Medical teachers' opinions about students with neurodevelopmental disorders and their management.

BACKGROUND: Some students have neurodevelopmental disorders that might affect their academic and professional careers if they are not identified and addressed by specific pedagogic adaptations. The objective of this work was to describe medical teachers' opinions of students with neurodevelopmental disorders and their management of these students. METHODS: An anonymous cross-sectional electronic survey was performed to describe medical teachers' opinions about the impact of neurodevelopmental disorders on the student's life and on the medical teachers' management. aThe survey was created, including visual analogic scales and free text, to assess teachers' opinions from identification and assessment of neurodevelopemental burden on students and teachers, to their own knowledge about neurodevelopemental disorders and the specific pedagogic management available. The survey was sent to 175 medical teachers in 2019, of whom 67 responded. Quantitative descriptive statistics and qualitative analysis of free text were reported. RESULTS: Many medical teachers report having encountered students who might have had neurodevelopmental disorders (dyspraxia 33%; dyslexia 46%; autism spectrum disorders 68%; attention deficit hyperactivity disorders 75%). Impact on students and on teachers was considered as important (mean VAS score for impact over 60/100 for all syndromes except for dyspraxia). Medical teachers' self-reported knowledge about neurodevelopmental disorders (mean VAS score 43.9/100) and available pedagogical adaptations (mean VAS score 19.0/100) was limited. The teachers were concerned about ethical issues (mean VAS score 72.2/100) but were interested in receiving specialized training (mean VAS score 64.4/100). CONCLUSION: Medical teachers feel unprepared to manage students with neurodevelopmental disorders. They would be interested in specific training and procedures about the pedagogic management of these students.

Physical Activity during Weekdays and Weekends in Persons with Multiple Sclerosis.

The assessment of the functional performance status of persons with multiple sclerosis (PwMS) is a useful tool to optimize healthcare. This concept does not seem to be extensively explored in this population. This study aimed to determine the level of activity of PwMS during weekdays and weekends, and to establish associations between clinical parameters. Forty-one PwMS and 16 healthy persons participated in this study. Their physical activity in real-life conditions was assessed with an accelerometer. For the clinical evaluations, the quality of life, fatigue, gait, and balance were assessed. The level of activity between PwMS for weekdays, weekends, Saturdays, and Sundays was significantly reduced compared with the reference group (p = 0.001-0.00001, d = 0.95-1.76). PwMS had a constant level of activity throughout the week, whereas the reference group increased its level of activity on Saturdays (p = 0.04, d = 0.69). The level of activity was correlated in descending order with multiple sclerosis disability, body mass index, gait velocity, six-minute walk test, and timed up and go test. This study showed that PwMS had a stable level of activity throughout the week, contrary to healthy persons. It could be necessary to develop programs to facilitate physical activity and participation during the weekdays, but especially during weekends.

A Medico-Socio-Economic Analysis of TeleEKG in Ivory Coast.

Background: TeleEKG is gradually being integrated into the care offered to the most isolated Ivorian populations, however, no medico-socio-economic analysis of its impact has yet been conducted. Introduction: The aim of this study was to assess the medico-socio-economic impact of a teleEKG network in the provision of cardiology care in Ivory Coast. Methods: A retrospective study of the data transmitted by the 10 centers involved in the pilot phase of the teleEKG project from January 2015 to December 2017. Results: The average ratio between the cost to the patient of performing an electrocardiogram (EKG) according to the traditional practice and using a teleEKG was 3.8 ± 1.64. The distance avoided by the 6,045 patients was 1,074,090 km (average 177.7 km/patient). The 6,045 teleEKGs carried out over the period of the study produced a total revenue of 36,270,000 XOF (55,290 EUR) or an average revenue per site of 3,627,000 XOF (5,529 EUR). Dyspnea on exertion (22%), and hypertension (21%) were the main indications for performing the EKG, and left ventricular hypertrophy was the most common electrical anomaly detected (19.8%). Acute coronary syndrome with persistent ST segment elevation was diagnosed in 0.7% of cases (40 cases) and atrial fibrillation in 1.12% of cases (68 cases). Discussion: These results confirm the key role telemedicine can play in the treatment of heart conditions in rural populations and the economic sustainability of such telemedicine networks. Conclusions: teleEKG offers economic accessibility to cardiology care for isolated populations in Ivory Coast.

Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke.

BACKGROUND: Trials of patent foramen ovale (PFO) closure to prevent recurrent stroke have been inconclusive. We investigated whether patients with cryptogenic stroke and echocardiographic features representing risk of stroke would benefit from PFO closure or anticoagulation, as compared with antiplatelet therapy. METHODS: In a multicenter, randomized, open-label trial, we assigned, in a 1:1:1 ratio, patients 16 to 60 years of age who had had a recent stroke attributed to PFO, with an associated atrial septal aneurysm or large interatrial shunt, to transcatheter PFO closure plus long-term antiplatelet therapy (PFO closure group), antiplatelet therapy alone (antiplatelet-only group), or oral anticoagulation (anticoagulation group) (randomization group 1). Patients with contraindications to anticoagulants or to PFO closure were randomly assigned to the alternative noncontraindicated treatment or to antiplatelet therapy (randomization groups 2 and 3). The primary outcome was occurrence of stroke. The comparison of PFO closure plus antiplatelet therapy with antiplatelet therapy alone was performed with combined data from randomization groups 1 and 2, and the comparison of oral anticoagulation with antiplatelet therapy alone was performed with combined data from randomization groups 1 and 3. RESULTS: A total of 663 patients underwent randomization and were followed for a mean (±SD) of 5.3±2.0 years. In the analysis of randomization groups 1 and 2, no stroke occurred among the 238 patients in the PFO closure group, whereas stroke occurred in 14 of the 235 patients in the antiplatelet-only group (hazard ratio, 0.03; 95% confidence interval, 0 to 0.26; P<0.001). Procedural complications from PFO closure occurred in 14 patients (5.9%). The rate of atrial fibrillation was higher in the PFO closure group than in the antiplatelet-only group (4.6% vs. 0.9%, P=0.02). The number of serious adverse events did not differ significantly between the treatment groups (P=0.56). In the analysis of randomization groups 1 and 3, stroke occurred in 3 of 187 patients assigned to oral anticoagulants and in 7 of 174 patients assigned to antiplatelet therapy alone. CONCLUSIONS: Among patients who had had a recent cryptogenic stroke attributed to PFO with an associated atrial septal aneurysm or large interatrial shunt, the rate of stroke recurrence was lower among those assigned to PFO closure combined with antiplatelet therapy than among those assigned to antiplatelet therapy alone. PFO closure was associated with an increased risk of atrial fibrillation. (Funded by the French Ministry of Health; CLOSE ClinicalTrials.gov number, NCT00562289 .).

What Are the Minimal Detectable Changes in SDMT and Verbal Fluency Tests for Assessing Changes in Cognitive Performance in Persons with Multiple Sclerosis and Non-Multiple Sclerosis Controls?

INTRODUCTION: Cognitive impairment is frequent in persons with multiple sclerosis (PwMS) and can impact on activities of daily living. The capacity to differentiate real changes from background statistical noise induced by human, instrumentational, and environmental variations inherent to the evaluation would improve cognitive assessments. OBJECTIVE: To assess the short-term reproducibility of cognitive tests in non-multiple sclerosis (non-MS) persons and PwMS. METHODS: Sixty-two PwMS and 19 non-MS persons performed 2 measurements, 1 week apart, of the Symbol Digit Modalities Test (SDMT) and phonological and semantic verbal fluency. Test-retest reliability was evaluated by the intraclass correlation coefficients (ICC) and agreement by standard error of measurement (SEM) and minimum detectable change (MDC). RESULTS: The reliability of the cognitive variables studied had moderate to high ICC values (ICC > 0.8) in both populations. The threshold to consider a significant cognitive modification evaluated by SEM and MDC was lower in PwMS compared with non-MS persons. CONCLUSIONS: SDMT and verbal fluency have good short-term reproducibility in PwMS. Specific SEM and MDC cutoffs based on the same design of evaluation (especially retest timing) and to the targeted pathological population (MS vs. healthy) should systematically be used to consider cognitive modification as significant in research protocol as well as in clinical practice.

Modification of both functional neurological symptoms and neuroimaging patterns with a good anatomoclinical concordance: a case report.

BACKGROUND: In the nineteenth century, Jean Martin Charcot explained functional neurological disorder (formerly called conversion disorder) as a "psychodynamic" lesion. Numerous advances in neuroimaging have permitted identification of the neural underpinnings of this disorder. CASE PRESENTATION: Herein we describe a case of functional neurological disorder (FND) with initial left sensorimotor deficit, in-coordinated limb movements, neglect, clouded consciousness, slurred speech and a semiology of visual impairment. A single photon emission computed tomography (SPECT) showed a right thalamic hypoperfusion, which is rather concordant with the initial semiology. Later, the semiology changed, presenting with a predominantly neurovisual complex presentation. The second SPECT showed no more thalamic abnormalities but an hypoperfusion in the right temporo-occipital junction, right inferior parietal lobe and left superior frontal lobe, which is also rather concordant with the changing semiology. CONCLUSIONS: This case illustrates the evolving neuroimaging patterns of FND but also the concordance between semiology and neuroimaging findings in FND supporting Charcot's theory of "dynamic lesion".

Main anatomical features of the calcarine sulcus: a 3D magnetic resonance imaging at 3T study.

OBJECTIVE: The purpose of our study was to determine the main anatomical features of the calcarine sulcus using a 3-T MRI. METHODS: Fifty human brains have been explored using an MRI 3-T in Doctors Center in Beirut (Lebanon). RESULTS: The calcarine sulcus was identified in 100% of cases. In most cases, it had a continuous aspect with several peaks. In all our specimens, the calcarine sulcus crosses the parieto-occipital fissure. The majority of their collateral branches and their connections with other sulci were located at the level of the calcarine sulcus properly. In the majority of specimens, the deepest part of the anterior calcarine sulcus forms a protrusion in the occipital horn of the lateral ventricle called calcar avis. CONCLUSION: Our study emphasizes the fact that the course patterns of the calcarine sulcus are highly variable. The description of the main anatomical features of the calcarine sulcus obtained from our study can be used as a reference for fMRI exploration and is useful for brain surgery.

Evaluation of a French Regional Telemedicine Network Dedicated to Neurological Emergencies: A 14-Year Study.

BACKGROUND: Equality in healthcare between urban and rural areas is problematic in France. Telemedicine networks are expected to improve equality in expertise assessment. We aimed to evaluate the use and impact of a regional rural French telemedicine network, dedicated to medical and surgical neurological emergencies, on interhospital patient transfers. METHODS: Eight community hospital emergency departments were remotely connected to the only university hospital in Franche-Comté, France. We prospectively obtained data from all patients consecutively admitted to emergency care departments in the region and who received medical or neurosurgical expertise by telemedicine from January 2002 to December 2015. The reasons for requesting expertise, number of requested neurological opinions, and interhospital patient transfers were analyzed. Economic savings were determined by estimating the cost of avoided transfers. RESULTS: A total of 23,710 patients had telemedicine consultations in the region. The network was used by every community hospital (independently of the existence of local neurological teams). These consultations were overwhelmingly for cases of stroke (30%) and head or spinal injuries (36%). Cerebral tumors represented 9% of teleconsultations. In 2015, 75% of patients admitted to the remote hospitals that did not have onsite neurological expertise nevertheless received neurovascular tele-expertise. The rate of thrombolyzed patients dramatically increased within 13 years regionally (9.9%) and 33.5% of thrombolyses were performed by telemedicine. The number of patients examined by telemedicine and admitted for head or spinal injuries also increased over the 13-year period (12% vs. 21%). Secondary interhospital transfers were halved for both pathologies. The estimated saving is ∼€3.5 million. CONCLUSION: Telemedicine networks facilitate acute-phase neurological assessment and prevent unnecessary secondary interhospital transfers.

Don't forget the lyrics! Spatiotemporal dynamics of neural mechanisms spontaneously evoked by gaps of silence in familiar and newly learned songs.

The vast majority of people experience musical imagery, the sensation of reliving a song in absence of any external stimulation. Internal perception of a song can be deliberate and effortful, but also may occur involuntarily and spontaneously. Moreover, musical imagery is also involuntarily used for automatically completing missing parts of music or lyrics from a familiar song. The aim of our study was to explore the onset of musical imagery dynamics that leads to the automatic completion of missing lyrics. High-density electroencephalography was used to record the cerebral activity of twenty healthy volunteers while they were passively listening to unfamiliar songs, very familiar songs, and songs previously listened to for two weeks. Silent gaps inserted into these songs elicited a series of neural activations encompassing perceptual, attentional and cognitive mechanisms (range 100-500ms). Familiarity and learning effects emerged as early as 100ms and lasted 400ms after silence occurred. Although participants reported more easily mentally imagining lyrics in familiar rather than passively learnt songs, the onset of neural mechanisms and the power spectrum underlying musical imagery were similar for both types of songs. This study offers new insights into the musical imagery dynamics evoked by gaps of silence and on the role of familiarity and learning processes in the generation of these dynamics. The automatic and effortless method presented here is a potentially useful tool to understand failure in the familiarity and learning processes of pathological populations.

Verbal Fluencies and Fampridine Treatment in Multiple Sclerosis.

BACKGROUND/AIMS: Fampridine is sometimes reported to improve cognition and especially the information-processing speed. Motor improvement might be a confounding factor. The aim of this study was to evaluate the effects of fampridine on verbal fluencies in patients with multiple sclerosis (MS). METHODS: Fifty MS patients were included in a prospective monocentric open label trial with a mean Expanded Disability Status Scale of 5.3 ± 1.1. Assessments of verbal phonological and semantic fluencies were repeated twice (within 1 week) before fampridine treatment and twice after fampridine treatment in order to have the maximal practice effect. Gait velocity and fatigue (visual analogical scale) were also assessed. Distribution into gait responders, gait non-responders, fluency responders and fluency non-responders, was described. RESULTS: Verbal fluencies were significantly higher after fampridine treatment. No correlation was observed between phonological fluency improvement and semantic fluency improvement. Gait responders and gait non-responders did not present significant differences in verbal fluency performance and fatigue score. No correlation between gait velocity improvement and fatigue improvement compared with verbal fluency improvement was observed. CONCLUSION: Our results suggest that fampridine could have a selective procognitive effect on phonological fluency in MS, even in the gait non-responder patients.

A New Symptom, 'Palinendophonia', Associated with Pure Verbal Palinacousis Induced by a Right Inferior Temporal Lesion.

We describe the case of a patient with pure verbal palinacousis and perseveration of inner speech after a right inferior temporal lesion. The superior temporal lobe, including the superior temporal sulcus and the interhemispheric connection between the 2 superior temporal lobes, explored by tractography, were preserved. These regions are involved in voice processing, verbal short-term memory and inner speech. It can then be hypothesised that abnormal activity in this network has occurred. Palinacousis and 'palinendophonia', a term proposed for this symptom not previously reported, may be due to common cognitive processes disorders involved in both voice hearing and inner speech.

Mnesic Profiles According to the Size of Pericerebral Hematoma in Patients with Traumatic Brain Injury.

OBJECTIVE: The study aims to assess mnesic performances of patients, following a head injury with pericerebral hematoma, according to the size of the hematoma. METHODS: Cognitive performances of a group of 25 patients with large (≥10 mm) pericerebral hematomas were compared with those of a matched group of 25 patients with small (<10 mm) ones and a matched group of patient with moderate-severe traumatic brain injury with no pericerebral hematoma. RESULTS: Executive function and information processing speed were not significantly different. Mnesic performances of the large hematomas group were more impaired: cuing effect (63.5 vs. 80% and 83%; p = 0.002; x03B7;2 = 0.183) and total recall (37.5/48 vs. 43.2 and 44.2; p = 0.022; x03B7;2 = 0.65) of the Free and Cued Recall Test. CONCLUSION: Memory of those in the large hematomas group was impaired with probable storage/consolidation disorders. To identify specific cognitive disorders resulting from large hematomas, it is justified to systematically screen these disorders and to adapt their management.

Angelman syndrome: a case series assessing neurological issues in adulthood.

BACKGROUND: This study aimed to evaluate the clinical symptoms of Angelman syndrome (AS) in adults and to identify the neurological pathways affected in this disease. AS is a neurogenetic disorder resulting due to the deletion or inactivation of the ubiquitin-protein-ligase E3A gene on maternal chromosome 15. SUMMARY: A retrospective analysis of data from six adults patients with clinical, electroencephalographic and genetic confirmation of AS was performed. Movement disorders of the hands and mouth, laughing spells, severe expressive speech disorders, a happy nature, hyposomnia and anxiety are the major neurological characteristics of AS in adulthood. Cerebellar ataxia, muscle hypotonia and tremor, though constant in childhood, tend to be attenuated in adulthood. Epilepsy, one of the most frequent symptoms in childhood and in adulthood, is characterised by specific electroencephalographic patterns. Key Messages: These clinical characteristics are important to improve the clinical awareness and genetic diagnosis of AS. Clinicians must be better informed concerning the adult phenotype as it is not well described in the literature. We stress the importance of AS as one of the main causes of intractable epilepsy. The authors suggest frontal and cerebellar dysfunction. Further functional cerebral imaging studies are necessary.

Long-term follow-up study of endarterectomy versus angioplasty in patients with symptomatic severe carotid stenosis trial.

BACKGROUND AND PURPOSE: We aimed at comparing the long-term benefit-risk balance of carotid stenting versus endarterectomy for symptomatic carotid stenosis. METHODS: Long-term follow-up study of patients included in Endarterectomy Versus Angioplasty in Patients With Symptomatic Severe Carotid Stenosis (EVA-3S), a randomized, controlled trial of carotid stenting versus endarterectomy in 527 patients with recently symptomatic severe carotid stenosis, conducted in 30 centers in France. The main end point was a composite of any ipsilateral stroke after randomization or any procedural stroke or death. RESULTS: During a median follow-up of 7.1 years (interquartile range, 5.1-8.8 years; maximum 12.4 years), the primary end point occurred in 30 patients in the stenting group compared with 18 patients in the endarterectomy group. Cumulative probabilities of this outcome were 11.0% (95% confidence interval, 7.9-15.2) versus 6.3% (4.0-9.8) in the endarterectomy group at the 5-year follow-up (hazard ratio, 1.85; 1.00-3.40; P=0.04) and 11.5% (8.2-15.9) versus 7.6% (4.9-11.8; hazard ratio, 1.70; 0.95-3.06; P=0.07) at the 10-year follow-up. No difference was observed between treatment groups in the rates of ipsilateral stroke beyond the procedural period, severe carotid restenosis (≥70%) or occlusion, death, myocardial infarction, and revascularization procedures. CONCLUSIONS: The long-term benefit-risk balance of carotid stenting versus endarterectomy for symptomatic carotid stenosis favored endarterectomy, a difference driven by a lower risk of procedural stroke after endarterectomy. Both techniques were associated with low and similar long-term risks of recurrent ipsilateral stroke beyond the procedural period. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00190398.

A modular, computer-controlled system for olfactory stimulation in the MRI environment.

Although the cerebral networks involved in sensory perception are of general interest in neuroscience, registration of the effects of olfactory stimulation, especially in a magnetic resonance imaging (MRI) environment, presents particular problems and constraints. This article presents details of a reliable and portable system for olfactory stimulation that is modular in design and based on microcontroller technology. It has the following characteristics: (1) It is under software control; (2) the presentation of olfactory stimulation can be synchronized with respiration; (3) it can be manually controlled; and (4) it is fully compatible with an MRI environment. The principle underlying this system is to direct an odor to the subject's nostrils by switching airflow to different odor diffusers. The characteristics of this system were established using (1) ultraviolet (UV) spectroscopy, to measure its response time, and (2) gas chromatography, to measure the repeatability of odor presentation in terms of gas concentration. A response time of 200 ± 25 ms was obtained for the system, and the standard deviations of the gas concentration delivered during stimulation ranged from 1.5% to 22%, depending on the odor, the airflow, and the dilution of the odor used. Since it is portable, controlled by software, and reliable, on the basis of the results we obtained, this system will lend itself to a wide range of applications in olfactory neuroscience.

Neuro-orthopaedic check-up and walking in people with multiple sclerosis: toward a more specific assessment to improve rehabilitation results.

The rehabilitation process of people with multiple sclerosis (PwMS) is a challenge, and decision-making requires a thorough assessment to increase the chances of success in rehabilitation planning. The aim of this study was to investigate the importance of the neuroorthopaedic check-Up (NOChU) for gait prognosis. Participated in the study 105 PwMS with different levels of impairment. The NOChU includes measurements of passive range of motion (ROM), muscle strength, and spasticity. Additionally, was carried out the spatial-temporal analysis of the walking, Timed Up and Go test, and 6-min walk test. ROM remained relatively preserved to perform daily life activities except for ankle dorsiflexion. Muscle strength was also relatively preserved. Spasticity affected especially the ankle muscles, clearly the sural triceps. Among the NOChU measurements the catch seemed to have the most impact on walking on its different phases and on other activities. Accurate NOChU measurements play a crucial role in clinical settings, guiding informed decisions in rehabilitation planning. Future research endeavours could focus on exploring the correlations between NOChU deficiencies and the decline in walking capabilities among PwMS, with the goal of proposing personalized treatment strategies that address their specific requirements.

Telestroke network to robotic telestroke network: How to upgrade regional stroke care to include remote robotics?

Objective: Selected patients with large vessel occlusion (LVO) strokes can benefit from endovascular therapy (EVT). However, the effectiveness of EVT is largely dependent on how quickly the patient receives treatment. Recent technological developments have led to the first neurointerventional treatments using robotic assistance, opening up the possibility of performing remote stroke interventions. Existing telestroke networks provide acute stroke care, including remote administration of intravenous thrombolysis (IVT). Therefore, the introduction of remote EVT in distant stroke centers requires an adaptation of the existing telestroke networks. The aim of this work was to propose a framework for centers that are potential candidates for telerobotics according to the resources currently available in these centers. Methods: In this paper, we highlight the future challenges for including remote robotics in telestroke networks. A literature review provides potential solutions. Results: Existing telestroke networks need to determine which centers to prioritize for remote robotic technologies based on objective criteria and cost-effectiveness analysis. Organizational challenges include regional coordination and specific protocols. Technological challenges mainly concern telecommunication networks. Conclusions: Specific adaptations will be necessary if regional telestroke networks are to include remote robotics. Some of these can already be put in place, which could greatly help the future implementation of the technology.

French healthcare students and antibiotics: are they ready to promote their appropriate use?

Objectives: French healthcare students are required to carry out primary prevention interventions as part of the Healthcare Service by Healthcare Students (HSHS). The purpose of this study was to explore students' perceptions of preparedness to address the public's concerns about antibiotic use and how their perceptions changed after implementing their intervention. Methods: A questionnaire was sent twice during the 2020-2021 academic year to 920 multidisciplinary healthcare students (nursing, medicine, physiotherapy, pharmacy and midwifery students) enrolled in the HSHS in Franche-Comté (HSHS-FC). Results: This study included 870/920 students (94.6%). Medical and pharmacy students were the most concerned about the issue of antimicrobial resistance. Before enrollment in the HSHS-FC, 463 of the 870 students included (53.2%) reported having sufficient knowledge about antibiotics to lead preventive interventions, reaching 87.9% (58/66) for pharmacy students. Despite this relative lack of knowledge, 77.2% of students felt confident to promote the appropriate use of antibiotics in the healthcare service context. This rate ranged from 68.0% (17/25) for midwifery students to 93.9% (62/66) for pharmacy students. Irrespective of the topic of the intervention, students significantly improved their knowledge and ability to promote antibiotic use after training in the HSHS-FC. Conclusions: Theoretical prerequisites and a feeling of concern vary widely depending on the curriculum. The HSHS-FC promotes multidisciplinary collaboration and can contribute to improving students' knowledge. The support of an expert in antimicrobial resistance may be necessary to validate the content of the interventions proposed by the students.