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Until recently, there has been no consensus on the optimal operative window for decompressive surgery in acute spinal cord injury (aSCI). However, recent evidence is now supporting a role for early intervention in improving outcomes in this type of patients. The purpose of this letter is to discuss the implications for clinical practice within the European community. Critical appraisal and interpretation of these results for clinical implementation. Leveraging on the evidence that early (

Cervical dystonia is a non-degenerative movement disorder characterized by dysfunction of both motor and sensory cortico-basal ganglia networks. Deep brain stimulation targeted to the internal pallidum is an established treatment, but its specific mechanisms remain elusive, and response to therapy is highly variable. Modulation of key dysfunctional networks via axonal connections is likely important. Fifteen patients underwent preoperative diffusion-MRI acquisitions and then progressed to bilateral deep brain stimulation targeting the posterior internal pallidum. Severity of disease was assessed preoperatively and later at follow-up. Scans were used to generate tractography-derived connectivity estimates between the bilateral regions of stimulation and relevant structures. Connectivity to the putamen correlated with clinical improvement, and a series of cortical connectivity-based putaminal parcellations identified the primary motor putamen as the key node (r = 0.70, P = 0.004). A regression model with this connectivity and electrode coordinates explained 68% of the variance in outcomes (r = 0.83, P = 0.001), with both as significant explanatory variables. We conclude that modulation of the primary motor putamen–posterior internal pallidum limb of the cortico-basal ganglia loop is characteristic of successful deep brain stimulation treatment of cervical dystonia. Preoperative diffusion imaging contains additional information that predicts outcomes, implying utility for patient selection and/or individualized targeting., Raghu et al. report that the majority of variation in outcomes following pallidal DBS for cervical dystonia can be explained by electrode location and structural connectivity. Individual differences in the primary motor cortex–putamen–internal pallidal limb of the direct pathway offer the prospect of a personalized approach.

Objectives: Safe provision of transsphenoidal surgery for pituitary tumors (TSS) has been significantly disrupted by theCOVID-19 pandemic. We assess whether there was any compromise to patient and staff safety from COVID-19 fromundertaking TSS during the COVID-19 pandemic in our institution. Methods: We retrospectively review all the cases performed between the March 1 and September 11, 2020 and comparedour findings to the cases performed between March 1 and September 11, 2019. In doing so, we aim to assess the impact ofthe COVID-19 pandemic on our service. We review individual patient records to identify any COVID-19 relatedcomplications during or after their inpatient stay and evaluate any COVID-19 confirmed cases among staff involved in theseoperations. Results: Twenty-seven patients had TSS since March 2020 versus 39 during the same period in 2019. Of the patientstreated during the COVID-19 pandemic, 10 required urgent TSS for apoplexy or visual compromise, 10 needed expeditedsurgery and seven had elective procedures. Average duration of GA was 43 minutes (vs. 25 minutes in 2019), surgery 78minutes (vs. 79 minutes in 2019). The length of stay postsurgery was 2 days on average ([range: 1-9 days] vs. 3.6 days in2019 [range: 1-27 days]). No COVID-19 related complications were seen, no new infections developed and no staffinvolved contracted COVID-19. Measures taken to minimize risk included patients self-isolating prior to surgery andpreoperative COVID-19 testing with all patients operated on after April 2020 having received a COVID-19 antigen test at 1to 4 days before the date of their surgery. Theater and anesthetic process followed Trust COVID-19 guidance and physicalmeasures to reduce the spread of aerosols generated were used (clear sheet applied over the patient with small openingsfor instruments and endoscope ([ Fig. 1 ]), nasal latex slits ([ Fig. 2 ]), and full PPE (whenever necessary). Conclusion: We did not see any patient or staff COVID-19 complications or have any new COVID-19 cases contracted byundertaking transphenoidal surgery during the COVID-19 pandemic for pituitary tumors (TSS), with appropriate testing andprecautions in place. Anesthetic time did increase for these cases but there again were no compromises to patient safety orrecovery from this.

Background Stroke can lead to significant impairment of upper limb function which affects performance of activities of daily living (ADL). Functional electrical stimulation (FES) involves electrical stimulation of motor neurons such that muscle groups contract and create or augment a moment about a joint. Whilst lower limb FES was established in post-stroke rehabilitation, there is a lack of clarity on the effectiveness of upper limb FES. This systematic review aims to evaluate the effectiveness of post-stroke upper limb FES on ADL and motor outcomes. Methods Systematic review of randomised controlled trials from MEDLINE, PsychINFO, EMBASE, CENTRAL, ISRCTN, ICTRP and ClinicalTrials.gov. Citation checking of included studies and systematic reviews. Eligibility criteria: participants > 18 years with haemorrhagic/ischaemic stroke, intervention group received upper limb FES plus standard care, control group received standard care. Outcomes were ADL (primary), functional motor ability (secondary) and other motor outcomes (tertiary). Quality assessment using GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria. Results Twenty studies were included. No significant benefit of FES was found for objective ADL measures reported in six studies (standardised mean difference (SMD) 0.64; 95% Confidence Interval (CI) [−0.02, 1.30]; total participants in FES group (n) = 67); combination of all ADL measures was not possible. Analysis of three studies where FES was initiated on average within 2 months post-stroke showed a significant benefit of FES on ADL (SMD 1.24; CI [0.46, 2.03]; n = 32). In three studies where FES was initiated more than 1 year after stroke, no significant ADL improvements were seen (SMD −0.10; CI [−0.59, 0.38], n = 35). Quality assessment using GRADE found very low quality evidence in all analyses due to heterogeneity, low participant numbers and lack of blinding. Conclusions FES is a promising therapy which could play a part in future stroke rehabilitation. This review found a statistically significant benefit from FES applied within 2 months of stroke on the primary outcome of ADL. However, due to the very low (GRADE) quality evidence of these analyses, firm conclusions cannot be drawn about the effectiveness of FES or its optimum therapeutic window. Hence, there is a need for high quality large-scale randomised controlled trials of upper limb FES after stroke. Trial Registration PROSPERO: CRD42015025162, Date:11/08/2015 Electronic supplementary material The online version of this article (doi:10.1186/s13643-017-0435-5) contains supplementary material, which is available to authorized users.

Acetylcholinesterase (AChE) is now well known to have a secondary, non-enzymatic function independent of cholinergic transmission. In the last decade, the part of the molecule responsible for this action has been identified, i.e. a 14 amino acid peptide fragment ('T14'), deriving from the C-terminus of AChE: this peptide has been shown to be bioactive in a range of preparations and to act at an allosteric site on α₇ nicotinic acetylcholine receptors (α₇-nAChRs). Of particular significance is the finding that AChE-related peptides trigger calcium-induced neurotoxicity that may be pivotal in the process of neurodegenerative diseases, such as Alzheimer's. However to date all studies have been performed on isolated cell preparations. The aim of this study was therefore to characterise the bioactivity of T14 on meso-scale in vitro cortical networks ('neuronal assemblies') from rat brain slices containing orbitofrontal cortex. Local field potential (LFP) recordings showed that the T14 peptide has a selective, holistic action on cortical networks in a modulatory biphasic manner i.e. predisposing excitation at concentrations of up to 1 μM, after which the trend is reversed in favour of inhibition at higher doses (>1 μM). By contrast, a scrambled variant of the T14 peptide sequence (S14), showed no significant changes in neuronal activation. Optical imaging using voltage-sensitive dyes (VSDI) corroborated the electrophysiological findings and also provided further insight into the spatial dynamics of the effects of the peptide: T14 application had a facilitatory effect i.e. increased the time-course of activation at sub-micromolar concentrations only (700 nM) without significantly affecting the spread of evoked assemblies. Moreover: co-applying T14 with the α₇-nAChR competitive antagonist methyllycaconitine (MLA) produced inhibition in activation synchrony not seen with either agent on their own, suggesting an additive inhibitory effect. In conclusion, the T14 peptide derived from AChE produced a dose-dependent biphasic modulation of cortical networks activity dependent on the α₇-nAChR: these findings should thus provide a more comprehensive insight into the immediate actions of a novel bioactive agent of high potential relevance to neurodegenerative disorders such as Alzheimer's disease.