Global synergistic actions to improve brain health for human development.

The global burden of neurological disorders is substantial and increasing, especially in low-resource settings. The current increased global interest in brain health and its impact on population wellbeing and economic growth, highlighted in the World Health Organization's new Intersectoral Global Action Plan on Epilepsy and other Neurological Disorders 2022-2031, presents an opportunity to rethink the delivery of neurological services. In this Perspective, we highlight the global burden of neurological disorders and propose pragmatic solutions to enhance neurological health, with an emphasis on building global synergies and fostering a 'neurological revolution' across four key pillars - surveillance, prevention, acute care and rehabilitation - termed the neurological quadrangle. Innovative strategies for achieving this transformation include the recognition and promotion of holistic, spiritual and planetary health. These strategies can be deployed through co-design and co-implementation to create equitable and inclusive access to services for the promotion, protection and recovery of neurological health in all human populations across the life course.

Environmental neurology in the tropics.

We address the impact of the tropical environment on the human nervous system using the multifaceted approach characteristic of environmental neurology. First, environmental factors are examined according to their nature (physical, chemical and biological) and in relation to human activity and behavior. Some factors are specific to the tropics (climate and infections), while others are non-specific (chemicals, human communities and their way of life). Second, we examine the major role of human adaptation to the success of Homo sapiens, with emphasis on the linkage between thermoregulation and sleep-wake regulation. Third, we examine the performance of environmental neurology as a clinical discipline in tropical climates, with focus on the diagnostic and therapeutic challenges posed by human African trypanosomiasis. Finally, the prevention, early detection and monitoring of environmental neurological diseases is examined, as well as links with political and economic factors. In conclusion, practitioners of environmental neurology seek a global, multidisciplinary and holistic approach to understanding, preventing and treating neurological disorders within their purview. Environmental neurology integrates an expanded One Health concept by linking health and wellness to the interaction of plants, animals, humans and the ecosystem. Recent epidemics and the current COVID-19 pandemic exemplify the need for worldwide action to protect human health and biodiversity.

Integrated and patient-centred management of Parkinson's disease: a network model for reshaping chronic neurological care.

Chronic neurological diseases are the leading cause of disability globally. Yet, our health-care systems are not designed to meet the needs of many patients with chronic neurological conditions. Care is fragmented with poor interdisciplinary collaboration and lack of timely access to services and therapies. Furthermore, care is typically reactive, and complex problems are managed inadequately because of a scarcity of disease-specific expertise and insufficient use of non-pharmacological interventions. Treatment plans tend to focus on the disease rather than the individual living with it, and patients are often not involved in clinical decision making. By use of Parkinson's disease as a model condition, we show an integrated care concept with a patient-centred perspective that includes evidence-based solutions to improve health-care delivery for people with chronic neurological conditions. We anticipate that this integrated care model will improve the quality of life for patients, create a positive working environment for health-care professionals, and be affordable.

Integrative Medicine in Child Neurology: What Do Physicians Know and What Do They Want to Learn?

Pediatric neurology patients frequently use integrative medicine; however, providers may feel uncomfortable or unfamiliar with these therapies. Child neurologist attitudes toward integrative medicine and educational needs in integrative medicine have not been assessed. A national, anonymous survey was distributed to Child Neurology residents (n=294) and program directors (n=71) to assess attitudes toward specific integrative medicine modalities, practices in discussing integrative medicine with patients, and perceived need for a curriculum on integrative medicine; 61 (17%) partially and 53 (15%) fully completed the survey. Comparative analyses applied chi-square and independent t tests. Qualitative content analysis was performed on free text responses. Most providers surveyed consider mind and body practices safe (93% of respondents) and effective (84%), but have concerns about the safety of chiropractic manipulation (56% felt this was harmful), and the efficacy of homeopathy (none considered this effective). Few inquire about patient integrative medicine use regularly. Child Neurology residents are interested in further education on this topic.

Unravelling Functional Neurology: an overview of all published documents by FR Carrick, including a critical review of research articles on its effect or benefit.

Background: Functional Neurology (FN), founded by FR Carrick, is an approach used by some chiropractors to treat a multitude of conditions via the nervous system including the brain. However, it seems to lack easily obtainable scientific evidence for its clinical validity. Objectives: 1) To define the topics of FR Carrick's publications, 2) to define the proportion of articles that are research studies, case studies, abstracts and conference papers, 3) to define how many of these are clinical research studies that purported or appeared to deal with the effect or benefit of FN, 4) in these studies, to establish whether the design and overall study method were suitable for research into the effect or benefit of FN, and 5) to describe the evidence available in relation to the clinical effect or benefit of FN, taking into account seven minimal methodological criteria. Method: A literature search was done on Pubmed from its inception till October 2018, supplemented by a search on Scopus and ResearchGate to find all published documents by FR Carrick. We identified their types and topics, retaining for a critical review full text scientific articles appearing to test effect/benefit of FN procedures, subjecting them to a basic quality assessment (scoring 0-7). Results from studies of methodologically acceptable standard would be taken into account. Results: We found 121 published texts, 39 of which were full scientific research articles. Of these, 23 dealt with topics relating to FN. Fourteen articles reported on clinical validity but only seven included a control group. The methodological quality of these seven articles was low, ranging between 1.5-4 out of 7. We therefore did not further report the outcomes of these studies. Conclusion: We found no acceptable evidence in favour of effect/benefit of the FN approach. We therefore do not recommend its promotion as an evidence-based method. Further research on this topic should be conducted in collaboration with independent scientific institutions using commonly accepted research methods. Trial registration: PROSPERO This review was registered in PROSPERO (application date 23.02.2019; no CRD42019126345).

Introduction: La Neurologie Fonctionnelle (NF), telle que fondée par FR Carrick, est une approche thérapeutique principalement utilisée par certains chiropracteurs. Elle permettrait de traiter de nombreuses conditions via le système nerveux, notamment, en stimulant le cerveau. Cependant, l'évidence scientifique à propos de sa validité clinique est difficilement accessible. Objectifs: 1) définir les thèmes de publications de FR Carrick, 2) définir la proportion d'articles de recherche, d'études de cas, de résumés et de documents de conférences, 3) parmi eux, dénombrer les études de recherche clinique qui examinent/semblent examiner l'effet ou le bénéfice d'un traitement en NF, 4) définir si le schéma et la méthode de ces études sont adaptés pour étudier l'effet ou le bénéfice de la NF, 5) décrire l'évidence scientifique disponible concernant l'effet ou le bénéfice de la NF en prenant en compte sept critères méthodologiques basiques. Méthode: Une recherche bibliographique a été effectuée jusqu'en octobre 2018 sur Pubmed, Scopus et ResearchGate pour recueillir l'ensemble des documents publiés par FR Carrick et identifier leurs types et leurs thèmes respectifs. La qualité méthodologique des articles disponibles en texte intégral et semblant tester l'effet/le bénéfice d'une approche en NF a été évaluée pour établir leurs validités cliniques (score de 0 à 7). Seuls les résultats des études, ayant une méthodologie en accord avec les standards de recherche actuels ont été retenus. Résultats: 121 documents publiés par FR Carrick ont été recueillis, dont 39 en texte intégral. 23/39 articles s'intéressent à un thème associé à la NF. Quatorze d'entre eux, examinent la validité clinique de la NF, et seulement sept études ont inclus un groupe contrôle. La qualité méthodologique de ces sept études est faible, variant de 1.5 à 4/7. Les résultats de ces études n'ont donc pas été rapportés. Conclusion: Il semble donc qu'il n'y ait pas d'évidence scientifique en faveur de l'effet ou du bénéfice d'une intervention en NF. La NF ne devrait donc pas être promue comme une approche fondée sur les faits. Enfin, toutes nouvelles recherches sur ce sujet devraient être menées en collaboration avec des institutions scientifiques indépendantes et adopter une méthodologie en accord avec les standards de recherche actuels.

The neurobiological underpinnings of placebo and nocebo effects.

The placebo effect, once considered only a nuisance in clinical research, is today a target of scientific inquiry that allows us understand how words, rituals and, more in general, the whole psychosocial context around the patient, affect the response to a treatment and the course of a disease. Today we are in a good position to study all these complex psychological factors by using a physiological and neuroscientific approach that uses modern neurobiological tools to probe different brain functions. Since a placebo is represented by the whole ritual of the therapeutic act, the main concept that has emerged today is that words and rituals may modulate the same biochemical pathways that are modulated by drugs. Most of our knowledge about these mechanisms comes from the field of pain, and represents a biomedical, psychological and philosophical enterprise that is changing the way we approach and interpret medicine, psychology and human biology. If on the one hand we know some of the mechanisms of drug action in the central nervous system, on the other we can now understand how the clinician-patient interaction may affect different physiological functions. In fact, the placebo effect and the therapist-patient relationship can be approached by using the same biochemical, cellular and physiological tools of the materia medica. This represents an epochal transition, in which the distinction between drugs and words is progressively getting thinner, and which helps us overcome the old dichotomy between psychology and biology.

Antibiotics use and drug resistance analysis of neurology patients' Infection.

Recent studies have shown that nosocomial infection is an important factor affecting the quality and service level of neurology. Based on the characteristics of neurology patients, the application of antibacterial drugs has certain particular characteristic. In this paper, we analyzed the distribution of pathogenic bacteria in neurology patients in 2016-2017 year, and made statistics on the utilization of antibiotics. The results showed that 84 strains of pathogenic bacteria were isolated from the neurology department, including Gram-negative bacteria (44 strains, 52.38%), Gram-positive bacteria (31, 36.9%), and fungi (9, 10.71%). At the same time, as for the use of antibiotics, the drug category is most cephalosporins and the top 5 antiseptic drugs are cephalosporins, beta lactamase inhibitors, quinolones, aminosides and penicillins. The highest DUI (drug utilization index) value was for cefoperazone tazobactam (1.33), followed by ceftriaxone Mino (1.20) and ciprofloxacin (1.18). Clinicians should guide the selection of antimicrobial agents based on the results of etiological examination, and formulate a reasonable treatment plan based on the characteristics of patients, common pathogens and drug resistance.

Evolving a new neuropsychiatry.

Clinical neuroscience struggles with poor scientific validity of neuropsychiatric diagnosis and its negative impact on management. Sydenham's ancient conformity of type approach to nosology with its assumption that the symptom cluster and course of a disorder are due to a common etiology, has proven no match for the complicated comorbidities faced in neuropsychiatry. In the absence of accurate pathological biomarkers there is a challenge in finding a solid foundation for modern neuropsychiatry. We find standard psychiatric nosology to be of limited benefit at the general hospital bedside in evaluating and treating neuropsychiatric disorders. Consequently, we have developed over the years a neuro-circuitry-based training for our psychosomatic medicine fellows. In this commentary, we will introduce a strategy for understanding patients with neuropsychiatric disorders that may advance our ability to diagnose and treat them in accordance with neuroscientific evidence anchored in evolutionary neurocircuitry and attachment neurobehavior.

Las neurociencias clínicas luchan contra una pobre validación científica del diagnóstico neuropsiquiátrico y su impacto negativo sobre el manejo. La antigua conformidad de Sydenham con el tipo de aproximación a la nosología, asumiendo que el grupo de síntomas y el curso de un trastorno se deben a una etiología común, no ha demostrado ser compatible con las complicadas comorbilidades que enfrenta la neuropsiquiatría. En au-sencia de biomarcadores patológicos precisos existe un desafío para encontrar bases sólidas para la moderna neuropsiquiatría. Se cuenta con una nosología psiquiátrica estándar que es de beneficio limitado para pacientes del hospital general respecto a la evaluación y el tratamiento de los trastornos neuropsiquiátricos. En consecuencia, a través de los años se ha desarrollado un entrenamiento para los residentes de medicina psicosomática en base a circuitos neurales. En este artículo breve, se presentará una estrategia para la comprensión de pacientes con trastornos neuropsiquiátricos que puede mejorar nuestra capacidad para diagnosticarlos y tratarlos de acuerdo con evidencia neurocientífica sustentada en circuitos neurales evolutivos y en las bases neuroconductuales del apego.

Les neurosciences cliniques sont en conflit avec la médiocre validité scientifique du diagnostic neuropsychiatrique et son impact négatif sur la prise en charge. La nosologie ancienne de type Sydenham, postulant que l'étiologie des groupes de symptômes et de l'évolution de la maladie est commune, a montré qu'elle ne s'appliquait pas aux comorbidités compliquées rencontrées en neuropsychiatrie. Il est difficile de trouver une base solide pour la neuropsychiatrie moderne en l'absence de biomarqueurs pathologiques précis. Au lit du malade à l'hôpital, la nosologie psychiatrique standard est de peu d'aide pour évaluer et traiter les troubles psychiatriques. Nous avons donc développé au fil des années un enseignement basé sur les circuits neurologiques pour nos confrères de médecine psychosomatique. Nous présentons dans ce commentaire une stratégie pour comprendre les patients atteints de troubles neuropsychiatriques, qui pourrait améliorer nos capacités de diagnostic et de traitement en accord avec les preuves neuroscientifiques enracinées dans l'évolution des circuits neurologiques et les comportements neurologiques de l'attachement.

Unravelling functional neurology: a critical review of clinical research articles on the effect or benefit of the functional neurology approach.

Background: Functional Neurology (FN), mainly practiced by chiropractors, proposes to have an effect or a benefit on varied clinical cases, from debilitating diseases to performance enhancement in asymptomatic people. Objectives and design: A critical review of publications captured in and from the journal Functional Neurology, Rehabilitation, and Ergonomics (FNRE) was performed in order to investigate whether there is evidence on clinical effects or benefits of FN. This review had five research objectives, three relating to the type of literature available through this journal, and two in relation to design and methodological aspects of the included studies. Method: All issues of the FNRE journal were searched (October 2017), including a handsearch of their lists of other relevant publications. In order to find evidence in relation to the effect or benefit of FN, the search was restricted to prospective clinical research studies with a control group, claiming or appearing to deal with the topic. The review was undertaken by two independent reviewers using two checklists, one relating to study description, and one on quality. Results were reported narratively. Results: Nine articles were found. The FNRE journal contained 168 authored texts, of which 36 were research studies (21%). Four of these were clinical research studies on FN effect or benefit (2%). Another five were obtained through the handsearch. The included studies were conducted on adults or children, symptomatic or not, and investigated various interventions consisting of single or multiple stimuli, of varied nature, all primarily said to be provided to stimulate brain areas. Conditions included attention deficit disorders, attention deficit and hyperactivity disorders, autism-spectrum disorders, cortical visual impairment, traumatic brain injury, and migraine. Balance and the "blind spot" were investigated in healthy subjects. Major design and methodological issues were identified and discussed for all the nine studies; only four were considered as (potentially) appropriate for further scrutiny. However, these were of low methodological quality and, therefore, no robust evidence could be found in relation to the effect or benefit of the tested FN interventions. Conclusions: This journal contains no acceptable evidence on the effect or benefit of FN in relation to various conditions and purported indications for intervention.

Feasibility of implementing an electronic social support and resource visualization tool for caregivers in a neuro-oncology clinic.

PURPOSE: The goals of this study were to assess the feasibility of a web-based application-electronic Social Network Assessment Program (eSNAP)-to automate the capture and visualization of family caregiver social network data of neuro-oncology patients. METHODS: Caregivers were recruited from a neuro-oncology clinic at an NCI-designated comprehensive cancer center. Participants completed baseline questionnaires on a laptop in clinic assessing demographic characteristics. After baseline, participants were randomly assigned to either create a social network visualization using eSNAP (intervention) or to usual care (control) condition. Those who used eSNAP provided likeability/usability data. All participants were asked to complete follow-up questionnaires at 3 and 6 weeks after baseline to determine feasibility of longitudinal study. RESULTS: We recruited 40 caregivers of patients with primary malignant brain tumor to participate in this study. Participants rated eSNAP usability and likeability highly, indicating that eSNAP would help them consider their available social support. At 3 weeks, 90% of participants completed questionnaires and 82.5% completed questionnaires at 6 weeks. CONCLUSIONS: There is a need to encourage family caregivers of patients with primary malignant brain tumor to engage their existing social network resources to help alleviate caregiver burden. Our findings suggest that our web-based application to address this issue is feasible to implement with high usability and likeability. This pilot study identified minor changes to the intervention to improve effectiveness and has implications for future research in this understudied population. TRIAL REGISTRATION: clinicaltrials.gov, protocol number NCT03026699.

Treatment of progressive multiple sclerosis: Challenges and promising perspectives.

Management of progressive multiple sclerosis (MS) is one of the main challenges of the new century. Based on our knowledge of pathophysiology, three therapeutic strategies are proposed: anti-inflammatory (ocrelizumab, siponimod…); remyelinating (opicinumab); and neuroprotective (high-dose biotin, ibudilast, simvastatin…). Nevertheless, despite recent promising positive clinical trials, new methodological approaches for therapeutic protocols with adaptable outcomes to assess progression are still needed.

Practice guideline: Cervical and ocular vestibular evoked myogenic potential testing: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology.

OBJECTIVE: To systematically review the evidence and make recommendations with regard to diagnostic utility of cervical and ocular vestibular evoked myogenic potentials (cVEMP and oVEMP, respectively). Four questions were asked: Does cVEMP accurately identify superior canal dehiscence syndrome (SCDS)? Does oVEMP accurately identify SCDS? For suspected vestibular symptoms, does cVEMP/oVEMP accurately identify vestibular dysfunction related to the saccule/utricle? For vestibular symptoms, does cVEMP/oVEMP accurately and substantively aid diagnosis of any specific vestibular disorder besides SCDS? METHODS: The guideline panel identified and classified relevant published studies (January 1980-December 2016) according to the 2004 American Academy of Neurology process. RESULTS AND RECOMMENDATIONS: Level C positive: Clinicians may use cVEMP stimulus threshold values to distinguish SCDS from controls (2 Class III studies) (sensitivity 86%-91%, specificity 90%-96%). Corrected cVEMP amplitude may be used to distinguish SCDS from controls (2 Class III studies) (sensitivity 100%, specificity 93%). Clinicians may use oVEMP amplitude to distinguish SCDS from normal controls (3 Class III studies) (sensitivity 77%-100%, specificity 98%-100%). oVEMP threshold may be used to aid in distinguishing SCDS from controls (3 Class III studies) (sensitivity 70%-100%, specificity 77%-100%). Level U: Evidence is insufficient to determine whether cVEMP and oVEMP can accurately identify vestibular function specifically related to the saccule/utricle, or whether cVEMP or oVEMP is useful in diagnosing vestibular neuritis or Ménière disease. Level C negative: It has not been demonstrated that cVEMP substantively aids in diagnosing benign paroxysmal positional vertigo, or that cVEMP or oVEMP aids in diagnosing/managing vestibular migraine.

Frenkel: ¿un precursor de la neurorrehabilitación? / Frenkel: one of the forerunners of neurorehabilitation?

El término ‘neurorrehabilitación’ es entendido como el proceso destinado a reducir la deficiencia, la limitación de la actividad y la restricción de la participación que padecen las personas como consecuencia de una enfermedad neurológica, y en el que los profesionales involucrados en dicho ámbito tendrán como objetivo la reducción del grado de afectación funcional del paciente. Debido al desconocimiento que existió en relación con la capacidad plástica que presenta el sistema nervioso humano, los orígenes científicos de la rehabilitación neurológica son relativamente recientes, y se sitúan alrededor de la Segunda Guerra Mundial. Sin embargo, existen indicios de que el neurólogo Heinrich Sebastian Frenkel (1860-1931) pudo establecer las bases de la neurorrehabilitación antes de esa época. En relación con los trabajos realizados y publicados por Frenkel, existen referentes históricos que apoyarían la hipótesis de que, considerando sus metodologías de tratamiento empleadas y documentadas, lo que denominó Übungstherapie (gimnasia neurológica) podría considerarse la base de la neurorrehabilitación moderna. Estos conocimientos pudieron haberse tenido en cuenta por multitud de autores que introdujeron dichas experiencias y aprendizajes en los diversos métodos terapéuticos que surgieron con posterioridad, incluso los más novedosos y tecnológicos, si bien las raíces de la neurorrehabilitación aplicada podrían encontrarse a finales del siglo XIX (AU)

Neurorehabilitation is understood as the process intended to reduce the deficiency, limitation of activity and restriction of participation experienced by people as a result of a neurological diseases, and where the professionals involved in this field will aim to reduce the functional involvement degree of the patient. Due to the ignorance existed about the plastic capacity in the nervous system in humans, the scientific origins of neurological rehabilitation is relatively recent, which are located around the Second World War. However, there are signs that the neurologist Heinrich Sebastian Frenkel (1860-1931) was able to establish the basis of neurorehabilitation before that time. There are historical concerning regarding the work conducted and published by Frenkel that would support the hypothesis, based on the characteristics of their treatment employed and documented methodologies, that what he called ‘Übungstherapie’ (neurological gymnastic), it could be considered as the basis of what we consider today as modern neurorehabilitation. This knowledge could have been used by many authors who introduced those experiences and lessons learned to the multiple therapeutic methods that emerged after, even the most innovative and technological, while the roots of neurorehabilitation could be found at the end of the 19th century (AU)

Synthesis of Findings, Current Investigations, and Future Directions: Operation Brain Trauma Therapy.

Operation Brain Trauma Therapy (OBTT) is a fully operational, rigorous, and productive multicenter, pre-clinical drug and circulating biomarker screening consortium for the field of traumatic brain injury (TBI). In this article, we synthesize the findings from the first five therapies tested by OBTT and discuss both the current work that is ongoing and potential future directions. Based on the results generated from the first five therapies tested within the exacting approach used by OBTT, four (nicotinamide, erythropoietin, cyclosporine A, and simvastatin) performed below or well below what was expected based on the published literature. OBTT has identified, however, the early post-TBI administration of levetiracetam as a promising agent and has advanced it to a gyrencephalic large animal model--fluid percussion injury in micropigs. The sixth and seventh therapies have just completed testing (glibenclamide and Kollidon VA 64), and an eighth drug (AER 271) is in testing. Incorporation of circulating brain injury biomarker assessments into these pre-clinical studies suggests considerable potential for diagnostic and theranostic utility of glial fibrillary acidic protein in pre-clinical studies. Given the failures in clinical translation of therapies in TBI, rigorous multicenter, pre-clinical approaches to therapeutic screening such as OBTT may be important for the ultimate translation of therapies to the human condition.

Therapeutic Use of Music and Television in Neurocritical Care: A Practice Survey.

INTRODUCTION: Although health care providers often play music via radio, or play television, to calm and soothe patients, limited research is available to guide practice. METHOD: This study used a 17-item practice survey that was distributed electronically to neurocritical care society members in July 2014. Responses were collated and analyzed using SAS (Version 9.3). RESULTS: There were 118 completed responses, including from 71 attending physicians, 9 resident or fellow physicians, 30 nurses, and 8 affiliate professional members. The majority of respondents sometimes or always play music (65%) and agree that music is therapeutic (70%). However, there was no clear practice pattern regarding when or why music or TV should be used as an intervention in the neurocritical care unit. CONCLUSION: The use of music and TV is a common intervention in the neurocritical care unit but lacks a strong scientific foundation and is associated with a high practice variance.

Procedural Headache Medicine in Neurology Residency Training: A Survey of US Program Directors.

OBJECTIVE: To survey neurology residency program directors (PDs) on trainee exposure, supervision, and credentialing in procedures widely utilized in headache medicine. BACKGROUND: Clinic-based procedures have assumed a prominent role in headache therapy. Headache fellows obtain procedural competence, but reliance on fellowship-trained neurologists cannot match the population eligible for treatments. The inclusion of educational modules and mechanisms for credentialing trainees pursuing procedural competence in residency curricula at individual programs is not known. METHODS: A web-based survey of US neurology residency PDs was designed by the American Headache Society (AHS) procedural special interest section in collaboration with AHS and American Academy of Neurology's Headache and Facial Pain section leadership. The survey addressed exposure, training, and credentialing in: (1) onabotulinumtoxinA (onabotA) injections, (2) extracranial peripheral nerve blocks (PNBs), and (3) trigger point injections (TPIs). RESULTS: Fifty-five PDs (42.6%) completed the survey. Compared to noncompleters, survey completers were more likely to feature headache fellowships at their institutions (38.2% vs 10.8%, P=0.0002). High exposure (onabotA=90.9%, PNBs=80.0%, TPIs=70.9%) usually featured hands-on patient instruction (66.2%) and lectures (55.7%). Supervised performance rates were high (onabotA=65.5%, PNBs=60.0%, TPIs=52.7%), usually in continuity clinic (60.0%) or headache elective (50.9%). Headache specialists (69.1%) or general neurology (32.7%) faculty most commonly trained residents. Formal credentialing was uncommon (16.4-18.2%), mostly by documenting supervised procedures (25.5%). Only 27.3% of programs permitted trainees to perform procedures independently. Most PDs felt procedural exposure (80.0-90.9%) and competence (50.9-56.4%) by all trainees was important. CONCLUSIONS: Resident exposure to procedures for headache is high, but credentialing mechanisms, while desired by most PDs, are not generally in place. Implementation of a credentialing process may ensure trainees enter practice with the ability to perform procedures safely and effectively.

An approach to improve the performance of subject-independent BCIs-based on motor imagery allocating subjects by gender.

BACKGROUND: One of the difficulties for the implementation of Brain-Computer Interface (BCI) systems for motor impaired patients is the time consumed in the system design process, since patients do not have the adequate physical nor psychological conditions to complete the process. For this reason most of BCIs are designed in a subject-dependent approach using data of healthy subjects. The developing of subject-independent systems is an option to decrease the required training sessions to design a BCI with patient functionality. This paper presents a proof-of-concept study to evaluate subject-independent system based on hand motor imagery taking gender into account. METHODS: Subject-Independent BCIs are proposed using Common Spatial Patterns and log variance features of two groups of healthy subjects; one of the groups was composed by people of male gender and the other one by people of female gender. The performance of the developed gender-specific BCI designs was evaluated with respect to a subject-independent BCI designed without taking gender into account, and afterwards its performance was evaluated with data of two healthy subjects that were not included in the initial sample. As an additional test to probe the potential use for subcortical stroke patients we applied the methodology to two patients with right hand weakness. T-test was employed to determine the significance of the difference between traditional approach and the proposed gender-specific approach. RESULTS: For most of the tested conditions, the gender-specific BCIs have a statistically significant better performance than those that did not take gender into account. It was also observed that with a BCI designed with log-variance features in the alpha and beta band of healthy subjects' data, it was possible to classify hand motor imagery of subcortical stroke patients above the practical level of chance. CONCLUSIONS: A larger subjects' sample test may be necessary to improve the performances of the gender-specific BCIs and to further test this methodology on different patients. The reduction of complexity in the implementation of BCI systems could bring these systems closer to applications such as controlling devices for the motor rehabilitation of stroke patients, and therefore, contribute to a more effective neurological rehabilitation.

History of physical and 'moral' treatment of hysteria.

This historical review presents the advances made mostly during the last 200 years on the description, concepts, theories, and (more specifically) cure of patients suffering from hysteria, a still obscure entity. The denomination of the syndrome has changed over time, from hysteria (reinvestigated by Paul Briquet and Jean-Martin Charcot) to pithiatism (Joseph Babinski), then to conversion neurosis (Sigmund Freud), and today functional neurological disorders according to the 2013 American Neurological Association DSM-5 classification. The treatment was renewed in the second half of the 19th century in Paris by Paul Briquet and then by Jean-Martin Charcot. Hysterical women, who represented the great majority of cases, were cured by physical therapy (notably physio-, hydro-, and electrotherapy, and in some cases ovary compression) and 'moral' therapies (general, causal therapy, rest, isolation, hypnosis, and suggestion). At the turn of the 19th and 20th centuries, psychotherapy, psychoanalysis, and persuasion were established respectively by Pierre Janet, Sigmund Freud, and Joseph Babinski. During World War I, military forces faced a large number of posttrauma neurosis cases among soldiers (named the 'Babinski-Froment war neurosis' and Myers 'shell shock', in the French and English literature, respectively). This led to the use of more brutal therapies in military hospitals, combining electrical shock and persuasion, particularly in France with Clovis Vincent and Gustave Roussy, but also in Great Britain and Germany. After World War I, this method was abandoned and there was a marked decrease in interest in hysteria for a long period of time. Today, the current treatment comprises (if possible intensive) physiotherapy, together with psychotherapy, and in some cases psychoanalysis. Antidepressants and anxiolytics may be required, and more recently cognitive and behavioral therapy. Repetitive transcranial magnetic stimulation is a new technique under investigation which may be promising in patients presenting with motor conversion syndrome (motor deficit or movement disorder). Functional neurological disorders remain a difficult problem to manage with frequent failures and chronic handicapping evolution. This emphasizes the need for therapeutic innovations in the future.

[2012: news in neurology]. / Neurologie.

In 2012, intramuscular midazolam appears as effective as intravenous lorezepam for the first line treatment of convulsive status epilepticus. Perampanel, a new anti-epileptic drug, will be soon available. Two oral treatments are now available for stroke prevention in atrial fibrillation setting. The methylphenidate and the Tai Chi could increase the walk capacity of patients suffering from Parkinson disease. A comprehensive cardiac work-up is essential for some congenital myopathy. A new drug against migraine seems free from vasoconstrictive effect. Antioxidants are harmful in Alzheimer disease. Some oral medication will be available for multiple sclerosis.