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Background A medical neuroscience curriculum that integrates broad categorization of neurological diseases in the first year of medical education has a functional utility to strengthen the foundation of medical students in clinical neuroscience. Students–patients interactive activities could provide an understanding of core curricula for basic neuroscience and clinical neurology. Methods Twelve neurological patients, with varying neurological diseases, volunteered to share their medical experiences with small groups of students in a 30-minute session. A debriefing segment with clinical and biomedical science faculty and students followed these sessions. Two structured student surveys – a pre and posttests were administered. Results 98.5% of students agreed (85.5% of these students strongly agreed) that patient integration into the first-year neuroscience module provided real-life experiences that were helpful in their understanding of clinical neuroscience. 95.6% of students agreed that their ability to interact with a diverse group of neurological patients was improved. Prior to the students–patients interactive session, only 91.1% of students agreed (52.6% of these students strongly agreed) that patient integration would be beneficial in their understanding of clinical neuroscience. Discussion The integration of patients into the neuroscience module provides better understanding of clinical concepts in neuroscience. It facilitates a meaningful discussions, stimulated critical thinking in neuroscience, and increased students׳ insights into patient–physician relationships, even at year one in the medical school, with significant real-life experiences.

Objective/Background This study assessed the relationship between health care workers' self-reported experience of headaches/migraines, their overall quality of life, and treatment outcomes. Methods The study sample consisted of adults employed by a self-insured hospital system located in the Southeast United States. Study participants responded to a web-based survey disseminated via work email accounts. The survey measured headache medication use, health care service utilization, and impacts on quality of life and treatment optimization using standardized instruments. Results We received responses from 2453 employees (response rate 33.8%), of which 84.4% reported headaches, suggesting that those with headaches were more likely to complete the survey. Forty percent of respondents reported mild to severe disability due to headaches, and approximately 65% used prescription or over-the-counter medications to treat headaches. Approximately 45% of participants taking headache medications reported unsatisfactory treatment. Among all respondents, those with mild, moderate, or severe migraine disability were 2.35, 1.7, or 2.08 times more likely to take headache medications than those with little or no migraine disability. Among those taking headache medications for treatment, respondents with nonclinical job titles, presenting better physical health status, or reporting little or no migraine disability were more likely to achieve treatment optimization. Conclusions Recognizing the potential over response by employees who have headaches, our study remains suggestive of a care improvement opportunity in the health care workforce.

Despite the existence of effective treatments for mental health problems in patients with multiple sclerosis (MS), such problems often go untreated or undertreated because of a variety of patient, provider, and organizational factors. As untreated psychological difficulties can interfere with MS treatment adherence, a collaborative partnership between medical and mental health providers is crucial. In the fall of 2003, the Medical College of Georgia's Augusta MS Center implemented an MS psychological consultation service. The goal of this service is to remove barriers to the emotional well-being of individuals with MS through convenient, collaborative, and coordinated psychological services provided during routine MS medical appointments. To better understand patient use of this new program and the types of problems addressed, we conducted a retrospective review of documentation from 197 consultations held from July 2004 through June 2006. Summary data on demographics, presenting problems, and resultant treatment plans reflect a broad array of concerns for which psychological consultation was sought, including psychiatric symptoms, difficulties with adjustment to illness, and cognitive problems. Given the barriers to mental health care for MS patients and the unique skills psychologists bring to the multidisciplinary MS team, on-site psychological consultation may be an effective method of providing mental health services to the MS population.

Sexual functioning problems are disproportionately frequent among individuals with multiple sclerosis (MS) and are associated with reduced sexual activity and satisfaction. Although effective treatments are available, patients often do not communicate with physicians or partners as openly and frequently as needed to optimize sexual functioning. The purpose of this study was to examine the effectiveness of a group-level educational intervention to increase perceived knowledge and communication ability regarding MS-related sexual health and intimacy concerns. Patients with MS and their partners attended a workshop that included didactic presentations, a multidisciplinary panel discussion, and a presentation by a sexual health consultant. Participants (N = 33) completed questionnaires before and after the workshop describing their sexual functioning, perceived knowledge of MS-related sexual problems, and willingness to communicate with partners and health-care providers about these issues. The results indicated a high frequency of sexual problems. Intention to discuss problems with one's significant other and health-care providers was associated with race and gender. Participants reported a significant increase in their knowledge of MS-related sexual problems and sexual satisfaction. Moreover, a trend was observed with regard to participants' likelihood of discussing these issues with partners. This study provides valuable information on the benefits of a multidisciplinary, real-world intervention for sexual/intimacy problems.

Through a standard neurological examination, the Expanded Disability Status Scale (EDSS) score is traditionally determined by a pen-and-paper method. The objectives of this study were to compare the interrater/method reliability of EDSS scores obtained through the pen-and-paper method with those obtained with the EDSS Calculator, evaluate test-retest reliability of the EDSS Calculator, and examine the validity of EDSS Calculator scores through correlation with the Ambulation Index (AI). During a single office visit, 62 subjects with multiple sclerosis (MS) from six study centers had disability levels evaluated by separate raters using the EDSS calculator and pen-and-paper methods in random order. Seven days later, subjects returned for reevaluation with the EDSS Calculator; AI was also evaluated. Mean EDSS scores for the sample were 3.5 ± 2.2 with the calculator and 3.4 ± 2.0 (range 0–8) with the traditional method. Interrater reliability between scores with the two methods was high (κ = 0.84; confidence interval [CI], 0.74–0.94). Test-retest reliability with the calculator was also high (κ = 0.93; CI, 0.86–0.996). Correlation between disability scores from the EDSS Calculator and AI was 0.73 (P

Identifying variables associated with patient activation in the multiple sclerosis population could serve to facilitate better multiple sclerosis self-management behaviors. Using a cross-sectional survey design, 199 participants were recruited from a multiple sclerosis center in the Southeastern United States. Depression, multiple sclerosis quality of life, and multiple Sclerosis self-efficacy were all significantly correlated with patient activation. Results of a hierarchical regression indicated that patient activation was significantly related to educational attainment, depression, and self-efficacy but not to quality of life. The results suggest several possible targets for intervention to increase patient activation, including health literacy, depression symptoms, and self-efficacy for multiple sclerosis disease management.

Patient engagement in multiple sclerosis (MS) care can be challenging at times given the unpredictable disease course, wide range of symptoms, variable therapeutic response to treatment and high rates of patient depression. Patient activation, a model for conceptualising patients' involvement in their health care, has been found useful for discerning patient differences in chronic illness management. The purpose of this study was to validate the patient activation measure (PAM-13) in an MS clinic sample.This was a survey study of 199 MS clinic patients. Participants completed the PAM-13 along with measures of MS medication adherence, self-efficacy, depression and quality of life.Results from Rasch and correlation analyses indicate that the PAM-13 is reliable and valid for the MS population. Activation was associated with MS self-efficacy, depression and quality of life but not with self-reported medication adherence. Also, participants with relapse-remitting MS, current employment, or high levels of education were more activated than other subgroups.The PAM-13 is a useful tool for understanding health behaviours in MS. The findings of this study support further clinical consideration and investigation into developing interventions to increase patient activation and improve health outcomes in MS.

A 27-year-old woman presented because of multiple daily episodes of painful “drawing” in her right arm and leg precipitated by hyperventilation (see video, segment 1). These episodes would typically last between 30 seconds and 2 minutes. Brain MRI and CSF analysis were consistent with multiple sclerosis (MS). MS-related paroxysmal hemidystonia was diagnosed because of a typical pattern of limb …

Overall, evidence suggests the effect of pregnancy is at least neutral and possibly positive on the course of MS. The lack of effect MS has on pregnancy outcomes also is significant. In the end, pregnancy is an individual decision.Physicians, and in particular neurologists, play a key role in providing tools to assist women who are living with MS make the most appropriate decision concerning family planning for themselves and their families.

Objective: To determine the relationship of language lateralization and hand preference to praxis performance following left and right hemispheric amobarbital-induced inactivations. Background: Patients who are aphasic from left cerebral dysfunction also frequently exhibit ideomotor apraxia in which they make temporal, spatial, and postural errors of learned skilled movements. However, hemispheric lateralization of the systems mediating ideomotor praxis in patients with atypical cerebral language dominance (i.e., bilateral or right hemispheric language function) remains uncertain. Methods: Subjects included 90 patients with intractable seizures who were undergoing the intracarotid amobarbital procedure (IAP) as part of their preoperative evaluation for epilepsy surgery. Hand preference was determined by the Benton Handedness Questionnaire. Praxis was assessed by the subject’s performance when pantomiming the use of four pictured tools. Results: During left IAP, patients with typical language dominance made more ideomotor apraxic errors than did patients with atypical language dominance. During right IAP, patients with atypical language dominance made more ideomotor apraxic errors than did patients with typical language dominance. Overall, patients with atypical language dominance made fewer ideomotor apraxic errors than did patients with typical language dominance. These relationships were present irrespective of hand preference. Conclusions: Language dominance is more closely associated with the laterality of temporal and spatial movement representations (i.e., ideomotor praxis dominance) than is hand preference. Patients with atypical language dominance exhibit more bilateral cerebral distribution of both language and praxis function.

Objective: To evaluate characteristics related to 2-year relapse rate for the TOP MS study completer cohort. Background The Therapy Optimization in MS Study (TOP MS) is a prospective, open-label parallel group study of patients who are being treated with disease-modifying therapies (DMT). All of the DMT have been shown to effectively reduce relapse rates. Design/Methods: Potential participants for TOP MS were identified at specialty pharmacies with medication therapy management programs. Signed informed consent forms were returned to the pharmacies, and study enrollment produced log-on instructions for the study website. At baseline and monthly intervals over 24 months, enrolled participants receive reminders to respond to surveys. Self-reported responses are entered directly into the study database. Results: The TOP MS completer cohort consists of 531 subjects with a mean duration of disease of 11.1+9.2 years. Nearly 90% of participants met the criteria for relapsing forms of MS. The 2-year relapse rate for this cohort was 35.3%. Glatiramer acetate was being used by 50.8%, and 49.2% were using interferon-beta at study enrollment. Over two years therapy change occurred for 50 patients (9.4%) and was significantly associated with the number of confirmed relapses (chi 2 = 13.9, df = 2, p = .001). While mean duration of current DMT treatment was 4.3+4.1 years, shorter duration was correlated with more confirmed relapses (p = .004). One-third of the completer cohort had used other DMT prior to starting their current therapy (mean number of previous therapies: 1.3) and number of previous DMT was positively correlated with number of confirmed relapses (p = .001). Disease duration and enrollment DMT were not associated with relapses. Conclusions: The two-year relapse rate in the completer cohort of the TOP MS Study was influenced by change in DMT therapy, time on DMT treatment, and number of previous DMT treatments. Supported by: Teva Pharmaceuticals. Disclosure: Dr. Coyle has received personal compensation for activities with Acorda Therapeutics, Avanir Pharmaceuticals, Bayer Pharmaceuticals Corporation, Biogen Idec, Genzyme Corporation, Novartis, Questcor, Roche Diagnostics Corporation, Sanofi-Aventis Pharmaceuticals, Inc., and Teva Neuroscience. Dr. Coyle has received personal compensation in an editorial capacity for NEURA. Dr. Coyle has received research support from Serono, Inc., Novartis, and Sanofi-Aventis Pharmaceuticals, Inc. Dr. Zwibel has received personal compensation for activities with Serono, Inc., and Teva Neuroscience. Dr. Zwibel has received research support from Teva Neuroscience. Dr. Cohen has received research support from Biogen Idec. Dr. Leist has received personal compensation for activities with EMD Serono, Teva Neuroscience and Bayer.Dr. Leist has received research support from Bayer, EMD Serono and Teva Neuroscience. Dr. Tullman has received personal compensation for activities with Acorda Therapeutics, Biogen Idec, Serono Inc., Novartis, Pfizer Inc., Teva Neuroscience, Sanofi-Aventis Pharmaceuticals, Abbott Labortories, Inc. and Vaccinex as a consultant and/or speaker. Dr. Tullman has received research support from Acorda Therapeutics, BioMS, Novartis, and Genentech, Inc. Dr. Markowitz has received personal compensation for activities with Bayer, Teva, EMD-Serono, Biogen Idec, and Eli Lilly. Dr. Hughes has received research support from Teva Neuroscience, Berlex Labratories and Genentech, Inc..