examination and magnetic resonance imaging. Through comprehensive examinations, the patient was tentatively diagnosed with meningoencephalitis of unknown origin (MUO) and treatment with prednisolone and cytosine arabinoside was started. The symptoms were improving with immunosuppressive treatment. However, severe bacterial cystitis occurred and we could not avoid tapering off prednisolone. Then, neurological signs recurred. Therefore, we added crisdesalazine, which allowed us to reduce the daily dosage of immunosuppressants easily. In another case, a 4-year-old, spayed female Yorkshire terrier dog (Case 2) was referred to our hospital showing a head tilt, circling, and loss of the menace reflex. The patient was tentatively diagnosed with MUO and treatment with some immunosuppressants was attempted. The clinical symptoms improved, but the alleviation was inadequate. Thus, we added crisdesalazine. The neurological signs then markedly improved. Moreover, the drugs could be tapered off more easily than before. Crisdesalazine is a novel drug that has antioxidant and anti-inflammatory action in brain disease and is used particularly for dementia. In this paper, we tried an off-label use of this drug in canine MUO patients, and found that it had, in these two patients, additional therapeutic effects on the MUO. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) is an incurable neurodegenerative disease that is rarely diagnosed at an early stage. Although the understanding of PD-related mechanisms has greatly improved over the last decade, the diagnosis of PD is still based on neurological examination through the identification of motor symptoms, including bradykinesia, rigidity, postural instability, and resting tremor. The early phase of PD is characterized by subtle symptoms with a misdiagnosis rate of approximately 16–20%. The difficulty in recognizing early PD has implications for the potential use of novel therapeutic approaches. For this reason, it is important to discover PD brain biomarkers that can indicate early dopaminergic dysfunction through their changes in body fluids, such as saliva, urine, blood, or cerebrospinal fluid (CSF). For the CFS-based test, the invasiveness of sampling is a major limitation, whereas the other body fluids are easier to obtain and could also allow population screening. Following the identification of the crucial role of alpha-synuclein (α-syn) in the pathology of PD, a very large number of studies have summarized its changes in body fluids. However, methodological problems have led to the poor diagnostic/prognostic value of this protein and alternative biomarkers are currently being investigated. The aim of this paper is therefore to summarize studies on protein biomarkers that are alternatives to α-syn, particularly those that change in nigrostriatal areas and in biofluids, with a focus on blood, and, eventually, saliva and urine. [ABSTRACT FROM AUTHOR]

The use of adrenaline during a cardiac arrest is well-established and supported by international guidelines. However, recent studies have questioned the appropriateness of adrenaline administration whereas other papers indicate that any benefit from adrenaline maybe time-sensitive. Two recently published studies have both challenged the use of adrenaline during resuscitation and whilst both papers used different methodologies they demonstrated similar results. The Paramedic 2 study was a placebo-based randomised control trial whereas the paper by Loomba et al., used a meta-analysis of 14 peer-reviewed publications recruiting 655,853 patients, 7.4% of whom received adrenaline. Neither study was able to demonstrate any meaningful survival benefit associated with adrenaline administration (Table 1 and 2). However, both studies noted poor neurological outcome in post-cardiac survivors. It is noteworthy that both of these studies used different, but validated, neurological scoring systems (either the Modified Rankin Scale or the Cerebral Performance Category). Whilst there is an acceptable correlation between the Modified Rankin Scale or the Cerebral Performance Category (Table 3) there is a degree of variation.5 This variation is partly due to what the two scales accept as being a good neurological outcome as well as an inbuilt degree of subjectiveness of any assessment of neurological status. Whilst The Paramedic 2 study and Loomba et al., meta-analysis demonstrated no benefit of adrenaline, studies by Goto et al., and Donnino et al., (adults) have published contradictory findings. Importantly Donnino et al., reported improved neurological status in non-shockable cardiac arrest when adrenaline was administered. However, to date no study has demonstrated a benefit of adrenaline when used to treat shockable cardiac arrest. Interestingly both Goto et al., and Donnino et al., indicated that any benefit from adrenaline administration was time-sensitive. Goto et al., noted that the optimal time for adrenaline administration was <9 minutes. Whereas, Donnino et al., reported on the impact of increasing time delay to the first dose noting that when adrenaline was administered <1 minute of confirmation of cardiac arrest, 12% of patients survived, but that this dropped to 9% after the fourth minute and was down to 7% after seven minutes (p < 0.001). The findings of Goto et al., and Donnino et al., represent a clinical challenge. Notably, during the Paramedic 2 study the average time of administration of adrenaline was approaching 20 minutes (6.6 minutes response time and 13.8 minutes) raising the question would the results of Paramedic 2 have been different if adrenaline was administered faster and whether adrenaline should only be administrated in witnessed cardiac arrest? The routine use of adrenaline as the mainstay of resuscitation is being challenged, especially with regards to long-term patient survival and its role in the management of shockable cardiac arrest. However, in specific patients, when given early, adrenaline may still have a role to play in resuscitation. The 2020 International Resuscitation Guidelines are eagerly awaited. [ABSTRACT FROM AUTHOR]

Controversy has arisen over interpretation of performance validity tests (PVTs) when multiple PVTs are given. Some papers state that more stringent criteria are needed to judge overall performance as invalid, while others argue that concerns about the number of PVTs are overstated and that widely used criteria are appropriate. We examine theoretical models and assumptions, and analyze published data to determine the magnitude of effects implied by theory and observed in practice. Assertions advanced in the primary papers are examined for consistency with the empirical data. Existing theoretical models do not account well for the diverse empirical data, substantial empirical effects remain poorly understood, and the primary papers include assertions that are not empirically supported. The results indicate that: (a) neuropsychology lacks solid theoretical bases for estimating PVT failure rates given various combinations of PVTs, and thus needs to rely on empirical data; (b) existing empirical data fail to support the application of any uniform criteria across the broad range of scenarios involving multiple PVTs; and (c) practice should rely on empirical studies involving combinations of PVTs that have been studied together, in samples clearly appropriate to the individual case, using experimental designs germane to the questions under consideration. [ABSTRACT FROM PUBLISHER]

The Box and Blocks Test (BBT) is a widely used outcome measure for manual dexterity assessments in neurological rehabilitation. The BBT score is based on the maximum number of cubes that a person is able to displace during a 60s time window. In this paper, a low-cost instrumented system to automatically obtain the number of cubes using proximity sensors is presented. For that purpose, the central partition of the BBT was sensorized, aiming to minimise the employed sensors and minimally alter the physical BBT box. The counting system, connected to the mobile app, allows for the self-administration of the test as users only need to follow the presented instructions. Firstly, the methodology used to automate the test scoring is presented, including the sensors' description and the prototype design. Then, the obtained success rate in cube counting is shown, with an average of 98% in trials with five healthy users. Finally, the conclusions and future work are shown. The results support the use of automated methods for upper limb assessment, providing more objective results and additional information about user performance. [ABSTRACT FROM AUTHOR]

The aim of this paper was to systematically review the literature on the significance of specific neurological signs in infancy, in particular in infants at risk for developmental problems such as cerebral palsy (CP). A literature search was performed using the databases PubMed, Embase, Web of Science, and AMED. Papers on infantile reactions ('primitive reflexes') and postural reactions were included if data were available allowing for calculation of sensitivity, specificity, or positive and negative predictive value for CP or atypical developmental outcome. Our search identified 23 articles on 20 different neurological signs. Properties of six neurological signs were reported in at least three different papers. The data indicated that, in early infancy, an absent Moro or plantar grasp response may be predictive for adverse developmental outcome. After early infancy, persistence of the Moro response and asymmetric tonic neck reflex was clinically significant. Prediction of a delayed emergence of the parachute reaction increases with age. Abnormal performances on the pull-to-sit manoeuvre and vertical suspension test have predictive significance throughout infancy. The neurological signs reviewed have some predictive value in infants at risk. For most of the signs, criteria for abnormality and significance are age-dependent. [ABSTRACT FROM AUTHOR]

Examines cerebral blood flow measurement. Recognition on the significance of the blood supply to the brain by the Greeks in early times; Elucidation that pressure on the vessels of the neck resulted in anesthesia sufficient to carry out certain surgical procedures; Development of techniques for the examination of the pial vessels; Focus of scientific investigations on the physiological aspects of the brain blood supply.

Aim: To determine the prevalence of long‐term mechanical insufflation‐exsufflation (MI‐E) and concomitant mechanical ventilation in children with neurological conditions, with reported reasons behind the initiation of treatment. Method: This was a population‐based, cross‐sectional study using Norwegian national registries and a questionnaire. Results: In total, 114 of 19 264 children with a neurological condition had an MI‐E device. Seventy‐three of 103 eligible children (31 females, 42 males), median (min–max) age of 10 years 1 month (1y 5mo–17y 10mo), reported their MI‐E treatment initiation. Overall, 76% reported airway clearance as the main reason to start long‐term MI‐E. A prophylactic use was mainly reported by children with neuromuscular disorders (NMDs). Prevalence and age at initiation differed by diagnosis. In spinal muscular atrophy and muscular dystrophies, MI‐E use was reported in 34% and 7% of children, of whom 83% and 57% respectively received ventilator support. One‐third of the MI‐E users were children with central nervous system (CNS) conditions, such as cerebral palsy and degenerative disorders, and ventilator support was provided in 31%. The overall use of concomitant ventilatory support among the long‐term MI‐E users was 56%. Interpretation: The prevalence of MI‐E in a neuropaediatric population was 6 per 1000, with two‐thirds having NMDs and one‐third having conditions of the CNS. The decision to initiate MI‐E in children with neurological conditions relies on clinical judgment. What this paper adds: The prevalence and age at initiation of mechanical insufflation/exsufflation (MI‐E) differed between diagnoses.MI‐E was most commonly used in spinal muscular atrophy, where it generally coincided with ventilatory support.One‐third of MI‐E devices were given to children with central nervous system conditions, and one‐third also received ventilatory support. What this paper adds: The prevalence and age at initiation of mechanical insufflation/exsufflation (MI‐E) differed between diagnoses.MI‐E was most commonly used in spinal muscular atrophy, where it generally coincided with ventilatory support.One‐third of MI‐E devices were given to children with central nervous system conditions, and one‐third also received ventilatory support. This article is commented on by Langdon and Cooper on pages 494–495 of this issue. [ABSTRACT FROM AUTHOR]

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Phenylketonuria (PKU) is an inherited metabolic disease characterized by a defective conversion of phenylalanine (Phe) to tyrosine, potentially leading to Phe accumulation in the brain. Dietary restriction since birth has led to normal cognitive development. However, PKU patients can still develop cognitive or behavioral abnormalities and subtle neurological deficits. Despite the increasing evidence in the field, the assessment of neurocognitive, psychopathological, and neurological follow-up of PKU patients at different ages is still debated. The high interindividual variability in the cognitive outcome of PKU patients makes the specificity of the neurocognitive and behavioral assessment extremely challenging. In the present paper, a multidisciplinary panel of Italian PKU experts discussed different tools available for cognitive, psychopathological, and neurological assessment at different ages based on the existing literature and daily clinical practice. This study aims to provide evidence and a real-life-based framework for a specific clinical assessment of pediatric, adolescent, and adult patients affected by PKU. [ABSTRACT FROM AUTHOR]