Post-infectious Transverse Myelitis Secondary to Hand, Foot, and Mouth Disease in a Pregnant Daycare Worker.

Transverse myelitis (TM) is a rare inflammatory disorder of the spinal cord that infections, vaccines, and autoimmune processes can cause or may have no discernible cause. About half of the cases are caused by an infection, usually a viral respiratory infection, flu-like illness, or sometimes a gastrointestinal infection. Although coxsackieviruses and enteroviruses are known to cause TM, it is more commonly associated with respiratory symptoms or systemic signs than a rash. In this case, we present a pregnant daycare worker who had a case of longitudinally extensive TM after an episode of hand, foot, and mouth disease (HFMD), which only showed the typical rash without fever or systemic signs.

Hospital Readmission Rates in Patients With Neuromyelitis Optica Spectrum Disorder.

BACKGROUND: Neuromyelitis optica spectrum disorder (NMOSD) is an aggressive central nervous system astrocytopathy often resulting in rapid neurologic decline. Patients have recurrent flares that require immunomodulatory therapy for relapse prevention. These patients are usually hospitalized and may need rehospitalization after decline. Hospital readmission rates are important indicators that can be used to gauge health care quality and have direct implications on hospital compensation. This study aims to identify high-risk characteristics of patients with NMOSD that can be used to predict hospital readmissions. METHODS: The 2017 Nationwide Readmissions Database was searched for hospital admissions for NMOSD in the United States. All patients with hospital readmission within 30 days of discharge from the index hospitalization were included. RESULTS: The 30-day all-cause readmission rate for NMOSD was 11.9% (95% CI, 10.6%-13.3%). Patients aged 65 to 74 years had higher odds of readmission; those with private insurance had decreased odds. Sex did not affect readmission. Several comorbidities, such as respiratory failure, peripheral vascular disease, neurocognitive disorders, and neurologic blindness, were predictive of readmissions. Plasma exchange increased the odds of readmission, whereas intravenous immunoglobulin and immunomodulatory infusions, such as chemotherapies and monoclonal antibodies, did not affect readmission. CONCLUSIONS: The most common etiologies for 30-day read-mission were neurologic, infectious, and respiratory. Treatment targeted toward these etiologies may result in reduced overall readmission, thereby decreasing overall disease burden.

Readmission Rates in Patients With Multiple Sclerosis: A Nationwide Cohort Study.

BACKGROUND: Multiple sclerosis (MS) is an inflammatory central nervous system demyelinating disorder resulting in neurologic decline. Patients predominantly have a relapsing and remitting disease course requiring multiple hospitalizations and, occasionally, rehospitalizations. Hospitalization readmission rates are important metrics that have direct financial implications for hospitals and serve as an indicator of disease burden on patients and society. We sought to analyze hospital readmissions of patients with MS and identify the subsequent predictive characteristics/comorbidities for readmission. METHODS: All hospital admissions due to MS were queried using the 2017 Nationwide Readmissions Database. All patients with nonelective rehospitalization within 30 days of discharge were examined. RESULTS: The 30-day readmission rate for MS is 10.6% (range, 10.4%-10.8%). Female sex has a protective role in readmission rates, and age has no effect. Comorbidities, including heart failure, acute kidney injury, chronic obstructive pulmonary disease, chronic kidney disease, respiratory failure, substance abuse, diabetes, hypertension, peripheral artery disease, liver failure, anemia, coagulation disorders, cancer, depression, and infections, are predictive of readmissions, whereas sleep apnea is protective. No effect is seen with neurologic blindness, plasma exchange, or intravenous immunoglobulin treatment. CONCLUSIONS: Several medical comorbidities are predictive of hospital readmission of patients with MS. Most rehospitalizations are due to infectious and neurologic etiologies; thus, targeted interventions may lead to lower readmission rates.

The Role of Benzodiazepines in the Treatment of Epilepsy.

OPINION STATEMENT: Benzodiazepines are commonly prescribed as anxiolytics, sedatives, and anticonvulsants. They act on the GABAA receptor by increasing the conductance chloride through ionic channels, promoting a state of central nervous system depression. The clinical properties of benzodiazepines are dependent upon the composition of the different subunits of the GABAA receptor. Each subunit, in turn, has multiple subtypes that are present throughout the central nervous system, all of which impart different clinical responses. Benzodiazepines are the first-line treatment of status epilepticus. Time to treatment is crucial, and clinical response to benzodiazepines is lost with prolonged status epilepticus. Non-intravenous routes of midazolam should be considered as an equally efficacious alternative to intravenous lorazepam, which is the most commonly administered benzodiazepine for status epilepticus when intravenous access is available. Outpatient therapy with benzodiazepines for the acute treatment of seizures is currently limited to rectal diazepam, but alternative routes of administration are under development. Clobazam and clonazepam are good options for seizure prophylaxis in patients with epilepsy refractory to multiple antiepileptic drugs. Clobazam is preferred due to its affinity for the α2 subunit of the GABAA receptor, which leads to less potential for sedation. Adverse effects of chronic benzodiazepine use are sedation, tolerance, and potential for addiction and misuse in some patients.