bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of mobile apps and technologies in child and adolescent mental health: a systematic review
Authors: Punukollu Mallika , Marques Mafalda
Published: July 2019

Question

This review will aim to critically evaluate the currently available literature concerning the use of online mobile-based applications and interventions in the detection, management and maintenance of children and young people’s mental health and well-being.

Study selection and analysis

A systematic literature search of six electronic databases was conducted for relevant publications until May 2019, with keywords pertaining to mental health, well-being and problems, mobile or internet apps or interventions and age of the study population. The resulting titles were screened and the remaining 92 articles were assessed against the inclusion and exclusion criteria with a total of 4 studies included in the final review.

Findings

In general, young people seem to engage very well with this type of tools, and they demonstrate some positive effects in emotional self-awareness. There have been some studies about this issue and many of the outcomes were notstatistically significant. However, it is still a sparsely documented area, and more research is needed in order to prove these effects.

Conclusions

Mental health apps directed at young people have the potential to be important assessment, management and treatment tools, therefore creating easier access to health services, helping in the prevention of mental health issues and capacitating to self-help in case of need. However, a limited number of studies are currently available, and further assessments should be made in order to determine the outcomes of this type of interventions.
114 Cognitive impairment in the community: a 16-month audit study of a neurology memory clinic in the inner sydney region
Authors: Rigney Louise , Chen Lily , Selby Alexis , Patel Tejas , Hwang Yun T , Mobbs Anthony ED , Mobbs Rowena EA
Published: July 2019

Introduction

Neurodegenerative disease is increasingly common, but neurology service utilisation by this population is unclear. This study presents an integrated metropolitan neurology clinic as a model of care, and examines care pathways and characteristics in patients with cognitive decline.

Methods

An audit of patients with dementia (n=136,51–96 yr,M:F1.1:1) and mild cognitive impairment (MCI)(n=28,56–83 yr,M:F0.6:1) over a 16 month period was performed using retrospective analysis of demographic characteristics, clinical information and frailty measures.

Results

The average duration of cognitive decline at presentation was 2.7 years in dementia (n=135,M=3.1,F=2.3) and 1.5 years MCI (n=28,M=1.7,F=1.3). Average age of patients with newly diagnosed dementia was 72 (M:F0.96:1) and MCI 70 (M:F1.03:1) with Alzheimer’s disease in 86(64%) dementia with Lewy bodies 13(10%) frontotemporal dementia 11(8%) and distinct overlap syndromes in 7(5%). Depression was associated with younger age at diagnosis(ave.60) versus anxiety(74) and agitation(75). Psychosis was in 14(10%) REM sleep behaviour disorder 6(5%). In the 12 months prior, falls were seen in 30(22%) and weight loss 29(21%). Allied health input occurred in 81% of dementia versus 68% MCI cases.

Conclusions

Delay in diagnosis from first clinical manifestation, high rate of psychological and medical comorbidity, presence of overlap syndromes, and allied health requirement, support the need for integrated neurological services in dementia.
117 Employment-activity status and multidisciplinary care engagement in patients with newly diagnosed dementia: a 16-month audit study within an inner sydney community neurology clinic
Authors: Rigney Louise , Selby Alexis , Chen Lily , Patel Tejas , Hwang Yun T , Mobbs Anthony ED , Mobbs Rowena EA
Published: July 2019

Introduction

Dementia is one of the leading causes of mortality and morbidity in Australia. Attitudes towards dementia in the workplace, tailored adjustments for disability, and patient-centred ‘exit with dignity’ strategies are of objective and subjective importance to patient wellbeing. This study aimed to assess employment characteristics in those with newly diagnosed dementia, and engagement with multidisciplinary supports.

Methods

An audit of patients with diagnosis of dementia (n=136,age51–96 yrs,M:F1.1:1) and mild cognitive impairment (MCI)(n=28,age56–83M:F0.6:1) over a 16 month period in 2017–18 was performed using online server data collection and retrospective analysis of general and employment demographic characteristics, presenting clinical information, and care across clinical psychology, psychotherapy, occupational therapy, speech pathology, and dietetics.

Results

Younger onset dementia was present in 14(10%). Of the 122 dementia cases aged above 65 years, 24(20%) were employed-active, 98(80%) were retired, and none were unemployed. Approximately 5% had a background in healthcare. Allied health support was provided in 106 cases (78%) with ≥3 supports in 28(21%) and was more common in those who were retired(76%) versus employed-active (21%). Clinical psychology or psychotherapy support was provided in 50(37%) cases of dementia.

Conclusions

The onset of dementia often co-exists with active employment. Community perception of employment status in dementia would be of future research interest. Provision of multidisciplinary allied health supports in dementia may facilitate coping, adjustment and cooperative strategies for exit with dignity but further studies are required in this cohort.
121 Diabetic ulnar neuropathy with non-localizing electrophysiology: a nerve ultrasound study
Authors: Pelosi Luciana , Blumhardt Lance , Yong Vivien
Published: July 2019

Introduction

The classification and management of diabetic ulnar mono-neuropathy with non-localizing electrophysiology (NL-UN) is challenging, as this could be due to a focal axonal lesion at the elbow that may require surgery or, be part of the mono-neuritis multiplex spectrum of diabetic neuropathy. The distinction cannot be made by clinical examination and electrophysiology.

We investigated the value of nerve ultrasound in this situation.

Methods

We analysed ulnar nerve ultrasound in 9 consecutive diabetic patients (5 males, mean age 65.4 years) with 12 NL-UN affected nerves. The ulnar neuropathy was clinically and electrophysiologically severe in 9 nerves and moderate in 3.

Results

Ultrasound showed diffuse ulnar nerve abnormality in 9 nerves (75%) and focal nerve abnormalities at the elbow in 3 (25%)

Conclusions

The majority of NL-UNs in this small sample of patients with diabetes were not due to focal lesions at the elbow. This is in contrast with the nerve ultrasound findings in non-diabetic patients with NL-UN, which almost invariably show a focal lesion at the elbow (Pelosi et al, 2018), and confirms that the pathophysiology of ulnar mono-neuropathy is different and more complex in diabetes.

Ultrasound appears to be a useful tool to classify NL-UN in the patient with diabetes and larger studies are indicated.

References

Pelosi, et al. Ulnar neuropathy with abnormal non-localizing electrophysiology: Clinical, electrophysiological and ultrasound findings. Clin Neurophysiol 2018, 129:2155–2161.
122 ‘My migraine voice: burden of migraine and it’s management in an australian cohort’
Authors: Jenkins Bronwyn , Hutton Elspeth , Stark Richard , Quintana Rebeca , Carboni Veruska , Yaghobian Dania , Wieliczko Guillaume , Vo Pamela
Published: July 2019

Introduction

Migraine is the greatest cause of disability under the age of 50. It impairs ability to function, work and maintain relationships. This survey aimed to assess the impact of migraine and its management.

Methods

A questionnaire was sent to patients >18 years old who had taken at least one preventive treatment for migraine in the past. We report here the Australian results.

Results

68% were women, mean age 41 years. 53% were in paid employment whilst 13% received a disability allowance due to migraine. All patients (n=320) in the Australian survey had ≥ 4 migraine days each month. 90% had taken at least one preventive (274), with 80% (194) needing to change the preventive treatments previously. Common comorbidities were depression (41%), anxiety (40%), chronic pain (29%), sleep disorder (25%) and overweight (24%).

Diagnosis rate on initial GP visit was 57%, with 26% receiving a diagnosis in <1 month and 55% by 6 months.

There was greater retention of use (60%) and satisfaction (60%) with acute therapies, compared with use (43%) and satisfaction (53%) with preventives. Dissatisfaction with preventives included lack of efficacy (54%) and too many side effects (36%). Most (>60%) patients reported fear of the next attack, feeling hopeless and difficulty thinking clearly during attacks. Employers were often (69%) aware of the migraines, but only 24% offered any support. Migraine had negative impacts on relationships.

Conclusion

The Migraine Voice Survey highlights the true burden of migraine in Australia and limitations of current management options.
011 Melbourne mobile stroke unit halves workflow for acute stroke reperfusion therapy
Authors: Zhao Henry , Coote Skye , Langenberg Francesca , Easton Damien , Stephenson Michael , Smith Karen , Bernard Stephen , Desmond Patricia , Mitchell Peter , Yan Bernard , Campbell Bruce CV , Parsons Mark , Donnan Geoffrey A , Davis Stephen M
Published: July 2019

Background

The Melbourne Mobile Stroke Unit (MSU) utilises a specialised ambulance with on-board CT scanner and multidisciplinary team to provide on-scene imaging, treatment and triage for central Melbourne, Australia. We describe the operational impact of the MSU on commencement of acute reperfusion therapy.

Methods

Data from the first 12 months of operation were collected for all patients receiving reperfusion therapy from November 2017. Workflow times were compared to contemporary published Australian data and historical controls from Royal Melbourne Hospital.

Results

In the first calendar 12 months of operation, the Melbourne MSU operated 30.5 service weeks and provided prehospital thrombolysis (tPA) to n=52 patients (44% of eligible infarcts) and directed n=33 patients for endovascular thrombectomy, of which 48% required bypass from the closest non-thrombectomy hospital. The overall median onset-to-tPA for MSU patients was 97.5 mins compared to the Australian metropolitan median of 150 mins. Thrombolysis in the first ‘golden hour’ increased to 13.5% from 3.3% in-hospital. Median onset-to-groin for MSU patients receiving EVT was 162 mins compared to 234 mins from historical controls.

Discussion

Prehospital treatment and triage using the Mobile Stroke Unit in metropolitan Melbourne resulted in substantial improvements in commencement of reperfusion therapy. Workflow times are approximately halved for thrombolysis and endovascular thrombectomy respectively. Prehospital thrombolysis also allowed a >400% increase in the proportion of treatment in the first ‘golden hour’.
124 Correlating structure and function to better identify surrogate end points for clinical trial design: a longitudinal clinical and imaging study of primary progressive aphasia
Authors: Mahoney Colin
Published: July 2019

Introduction

Measuring longitudinal change in white matter tracts offers a highly sensitive way of monitoring the course of a range of neurodegenerative conditions. However, it remains unclear how structural changes correlate with symptom progression. Clinically meaningful outcomes remain a key requirement in therapeutic trial design so imaging biomarkers need to accurately predict these outcomes. Identifying surrogate clinical end points is of particular importance in neurodegenerative conditions where clinical change evolves slowly. To address this the current study aims to identify potential surrogate end points by assessing correlations between clinical and neuroimaging measures.

Methods

30 patients meeting consensus criteria for a diagnosis of primary progressive aphasia underwent longitudinal imaging and neuropsychological assessments at baseline and one year. A mixed effects model was designed to test for significant interactions over time between changes in neuropsychological performance and Fractional Anisotropy (FA) in key white matter tracts.

Results

Declining single word comprehension correlated with reducing FA within bilateral inferior longitudinal fasciculus (ILF), bilateral superior longitudinal fasciculus (SLF) and the genu of the corpus callosum; declining naming ability correlated with reducing FA in the left ILF, right uncinate fasciculus and right SLF; declining word repetition correlated with reducing FA within the left ILF.

Conclusions

Declining neuropsychological scores correlated with longitudinal decline in FA in a number of white matter tracts across an anatomically distributed language network. Correlations between function and structure provide evidence that monitoring structural white matter changes in the tracks identified may have value as a surrogate end point for future clinical trials.
132 Brushstrokes after stroke – art and neuroplasticity
Authors: Narasimhan Manisha , Ramon Lucy
Published: July 2019

Introduction

Despite current developments in acute stroke therapies, 65% of stroke patients have varying degrees of disability. Whilst focus on acute stroke reperfusion strategies is vital, stroke survivors still need support and appropriate opportunities for rehabilitation.

Methods and results

This is an inspiring story of an 86-year old patient with locked in syndrome who rediscovered her artistic talent after a disabling stroke. She presented with right hemiparesis, bilateral ptosis, ophthalmoplegia and aphasia. Her MRI showed multiple infarcts affecting the midbrain, thalamic, cerebellar and occipital regions. There was stenosis of the right vertebral artery- the left was hypoplastic, and new atrial fibrillation was detected.

There was no response to early rehabilitation strategies and her husband decided to care for her at home. He used creative strategies to encourage motor skills and participation in daily activities, and despite never regaining speech or independent mobility, she was able to interact meaningfully with him and her environment. They enjoyed a full and active life until her demise last year.

The patient was an accomplished artist and, with the help of her husband, reengaged in painting. This resulted in an original collection of paintings that formed an exhibition in Wollongong Art Gallery.

Conclusion

This is a life affirming story of love, enablement and ingenuity after disabling strokes, and a reminder that neuroplasticity can occur at any age. Art can provide a way to harness neuroplasticity to improve neurological deficits and quality of life, even despite significant disability. ‘A man paints with his brains and not with his hands. ‘(Michaelangelo).
134 Cladribine: a multicentre long-term efficacy biomarker australian study (CLOBAS)
Authors: Lechner-Scott Jeannette , Maltby Vicky , Lyndon Amanda , Monif Mastura , Kilpatrick Trevor , Butzkueven Helmut , Taylor Bruce , McCombe Pamela , Hodgkinson Suzanne , Fabis-Pedrini Marzena , Kermode Allan , Barnett Michael , Kalincik Tomas
Published: July 2019

Introduction

Cladribine tablets (marketed as Mavenclad®) is a new oral therapy, which has recently been listed on the pharmaceuticals benefit scheme (PBS) in Australia for treatment of relapsing MS. The current dosing schedule is for 2 courses given a year apart, which has been shown to be effective for treatment of MS up to 4 years in 75% of patients (based on annualised relapse rate). However, re-initiation of therapy after year 4 has not been studied.

Methods

This will be a multicentre, 6-year, phase IV, low interventional trial. Subjects considered for treatment with cladribine will receive an initial treatment course in year 1 and a continuing treatment course in year 2. After year 3, patients will have the option for re-dosing, if clinically indicated or to switch to another disease modifying therapy. Throughout the duration of the study we will assess blood based biomarkers including lymphocyte subsets, serum neurofilament light chain, DNA methylation and RNA analysis as well as MRI findings (brain volume/lesion load) and cognitive performance.

Results

This study has been approved by the Hunter New England Local Health District Human Research Ethics Committee. The study is due to commence on March 14th.

Conclusions

This will be the first long-term efficacy trial of cladribine which offers re-initiation of therapy after the initial two courses. We expect this study will be an indication if any of the assessed biomarkers can be used to predict treatment efficacy or the need for re-initiation of Cladribine in MS patients.
014 AVXS-101 gene-replacement therapy (GRT) in presymptomatic spinal muscular atrophy (SMA): study update
Authors: Farrar Michelle , Swoboda Kathryn J , Schultz Meredith , McMillan Hugh , Parsons Julie , Alexander Ian E , Kernbauer Elaine , Farrow Marcia , Ogrinc Francis G , Feltner Douglas E , McGill Bryan E , Spector Sidney A , L’Italien James , Sproule Douglas M , Strauss Kevin A
Published: July 2019

Introduction

SMA is a neurodegenerative disease caused by biallelic deletion/mutation of the survival motor neuron 1 gene (SMN1). Copies of a similar gene (SMN2) modify disease severity. In a phase 1 study, SMN GRT onasemnogene abeparvovec (AVXS-101) improved outcomes of symptomatic SMA patients with two SMN2 copies (2xSMN2) dosed ≤6 months. Because motor neuron loss can be insidious and disease progression is rapid, early intervention is critical. This study evaluates AVXS-101 in presymptomatic SMA newborns.

Methods

SPR1NT is a multicenter, open-label, phase 3 study (NCT03505099) enrolling ≥27 SMA patients with 2–3xSMN2. Asymptomatic infants ≤6 weeks receive a one-time intravenous AVXS-101 infusion (1.1×1014 vg/kg). Safety and efficacy are assessed through study end (18 [2xSMN2] or 24 months [3xSMN2]). Primary outcomes: independent sitting for ≥30 seconds (18 months [2xSMN2]) or assisted standing (24 months [3xSMN2]).

Results

From April–September 2018, 7 infants received AVXS-101 (4 female; 6 with 2xSMN2) at ages 8–37 days. Mean baseline Children’s Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP-INTEND) score was 41.7 (n=6), which increased by 6.8, 11.0, 18.0, and 22.5 points at day 14 (n=4), month 1 (n=3), 2 (n=3), and 3 (n=2). As of January 31, 2019, 15 asymptomatic infants have been enrolled in SPR1NT and dosed with AVXS-101. Updated data available at the time of the congress will be presented.

Conclusions

Preliminary data from SPR1NT show rapid motor function improvements in presymptomatic SMA patients.
017 Widespread extra-motor abnormality is a prominent MRI signature of ALS: a cross-cohort study
Authors: Tu Sicong , Turner Martin R , Kiernan Matthew C
Published: July 2019

Introduction

Amyotrophic lateral sclerosis (ALS) is a heterogeneous neurodegenerative disease characterised by motor dysfunction, but now recognised as a complex multi-system disorder. Neuroimaging studies’ indicate an expanding, though inconsistent, list of extra-motor neural involvement. The objective of the current study was to examine pattern of grey matter change across two clinically well matched patient cohorts to identify core neural changes underlying ALS.

Methods

Independent ALS and age-matched healthy control cohorts were compared from Oxford (ALS: 45; Control: 34) and Sydney (ALS: 45; Control: 27). Whole-brain voxel-based morphometry and subcortical volumetric analyses were carried out.

Results

Subcortical volumetric reduction was consistently observed in the thalamus, caudate and hippocampus (all p < 0.05). Pattern of cortical grey matter atrophy showed variability across ALS cohorts, but consistently implicated crus I-II of the cerebellum and orbitofrontal cortices (p < 0.01, family-wise error corrected).

Conclusions

The core grey matter MRI signature of ALS comprises extensive extra-motor cortical and subcortical abnormality. Significant variability exists, which highlights the heterogeneous nature of ALS as defined by current diagnostic guidelines.
018 Role of transcallosal inhibition in disease spread in ALS
Authors: Bos Mehdi Van den , Howells James , Higashihara Mana , Geevasinga Nimeshan , Kiernan Matthew , Vucic Steve
Published: July 2019

Introduction

There is substantial evidence for the cortical origin of amyotrophic lateral sclerosis (ALS). Impaired function of the corpus callosum has been demonstrated in ALS patients and may play a role in disease spread, potentially mediating the spread of cortical hyperexcitability between hemispheres. We assessed transcallosal inhibition, utilising the threshold tracking transcranial magnetic stimulation (TMS) technique to assess transcallosal inhibition and related the changes to disease involvement.

Methods

Threshold tracking TMS was undertaken in 15 ALS patients and results were compared to 16 healthy controls. Interhemispheric inhibition was assessed using a figure of eight coil over each hemisphere across interstimulus intervals ranging from 8 to 40ms.

Results

Transcallosal inhibition was reduced in ALS patients (0.9 ± 1.0%) when compared to controls (6.6 ± 1.0%, P=0.03). Importantly differences in transcallosal inhibition between hemispheres were evident in ALS patients. Specifically, transcallosal inhibition projecting from the motor cortex contralateral to disease onset (0.9 ± 1.0%) was significantly lower when compared to projection form the ipsilateral motor cortex (3.2 ± 1.0%, P=0.036). Abnormalities of transcallosal inhibition correlated with upper motor neurone dysfunction and greater functional disability in ALS.

Conclusion

Abnormalities of transcallosal inhibition were demonstrated in ALS patients and were associated with clinical features. Consequently, dysfunction of transcallosal fibres may contribute to development of cortical hyperexcitability, a pathogenic mechanism in ALS. Strategies aimed at modulating dysfunction may prove therapeutically useful in ALS.
027 Will refractory patients respond to erenumab in the real world?
Authors: Jenkins Bronwyn , Cheng Shuli , Hutton Elspeth
Published: July 2019

Introduction

Erenumab has been studied in Randomised Controlled Trials (RCT), with stricter exclusion criteria than real world populations.

Methods

65 patients from two Australian headache centres on Erenumab had primary outcomes of ≥ 50% response in monthly migraine days (MMD) and monthly headache days (MHD), compared to their demographics, frequency, duration of Chronic Migraine (CM), failed prophylactic medications, severity scores and medication overuse headache (MOH).

Results

35% (23/65) had daily headaches, with ≥ 50% MHD and MMD reduction in this subgroup of 17% (4/23) and 65% (13/20), respectively. Duration of CM was >10 years in 48% (29/61), with ≥ 50% MHD and MMD reduction in 28% (8/29) and 48% (13/27), respectively. 100% (64/64) had failed > 3 prophylactic medications with ≥50% MHD and MMD reduction in 30% (19/64) and 47% (27/58), respectively, with reducing rates of ≥ 50%MMD reduction if >5 (29%; 17/58) and >10 (22%;2/9). 95% had high severity scores (HIT-6 score >60), with a ≥ 50% MMD reduction in 43% (23/54). MOH occurred in 41% (24/58) for triptan and 29% (17/58) for codeine medications, with a ≥ 50% MMD reduction in 71% (17/24) and 41% (7/17), respectively (all groups p>0.05).

Conclusion

This real world cohort treated with Erenumab included patients that would be excluded from RCT analysis- including more chronic, frequent, severe and refractory migraine. Despite this, there were still ≥50% responders in more severe subgroups, particularly daily headache, high severity scores and triptan MOH. Measuring MMD may be more sensitive for assessing improvement than MHD.
028 Delayed CT imaging leading to delays in acute stroke management in regional australia
Authors: Nindra Udit , Wonson Toni M , Fuller Karen
Published: July 2019

Introduction

Urgent CT imaging is crucial for acute stroke management to allow for timely thrombolysis and early referral to a peripheral endovascular thrombectomy (ECR) service. Delays in CT imaging are suspected to correlate with lengthening door-to-needle time (DNT) and arrival-to-referral time (ART) in regional Australia.

Methods and results

We retrospectively analysed 656 acute stroke admissions between 2016 and 2018 to determine mean DNT and ART in addition to influencing factors such as age, gender, onset to arrival time & baseline National Institute of Health Stroke Scale (NIHSS) score. Over 3 years, 70 patients underwent thrombolysis and 56 ECR. The mean DNT was 108 minutes with mean arrival to CT time of 30 minutes. Multiple linear regression displayed a positive correlation between arrival to CT time and DNT (p<0.01). For every 10-minute delay in CT imaging, there was a 6-minute delay in DNT (95% CI 2 – 11 minutes). The mean ART was 150 minutes. A positive correlation was again seen between ART and arrival to CT Time (p=0.02). For every 10-minute delay in CT imaging, there was a 9-minute delay in ART (95% CI 1 – 16 minutes).

Conclusions

It is known that early initiation of both thrombolysis and ECR are associated with positive patient outcomes. There is a need to reduce time taken to complete CT imaging in regional Australia, as it is clearly shown to be associated with lengthened time for treatment initiation and timely referral. Reduction in this arrival to CT time will likely improve patient outcomes.
046 A critical review of biomarkers for hereditary spastic paraplegia
Authors: Siow Sue-Faye , Wali Gautam , Sue Carolyn , Kumar Kishore R
Published: July 2019

Introduction

Hereditary spastic paraplegia (HSP) is a rare neurodegenerative condition characterised by lower limb weakness and spasticity. Currently, treatment is symptomatic and there is no disease modifying therapy. Though candidate therapeutic agents have been identified, sensitive biomarkers to measure treatment efficacy in clinical drug trials are lacking. There are many challenges in the search for appropriate biomarkers including the rarity of HSP, clinical and genetic heterogeneity of HSP and slow disease progression.

Methods

We performed a search on PubMed and Medline using the search terms (‘hereditary spastic paraplegia’ OR ‘spastic paraparesis’) AND ‘biomarker*’. We searched the reference lists of relevant articles to identify further studies. We collected data on number of participants, HSP genotype, methodology, and outcomes.

Results

72 papers were identified: 2 on Rating scales, 9 on gait analysis, 33 on neurophysiological measures, 23 on neuroimaging markers and 5 on biochemical markers. The studies reviewed demonstrated variation in methodologies and outcomes, including mixed genotype (41/72 papers) and genotype-specific (31/72 papers) patient cohorts, varied neurophysiological techniques and different outcome measures. 68/72 studies reviewed had small patient numbers (<50 patients). All potential biomarkers reviewed were able to differentiate HSP patients from controls. Only diffusion tensor imaging (DTI) parameters showed significant correlation with disease severity.

Conclusion

Although useful as diagnostic biomarkers, further studies are required to evaluate these potential biomarkers longitudinally and to assess their reliability as surrogates for underlying neurodegenerative changes and clinical disease severity. DTI showed the most promise as a biomarker for disease severity in HSP.
077 An unusual presentation of antibody negative autoimmune encephalitis: a case report
Authors: Upadhyay Viral , Malkan Ashish , Park Hyunmin
Published: July 2019

Introduction

Immune-mediated encephalitis can occur in the absence of measurable pathogenic antibodies in CSF or serum.

Methods and results

We present the case of a 29-year-old Sudanese woman presented with four days history of meningism. She is three months post-partum with her fifth child and does not have significant past medical history. She is a current smoker with history of methamphetamine and heroin use until 5 years ago. There were no focal neurological deficits on examination. CT brain was normal and her CSF had 420×106/L leucocytes (Polymorphs 18, Mononuclears 402). Three days later, she deteriorated clinically with GCS 11 and developed left sided hemiplegia requiring intubation and ventilation in intensive care.

The CSF culture along with autoimmune encephalitis panel, anti-neuronal antibodies, HSV, VZV, Enterovirus, cryptococcal antigen, TB quantiferon, HIV, Malaria were negative. Her immunology tests were unremarkable including rheumatoid factor, complements, anti-nuclear antibodies, dsDNA, PR3, MPO, RNP, Smith, Ro, La, Scleroderma 70 and Jo-1 antibodies. The MRI Brain showed persistent changes in right hemispheric cortical and subcortical gyriform FLAIR hyperintensities which were also present in DWI images. The EEG showed right temporo-occipital region 7–8 Hz rhythmic discharges with generalised diffuse slowing. She had right parietal lobe brain biopsy which shows perivascular and intramural inflammation by mononuclear cells almost comprised of CD3 T-cells consistent with encephalitis associated with secondary lymphocytic vasculitis. She was treated with intravenous pulsed methylprednisolone and IVIg followed by plasma exchange. Then given high dose oral corticosteroids with slow tapering and intravenous Cyclophosphamide four weekly. Significant neurological improvement noted over next 8 weeks with patient being alert and participating in ongoing multidisciplinary rehabilitation for hemiplegia.

Conclusion

A case of cerebral biopsy confirmed, CSF and serum antibody-negative encephalitis is presented.
078 Sensory nerve abnormalities in motor neuron disease
Authors: MacDonald Allycia , Needham Merrilee , Alvaro Anthony
Published: July 2019

Introduction

Electrodiagnostic evaluation is crucial in establishing the diagnosis of motor neuron disease (MND) and excluding other pathologies. It is recommended that sensory nerve conduction studies (NCS) include the ulnar and sural nerves, and generally accepted that sensory nerves are normal in MND. There are however previous reports in the literature documenting variable sensory abnormalities in patients with MND. We sought to determine the frequency of unexplained sensory abnormalities seen on NCS in patients with MND.

Methods

Medical records of patients attending our tertiary MND clinic over a 2 year period were reviewed. We identified 92 patients with a clinical diagnosis of MND for whom electrodiagnostic studies were available to review. Sensory abnormalities in patients without a clear underlying aetiology (eg. compressive neuropathies, diabetes) were considered unexplained.

Results

Unexplained sensory abnormalities were detected in at least one nerve in 18/92 (20%) patients. In 17 of those 18 patients, the ulnar sensory response was abnormal. 12 of 18 patients demonstrated abnormalities in 2 or more sensory nerves. Sensory abnormalities were present in 4 of 37 (10.8%) patients with bulbar onset MND and 14 of 55 (25.4%) patients with limb onset MND. Sensory symptoms were infrequently reported and did not correlate with abnormalities found on NCS.

Conclusions

Unexplained sensory nerve action potential abnormalities are not uncommon in MND, with ulnar sensory responses the most frequently affected. These findings raise the possibility of sensory nerve pathology in patients with MND and suggest that the presence of unexplained sensory abnormalities should not exclude a diagnosis of MND.
084 Separating stroke from vestibular neuritis by vestibular function test parameters
Authors: Calic Zeljka , Nham Benjamin , Taylor Rachel , Young Allison , Anderson Craig , Cappelen-Smith Cecilia , Cordato Dennis , Welgampola Miriam
Published: July 2019

Introduction

Vestibular neuritis (VN) and posterior circulation stroke (PCS) are the commonest causes of acute vestibular syndrome (AVS). We aim to identify discriminators of VN from PCS by testing all five vestibular end-organs in patients presenting with AVS.

Methods

Three-dimensional video-head impulse test (v-HIT), cervical and ocular-vestibular evoked myogenic potentials (c-and oVEMP) and subjective visual horizontal (SVH) tests were performed in 22 patients with VN and 22 with PCS. Ipsilesional horizontal, anterior and posterior canal (HC, AC, PC) v-HIT gain and first catch-up saccade characteristics, VEMP amplitude asymmetry-ratios were compared.

Results

All VN and 6 PCS patients had positive clinical HIT. Mean time to testing was 4.7 days for VN, 7.0 days for PCS. VN mean ipsilesional HC and AC first saccade amplitude was larger, peak-velocities faster and onset latencies earlier compared to PCS (p<0.05). No significant difference between VN and PCS in first saccade characteristics was found in PC. Ipsilesional first saccade amplitude, peak-velocity and duration were significantly different between PCS and controls for all canals (p<0.05). A gain <0.68 and first saccade amplitudes >2.2°separated VN from PCS with sensitivities of 95.5% and 86.4% and specificities of 72.7% and 63.6%. First saccade amplitude of >0.91°identified PCS from controls with sensitivity of 68.2% and specificity of 70%. Abnormality rates for AC cVEMP, BC oVEMP and SVH were 42.9%, 50% and 91% for VN and 38.1%, 9% 72% for PCS.

Conclusion

v-HIT gain and catch-up saccade metrics are useful separators of VN from PCS. Detailed saccade analysis complements existing vestibular tests.
085 Syndrome of transient headache and neurologic deficits with cerebral fluid lymphocytosis (HANDL) as a mimic for transient ischaemic attack (TIA)
Authors: Ashhurst Jasmine F , Haddad Rami
Published: July 2019

Introduction

HaNDL is a rare neurological disorder of unknown aetiology that is characterised by headache, neurological deficit and pleocytosis in the cerebrospinal fluid (CSF). It is a benign condition that has spontaneous resolution of symptoms within months.

A 50 year old female presented to Emergency with an acute focal neurological deficit of right sided weakness, dysphasia and dysarthria lasting less than one hour. Over the preceding months she had a new onset of headache. She was worked up for a likely diagnosis of TIA.

Methods

Case report.

Results

Initial CT Brain(angiography) showed no stroke or other identifiable cause of symptoms.

MRI brain showed excessive nonspecific T2 hyperintensities, requiring further investigation for possible vasculitis. MR angiography was normal and there was no evidence of stroke.

Viral PCR’s were negative.

Lumbar puncture (LP) showed pleocytosis (leucocytes 309×10E6/L), raised intracranial pressure and high protein, raising suspicion for HaNDL. This normalised on subsequent outpatient LP, along with symptoms.

Conclusions

A diagnosis of HaNDL is made as a diagnosis of exclusion, though should be considered as a differential diagnosis for various presentations in which transient acute focal neurology is a presenting complaint.

Due to relatively few reported cases of HaNDL, it is possible that HaNDL is being underdiagnosed due to variability in patient presentation and lack of understanding of the syndrome.

As in this case, when a patient presents with transient acute focal neurology in the absence of headache as a prominent presenting symptom, it is reasonable to consider HaNDL as a differential diagnosis.
101 Case report: to stent, or not to stent? The pale cast of evidence-based practice in acute stroke
Authors: Blair Chris , Bhatia Kartik , Brunacci David , Worthington John , Ahmed Rebekah
Published: July 2019

Introduction

With approximately 200 procedures performed in the last year at our centre, worthwhile clinical lessons continue to emerge in the practice of endovascular clot retrieval (ECR) for acute stroke. This case demonstrates the value of considered clinical appraisal in a dynamic, information-rich setting. A 68 year-old man with established vertebrobasilar atherosclerotic disease developed capricious, blood pressure-sensitive neurological deficits after successful ECR for a basilar artery stroke, inviting the possibility of further intervention in the form of intracranial stenting. We avoided pursuing this course of action in favour of a more measured approach, entailing the provision of vasopressor support over the following week.

Method

Following ECR, our patient was admitted to the intensive care unit for continuous blood pressure monitoring and close observation of his neurological deficits with serial NIHSS (National Institutes of Health Stroke Scale) scoring. Systolic blood pressures were maintained between 140–160 mmHg using vasopressor support, with the aim of allowing time for recovery of vascular autoregulation and collateralization.

Results

Over six days, the patient developed moderate left upper and lower limb weakness. An MRI performed on Day 5 revealed limited interval infarction of the right hemipons and cerebellum, with complete re-occlusion of the mid-basilar arterial segment. He left the ICU with a NIHSS score of 7, and was living independently at 90-day follow-up (Modified Rankin Score 1).

Conclusion

The ultimately favourable net outcome for our patient clearly illustrates the imperative to remain within the boundaries of evidence-based practice in this bold and rapidly evolving discipline.
102 Late-onset paradoxical reactions in neurotuberculosis presenting 18 months and 20 years after treatment
Authors: Leadbetter Ruth , Blackmore Timothy , Rosemergy Ian
Published: July 2019

Introduction

Paradoxical reactions (PRs) during treatment of neurotuberculosis are common but late-onset PRs after completion of anti-tuberculous treatment are reported very rarely. The management of late-onset PRs is challenging as excluding other diagnoses is difficult without invasive testing.

Methods

Two cases of late-onset PRs after treatment for neurotuberculosis are reported. The timing of onset, clinical and radiological features of these PRs are described and the diagnostic work up and outcomes after empiric immunosuppression reviewed.

Results

A 24-year-old woman presented with right-sided focal motor seizures 18 months after receiving anti-tuberculous treatment for neurotuberculosis. MRI showed enlargement of a previous left frontal tuberculoma with extensive oedema. A biopsy was not performed as the lesion involved eloquent brain and the patient declined a lumbar puncture. She was treated empirically with corticosteroids for six months and had clinical and radiological improvement.

A 56-year-old woman presented with left leg weakness and numbness 20 years after treatment for multiple cerebral tuberculomas. MRI showed a new confluent area of T2 hyperintensity in the right frontal and parietal lobes. Cerebrospinal fluid was negative for acid-fast bacilli. She was treated with corticosteroids for 2 months with progressive improvement.

Conclusions

Late onset PRs to neurotuberculosis can occur months to years after completing anti-tuberculous therapy. Recognising this entity is important so unnecessary treatments and brain biopsy may be avoided. Empiric immunosuppression with corticosteroids appears to be safe if early follow up and repeat imaging is arranged.
Direct modeling of subway ridership at the station level: a study based on mixed geographically weighted regression
Authors: Yang Hongtai , Xu Taorang , Chen Dexin , Yang Haipeng , Pu Li
Published: July 2019

Station-level ridership modeling is one of the ways to forecast metro ridership and reveal how factors influence ridership. Previous studies assumed that the relationships between the dependent variable and independent variables are either global or local, as indicated by the global model or the geographically weighted regression (GWR) model. This study explores the possibility that some independent variables have spatially varying relationships with metro ridership while others have constant relationships by employing the mixed GWR model. Data from the Chicago metro system were used. To establish an effective forecasting model, possible influencing factors are collected. OLS model results indicate that the proportion of recreational jobs to total jobs, number of bus stops, employment density, number of high-income workers, and the type of station (transfer or terminal) are significant variables influencing station-level metro ridership. By using the mixed GWR model, we find that the proportion of recreational jobs to total jobs is a global variable while the others are local variables. By comparing the results of mixed GWR, full GWR, and OLS models, we find that mixed GWR fits the data better and the residuals are less correlated. However, results of cross-validation indicate that the prediction power of the OLS model is better than that of the full and mixed GWR models.
A major hydrobiological change in Dasht-e Arjan Wetland (southwestern Iran) during the late glacial – early Holocene transition revealed by subfossil chironomids
Authors: Aubert Cyril , Djamali Morteza , Jones Matthew , Lahijani Hamid , Marriner Nick , Naderi-Beni Abdolmajid , Sharifi Arash , Ponel Philippe , Gandouin Emmanuel
Published: July 2019

The late glacial – early Holocene transition is a key period in the earth’s history. However, although this transition is well studied in Europe, it is not well constrained in the Middle East and palaeohydrological records with robust chronologies remain scarce from this region. Here we present an interesting hydrobiological record showing a major environmental change occurring in the Dasht-e Arjan Wetland (southwestern Iran, near to Persepolis) during the late glacial – early Holocene transition (ca. 11 650 years cal BP). We use subfossil chironomids (Insecta: Diptera) as a proxy for hydrological changes and to reconstruct lake-level fluctuations. The Arjan wetland was a deep lake during the Younger Dryas marked by a dominance of Chironomus plumosus/anthracinus-type, taxa adapted to anoxic conditions of deep waters. At the beginning of the Holocene, a drastic decrease (more than 80% to less than 10%) of Chironomus plumosus/anthracinus-type, combined with diversification of littoral taxa such as Polypedilum nubeculosum-type, Dicrotendipes nervosus-type, and Glyptotendipes pallens-type, suggests a lake-level decrease and a more vegetalized aquatic environment. We compare and contrast the chironomid record of Arjan with a similar record from northwestern Iran. The palaeoclimatic significance of the record, at a local and regional scale, is subsequently discussed. The increase in Northern Hemisphere temperatures, inferred by geochemical data from NGRIP, at the beginning of the Holocene best explains the change from the Younger Dryas highstand to early Holocene lowstand conditions in the Dasht-e Arjan wetland. However, a contribution of the meltwater inflow from small local glaciers in the catchment basin is not excluded.
Epileptic Seizure Detection with EEG Textural Features and Imbalanced Classification Based on EasyEnsemble Learning
Authors: Sun Chengfa , Cui Hui , Zhou Weidong , Nie Weiwei , Wang Xiuying , Yuan Qi
Published: July 2019

Imbalance data classification is a challenging task in automatic seizure detection from electroencephalogram (EEG) recordings when the durations of non-seizure periods are much longer than those of seizure activities. An imbalanced learning model is proposed in this paper to improve the identification of seizure events in long-term EEG signals. To better represent the underlying microstructure distributions of EEG signals while preserving the non-stationary nature, discrete wavelet transform (DWT) and uniform 1D-LBP feature extraction procedure are introduced. A learning framework is then designed by the ensemble of weakly trained support vector machines (SVMs). Under-sampling is employed to split the imbalanced seizure and non-seizure samples into multiple balanced subsets where each of them is utilized to train an individual SVM classifier. The weak SVMs are incorporated to build a strong classifier which emphasizes seizure samples and in the meantime analyzing the imbalanced class distribution of EEG data. Final seizure detection results are obtained in a multi-level decision fusion process by considering temporal and frequency factors. The model was validated over two long-term and one short-term public EEG databases. The model achieved a [Formula: see text]-mean of 97.14% with respect to epoch-level assessment, an event-level sensitivity of 96.67%, and a false detection rate of 0.86/h on the long-term intracranial database. An epoch-level [Formula: see text]-mean of 95.28% and event-level false detection rate of 0.81/h were yielded over the long-term scalp database. The comparisons with 14 published methods demonstrated the improved detection performance for imbalanced EEG signals and the generalizability of the proposed model.
Reorganization of Large-Scale Functional Networks During Low-Frequency Electrical Stimulation of the Cortical Surface
Authors: File Bálint , Nánási Tibor , Tóth Emília , Bokodi Virág , Tóth Brigitta , Hajnal Boglárka , Kardos Zsófia , Entz László , Erőss Loránd , Ulbert István , Fabó Dániel
Published: July 2019

We investigated the functional network reorganization caused by low-frequency electrical stimulation (LFES) of human brain cortical surface. Intracranial EEG data from subdural grid positions were analyzed in 16 pre-surgery epileptic patients. LFES was performed by injecting current pulses (10[Formula: see text]mA, 0.2[Formula: see text]ms pulse width, 0.5[Formula: see text]Hz, 25 trials) into all adjacent electrode contacts. Dynamic functional connectivity analysis was carried out on two frequency bands (low: 1–4[Formula: see text]Hz; high: 10–40[Formula: see text]Hz) to investigate the early, high frequency and late, low frequency responses elicited by the stimulation. The centralization increased in early compared to late responses, suggesting a more prominent role of direct neural links between primarily activated areas and distant brain regions. Injecting the current into the seizure onset zone (SOZ) evoked a more integrated functional topology during the early (N1) period of the response, whereas during the late (N2) period — regardless of the stimulation site — the connectedness of the SOZ was elevated compared to the non-SOZ tissue. The abnormal behavior of the epileptic sub-network during both part of the responses supports the idea of the pathogenic role of impaired inhibition and excitation mechanisms in epilepsy.
A note on the relations between elastic and inelastic interactions and increasing ratio σel(s)/σtot(s) at the LHC
Authors: Troshin S. M. , Tyurin N. E.
Published: July 2019

We comment briefly on relations between the elastic and inelastic cross-sections valid for the shadow and reflective modes of the elastic scattering. Those are based on the unitarity arguments. It is shown that the redistribution of the probabilities of the elastic and inelastic interactions (the form of the inelastic overlap function becomes peripheral) under the reflective scattering mode can lead to increasing ratio of [Formula: see text] at the LHC energies. In the shadow scattering mode, the mechanism of this increase is a different one, since the impact parameter dependence of the inelastic interactions probability is central in this mode. A short notice is also given on the slope parameter and the leading contributions to its energy dependence in both modes.
TPF imaging of Rhodamine B at different detection windows
Authors: Hou Guozhong , Dong Zhiwei , Zhang Sheng , Zhang Zhibin , Xia Yuanqin
Published: July 2019

Broadband two-photon fluorescence (TPF) imaging system based on femtosecond oscillator is built. Broadband TPF signal generated from Rhodamine B molecule is detected at different detection windows. Both TPF signals detected at short wavelength detection window of 545–615 nm and long wavelength detection window of 642–708 nm are used for TPF imaging. Through switching detection window from short wavelength to long wavelength, deepened imaging depth is achieved. The TPF imaging results, with single [Formula: see text] pixels frame taking time of 4–8 s, demonstrate high performance and the good reliability of the imaging system.