Neurophobia inception: a study of trainees' perceptions of neurology education.

OBJECTIVES: We wanted to examine the extent to which "neurophobia" exists among medical students and determine if students' perceptions of neurology differ by year of study while exploring the factors that contribute to the development of "neurophobia". METHODS: We used a two-phase, sequential, mixed-methods explanatory design in this single centre study. Phase 1 involved the collection and analysis of a questionnaire administered to students in the first three years of medical school. Phase 2 involved focus groups of a subgroup of students who demonstrated evidence of neurophobia in Phase 1. RESULTS: In total, 187 (39 %) undergraduate medical trainees responded to the questionnaire (response rates of 37%, 44% and 19% for first-, second- and third-year students, respectively). 24% of respondents indicated that they were afraid of clinical neurology and 32% were afraid of the academic neurosciences. Additionally, 46% of respondents thought that clinical neurology is one of the most difficult disciplines in medicine. Phase 2 findings revealed that many students reported negative preconceptions about neurology and commented on neurology's difficulty. Some experienced changes in these conceptions following their neurology block. Past clinical, educational, and personal experiences in neurology impacted their comfort level. CONCLUSIONS: This study shows that the level of comfort towards clinical neurology increases following students' participation in second-year neurology blocks, but that third-year students continue to show signs of neurophobia with lower comfort levels. It provides insight into why neurophobia exists amongst medical students and sheds light on pre-existing and emerging factors contributing to this sense of neurophobia.

Differences in retinal nerve fiber layer atrophy between multiple sclerosis subtypes.

OBJECTIVES: To determine whether retinal nerve fiber layer (RNFL) atrophy in the afferent visual pathway may complement existing tools used to describe and characterize differences across MS subtypes. METHODS: Optical coherence tomography-measured RNFL values were compared over two years in 35 patients (70 eyes) with optic neuritis (ON) as a clinically isolated syndrome (CIS); 39 patients (78 eyes) with relapsing remitting MS (RRMS); and 7 patients (14 eyes) with secondary progressive MS (SPMS). RESULTS: RNFL comparisons involving eyes without ON yielded greater differences between MS subtypes than ON-affected eyes. Overall RNFL values in non-affected eyes were reduced in SPMS patients (83.4 microm), relative to CIS (101.2 microm) (p=0.0009), and RRMS patients (103.7 microm) (p=0.001); and temporal RNFL atrophy was greater in RRMS (64.4 microm) eyes as compared to CIS eyes (73.2 microm) (p=0.02). In ON-affected eyes, RNFL atrophy was greater in SPMS patients (39.5 microm) than CIS patients (58.1 microm) (p=0.03), and in RRMS patients (48.2 microm) relative to CIS patients (p=0.05). RNFL values did not change significantly for any MS subtype during the two-year duration of the study. INTERPRETATION: RNFL thickness may represent a structural marker, which can help distinguish MS subtypes, because the extent of atrophy is commensurate with disease progression. RNFL comparisons between non-affected eyes revealed greater differences between CIS, RRMS, and SPMS patients relative to ON-affected eyes, because the impact of prior ON may supplant the effects of disease subtype.

fMRI investigation of disinhibition in cognitively impaired patients with multiple sclerosis.

UNLABELLED: Although deficits in executive functioning are well known cognitive sequelae of multiple sclerosis (MS), less is known about patients' performance on response inhibition tasks in particular. Behavioural observation of cognitively impaired MS patients often reveals impulsivity. However, knowledge about associated neural activity during response inhibition measurable with functional magnetic resonance imaging (fMRI) is lacking. In the current study the performance and fMRI activation patterns of patients with MS on a response inhibition task (Go/No-Go) were investigated. METHODS: Ten cognitively impaired patients with MS (with little or no physical disability) and 10 sex-, age- and education-matched healthy controls performed a Go/No-Go task while in the MR scanner. RESULTS: MS patients had significantly more commission errors than controls but did not demonstrate longer reaction times. Controlling for this difference, whole brain random effects analyses revealed that patients demonstrated more activation than controls in the fusiform gyrus, cingulate gyrus (including the anterior cingulate gyrus), cerebellum and putamen. Patients demonstrated less activity than controls in the supramarginal gyrus. CONCLUSIONS: MS patients exhibited significant neural compensation during response inhibition when compared with controls. The specific results provide new insight into the neural processing underlying the impulsivity often observed in cognitively impaired individuals with MS.