Search

Background: Patients with Parkinson's disease might develop treatment‐resistant axial dysfunction after bilateral subthalamic stimulation. Objectives: To study whether lateralized stimulation (unilateral 50% amplitude reduction) for ≥21 days results in ≥0.13 m/s faster gait velocity in the dopaminergic ON state in these patients, and its effects on motor and axial function, quantitative gait and speech measures, quality of life, and selected cognitive tasks. Methods: Randomized, double‐blinded, double‐crossover trial. Results: In 22 participants (51–79 years old, 15 women), there were no significant changes in gait velocity, quality of life, cognitive, and speech measures. Reducing left‐sided amplitude resulted in a 2.5‐point improvement in axial motor Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS‐UPDRS) (P = 0.005, uncorrected) and a 1.9‐point improvement in the Freezing of Gait Questionnaire (P = 0.024, uncorrected). Conclusions: Lateralized subthalamic stimulation does not result in meaningful improvement in gait velocity in patients with Parkinson's disease who develop treatment‐resistant axial dysfunction after bilateral subthalamic stimulation. Left subthalamic overstimulation may contribute to axial deterioration in these patients. © 2022 International Parkinson and Movement Disorder Society [ABSTRACT FROM AUTHOR]

Background: Celiac disease is associated with motor cortex hyperexcitability and neurological manifestations including cortical myoclonus. Electroencephalography abnormalities have been described, but no distinct pattern has been reported. Methods: We describe the neurophysiological characteristics of 3 patients with celiac‐associated cortical myoclonus using electroencephalography, magnetoencephalography, and transcranial magnetic stimulation. Results: Electroencephalography in all cases demonstrated lateralized low‐amplitude, electropositive beta‐frequency polyspike activity over the central head region, corresponding to motor cortex contralateral to the myoclonic limb. Jerk‐locked back‐averaging demonstrated a preceding cortical potential; magnetoencephalography source localization revealed a cortical generator in the posterior wall of the precentral gyrus for the back‐averaged potential and oscillatory abnormality. In 1 patient, cerebellar inhibition of the motor cortex was physiologically normal. Conclusions: Central head oscillatory, low‐amplitude, electropositive electroencephalography polyspike activity may be a distinct marker of celiac‐related cortical myoclonus and is consistent with celiac‐related motor cortex hyperexcitability, which may not necessarily result from cerebellar disinhibition. © 2020 International Parkinson and Movement Disorder Society [ABSTRACT FROM AUTHOR]

A case study of 29-Year-old man is presented to the emergency department with history of headache and blurry vision. Topics including examines he had received a diagnosis of gastrointestinal tuberculosis and had begun antituberculosis therapy and considered physical examination was notable for nuchal rigidity, papilledema, and a relative afferent pupillary defect on the right side.

Medical education has drastically transformed during the COVID-19 pandemic. Measures such as adopting telemedicine visits, minimizing the number of trainees on service, discontinuing external rotations, and converting in-person to online didactics have been broadly and swiftly implemented. While these innovations have promoted greater interconnectivity amongst institutions and made continuing medical education possible, international exchange programs in medical education are still largely disrupted. In response to the changing guidelines and restrictions necessitated by the COVID-19 pandemic, the authors used Kern's six-step approach to design and implement a virtual curriculum to replace the in-person activities of the 2020-2021 Neurology Peru-Rochester exchange program (NeuroPro). Twenty-seven trainees participated in this virtual adaptation. The average daily attendance was ≥85% and the program was rated 9/10 on average in a feedback survey (63% response rate). The median percentage of correct answers during the pre-test was 64% and it increased to 79% during the post-test (P = 0.003). Virtual adaptation of international exchange programs in medical education is feasible to safely continue international collaborative efforts to promote symbiotic building of local expertise and cross-cultural exchange during the ongoing COVID-19 pandemic and beyond., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2022 The Author(s).)