bluuebunny/crossref_metadata_2025 huggingface dataset:
P.005 Ovarian resection in anti-NMDAr encephalitis
Authors: Iyengar Y , Hébert J , Climans SA , Wennberg RA , Tang-Wai DF
Published: January 2022

Background: Anti-N-methyl-D-aspartate receptor
encephalitis (NMDArE) is commonly associated with ovarian teratomas,
surgical resection of which can lead to significant neurologic improvement.
However, the necessity of aggressive resection at the time of diagnosis is
unknown; specifically, whether unilateral or bilateral oophorectomy, versus
lesionectomy and partial oophorectomy (ovariotomy), is required.
Methods: Eleven patients with NMDArE who
underwent ovarian resection between January 1st 2012
and December 31st 2020 were retrospectively identified.
Primary outcome was good one-year functional status, defined as modified
Rankin Scale (mRS) score of 0-1. Results: Median age
at encephalitis onset was 24 years (19–38); median delay from symptom onset
to surgery was 39 days (16–129). Six patients (54.5%) had good mRS scores,
unrelated to surgical resection type. Conclusions:
Added clinical benefit of aggressive ovarian resection techniques at
one-year follow-up was not identified in our data. Further longitudinal
studies are needed to determine the indications for different surgical
techniques in patients with NMDArE.

Ovarian resection approaches and associated functional
outcomes in patients with NMDArE
P.013 Machine Learning on Drawing Tests of Cognition: A Systematic
Review
Authors: Kamhawy R , Mcginn R , He H , Ho J , Sharma M , Bhagirath V
Published: January 2022

Background: Machine learning (ML) methods hold promise in allowing early
detection of dementia. We performed a systematic review to assess the
quality of published evidence for using ML methods applied to drawing tests
of cognition, and to describe the accuracy of the methods. Methods: Embase,
Medline, and Cochrane Central Library databases were searched for potential
studies up to December 8, 2018 by four independent reviewers. Included
articles satisfied the following criteria: 1) use of ML on 2) a drawing test
in order to 3) assess cognition. The quality of evidence was then assessed
using GRADE methodology. Results: The initial search yielded 4620 citations.
Of these, 64 were eligible for full text review. 18 articles then met
inclusion criteria. Median AUC across all models was 0.765, with certain ML
algorithms performing better in terms of AUC or diagnostic accuracy.
However, based on GRADE, the quality of evidence was deemed very low.
Conclusions: ML has been applied by several groups to drawing tests of
cognition. The quality of evidence is currently too low to make
recommendations on their use. Future work must focus on improving reporting,
and using standard algorithms and larger, more diverse datasets to improve
comparability and generalizability.
P.019 A machine learning approach to asymmetric burst suppression and
refractory status epilepticus outcome
Authors: Farhani G , Farhani N , Ng MC
Published: January 2022

Background: Treatment of refractory status
epilepticus (RSE) is often titrated to achieve EEG burst suppression.
However, optimal burst suppression characteristics are largely unknown. We
used an unsupervised machine learning algorithm to predict RSE outcome based
on the quantitative burst suppression ratio (QBSR).
Methods: We conducted principal component
analysis (PCA) as a linear combination of 22 QBSR features from non-anoxic
adult RSE patients at the Winnipeg Health Sciences Centre. We also
determined the most predictive components that significantly differed
between survivors and non-survivors. Results: Using
135,765 QBSRs from 7 survivors and 10 non-survivors, PCA identified a
predominantly non-survivor cluster of 8 patients (75% non-survivors). The
first 2 PCA components comprised 75% data variance. The most important first
component feature was skewness of QBSR distribution in the right or left
hemisphere (0.52 each). The most important second component feature was
third QBSR quantile of the left hemisphere (0.49). Only right hemispheric
QBSR features significantly differed between groups: QBSR skewness for the
first component (Benjamini-Hochberg adjusted p=0.038) and average QBSR for
the second component (0.32, Benjamini-Hochberg adjusted p=0.046).
Conclusions: Our pilot study shows that RSE
patient survival may be impacted by QBSR, with differential hemispheric EEG
burst suppression characteristics predicting poor RSE outcome.
P.026 Erenumab associated with high persistence among Canadian patients
for preventive treatment of chronic and episodic migraine in real-world
practice
Authors: Bastien N , Chhibber S , Gladstone J , Lanthier-Martel J , Rochdi D , Lan T , Minhas D , Neish C
Published: January 2022

Background: Real world use of oral prophylactic
migraine therapies is often limited by poor patient tolerance. The objective
of this study was to describe the demographics and clinical characteristics
of patients prescribed erenumab following its launch in Canada (September
2018) and to evaluate the real-world treatment persistence and dose
management. Methods: This was a retrospective,
descriptive analysis of de-identified secondary patient data that includes
baseline demographics, clinical characteristics, plus erenumab treatment
management, collected through Novartis’ Go Program® (Patient Support
Program). Only data collected from patients with a documented informed
consent were included in the analysis. Results:
14,282 patients met eligibility criteria. The mean age of patients was 46.3
years, 83.0% were female, and 66.1% reported having ≥15 monthly migraine
days. 52.5% were initiated on the 140 mg dose of erenumab and 59.3% of those
who initiated the 70 mg dose escalated to 140 mg within 360 days. After 360
and 450 days, the KM-derived persistence was 71.0% and 63.4%, respectively.
Conclusions: The high persistence reported here
suggests that erenumab has a meaningful degree of tolerability in the
real-world setting and increases confidence that the real-world use and
benefits of erenumab will not be undermined by the poor persistence observed
with traditional migraine prophylactic agents.
P.028 Surgical Treatment for Idiopathic Intracranial Hypertension –
Strategy for the Better Management
Authors: Chief Moon-Riley K , Meguro K , Persad A
Published: January 2022

Background: Idiopathic intracranial hypertension
(IIH) is a condition of increased intracranial pressure in the absence of a
space-occupying lesion. The goal of this study is to investigate which
factors may influence outcomes in order to improve surgical strategy. We
hypothesized diabetes, hypertension, smoking, and obesity influence patients
prognosis. Methods: This retrospective chart review
included patients diagnosed with IIH who underwent surgical intervention.
All patients receiving surgery between 2008 and 2018 were included, and
divided into 2 cohorts. Cohort 1 representing favorable course and cohort 2
representing unfavorable course. Favorable course was defined as requiring
single surgery for management. Unfavorable course required multiple surgical
revisions. Results: Overall, 35/48 (73%) comprised
the favorable group. Thirteen patients (27%) comprised the unfavorable
group. Of the unfavorable group, 54% had LP shunts, with the remaining
receiving VP shunts. There was no association between type of shunt and
outcome. Common issues the unfavorable group encountered were persisting
symptoms, infections, obstruction of shunt and replacement of shunt. Smoking
and frequent follow-up were associated with unfavorable course. Gender, BMI,
age, comorbidities and shunt type were not associated with outcome.
Conclusions: We found smoking and patient
follow-up had a significant association with unfavorable outcome. Other
factors had no association with patient outcome.
P.042 Dopamine Dysregulation Syndrome in Parkinson’s Disease and its
Management with Advanced Therapies
Authors: Sasikumar S , Matta R , Fasano A
Published: January 2022

Background: Dopamine Dysregulation Syndrome (DDS)
is an adverse non-motor complication of dopamine replacement therapy in
Parkinson’s Disease. The current literature on DDS is limited, and it
remains underdiagnosed and challenging to manage.
Methods: We performed a retrospective chart
review and classified patients according to risk factors that have been
identified in the literature, UPDRS scores, intervention and outcome.
Univariate analyses were performed to quantify these characteristics.
Results: Prior psychiatric illness was identified
in 70% of patients, impulse control disorder in 89% and substance abuse in
3.7%. Interventions included reduction of dopamine therapy (88.9%), deep
brain stimulation (DBS) of the subthalamic nucleus (STN, 48.1%) or globus
pallidus interna (GPi, 7.4%), and levodopa-carbidopa intestinal gel (LCIG)
infusion (11.1%). Baseline UPDRS IV before treatment and MDS III after
treatment were not significant between intervention groups (p=0.09 and
p=0.13 respectively). Overall 88.9% patients improved at follow up, with
medication only (75%), STN DBS (100%), GPi DBS (100%) and LCIG (33%).
Relapse rate was 18.2%, in the STN group only.
Conclusions: Our results suggest that GPi DBS, in
concurrence with dopaminergic medication reduction, is the most effective
intervention. STN DBS might be also beneficial although the associated
medications reduction causes DDS relapse in a subgroup of patients.
P.216 Improving access to neurosurgeons through an electronic
consultation service
Authors: Wang A , Guglani S , McCutcheon T , Keely E , Alkherayf F
Published: January 2022

Background: Timely access to neurosurgeons for
clinical advice is limited depending on region and other social factors. An
eConsult service providing access to neurosurgeons in Ontario, Canada may
influence primary care provider (PCP) course of action and referral
behaviours. Methods: The Champlain BASE (Building
Access to Specialist Care via eConsult) service allows PCPs to access
specialist care in lieu of traditional face-to-face referrals. We conducted
a cross-sectional study of eConsult cases submitted to neurosurgeons by PCPs
between Jan 1, 2017 and Dec 31, 2018. Usage data and PCP responses to a
mandatory closeout survey were analyzed. Results: A
total of 432 eConsults were submitted. Specialist median response time was
2.29 days with 86.8% of responses occurring within 7 days. PCPs received a
new or additional course of action in 53% of cases. An unnecessary
face-to-face referral was avoided in 57% of all eConsults, and 50% of cases
where the PCP initially contemplated requesting a referral. Over 86% of
cases were rated at least 4 out of 5 in value for PCPs and their patients.
Conclusions: The use of eConsult improves access
to neurosurgeons by providing timely, highly-rated practice-changing
clinical advice while reducing the need for patients to attend face-to-face
office visits.
P.048 International MAGNIMS-CMSC-NAIMS consensus recommendations on the
use of standardized MRI in MS
Authors: Traboulsee A , Wattjes M , Ciccarelli O , Reich D , Banwell B , de Stefano N , Enzinger C , Fazekas F , Filippi M , Frederiksen J , Gasperini C , Hacohen Y , Kappos L , Li DK , Mankad K , Montalban X , Newsome S , Oh J , Palace J , Rocca M , Sastre-Garriga J , Tintore M , Vrenken H , Yours T , Barkhof F , Rovira A
Published: January 2022

Background: Standardized magnetic resonance
imaging (MRI) guidelines published in 2015 by the Europoean MAGNIMS group
and in 2016 by the CMSC are important for the diagnosis and monitoring of
patients with multiple sclerosis (MS) and for the appropriate use of MRI in
routine clinical practice. Methods: Two panels of
experts convened to update existing guidelines for a standardized MRI
protocol. The MAGNIMS panel convened in Graz, Austria in April 2019. The
CMSC NAIMS panel met separately and independently in Newark, USA in October
2019. Subsequently, the MAGNIMS, NAIMS, and CMSC working groups combined
their efforts to reach an international consensus
Results: The revised guidelines on MRI in MS
merges recommendations from MAGNIMS, CMSC, and NAIMS to improve the use of
MRI for diagnosis, prognosis and monitoring of individuals with MS. 3D
acquisitions are emphasized for optimal comparison over time. Core brain
sequences include a 3D-T2wFLAIR for lesion identification and monitoring
treatment effectiveness. Gadolinium-based contrast is recommended for
diagnostic studies and judicious use for routine monitoring of MS patients.
DWI sequences are recommended for PML safety monitoring.
Conclusions: The international consensus
guidelines strive for global acceptance of a useful and usable standard of
care for patients with MS.
P.053 A clinical mystery finally revealed
Authors: Aljohani Z , Venance S
Published: January 2022

Background: We report 2 brothers sharing FHL1
identified mutation. They presented in childhood with overlapping clinical
features characterized by early onset stiffness and increased muscle
definition with cardiac involvement. After 30 years of neurological
followup, the diagnosis is finally revealed. Methods:
At early ages, both had increased definition of upper trunk musculature. The
older brother had hypophonic voice with raspy character, which is to our
knowledge, not reported with this mutation before. He required a pacemaker
for arrhythmias, while the younger developed congestive heart failure.
Results: Their initial investigations failed to
unveil a diagnosis, including a negative next generation sequencing (NGS)
panel for AR LGMD. An expanded NGS sent on the older brother revealed he is
hemizygous for 1770 bp deletion within FHL 1 gene, this deletion includes
exon 7to 8, and confirmed on the other. Conclusions:
First reported in 2008, FHL1 mutations result in phenotypically distinct
neuromuscular disorders: X-linked myopathy with Postural Muscle Atrophy and
generalized hypertrophy, X-linked dominant scapuloperoneal Myopathy, and
Reducing Body Myopathy. Subsequently other phenotypes have been reported
including Emery-Dreifuss muscular dystrophy and hypertrophic cardiomyopathy.
Our patients present with a phenotype that had been reported with FHL1
mutation, highlighting the possible recognition of this presentation in
aiding a diagnostic approach.
P.056 Optimizing IVIg Use for Neuromuscular Conditions in British
Columbia, Canada – Targeting High and Chronic User Groups
Authors: Chapman K , Beauchamp A , Moisa Popurs M , Mosewich R , Beadon K
Published: January 2022

Background: Neuromuscular conditions account for
1/3 of IVIg use in BC and costs over $10 million annually. Since 2013, the
BC Neuromuscular Review Panel has developed diagnostic and treatment
algorithms for the use of IVIg. A framework was created to review high dose
and chronic users. Methods: Utilizing Central
Transfusion Registry data, all patients treated with IVIg for approved
neuromuscular conditions (CIDP, MG, MMN) since April 1, 2013 were
identified. Annual cohorts for patients using higher than usual dose and
chronic use (>3 years) were established, and evaluated annually. Patient
specific recommendations were made. Results: The
initial cohort identified 38 high users of 377 patients receiving IVIg. 27
appropriate, 9 “not appropriate”. Subsequent cohorts showed a decrease in
number of patients receiving inappropriate IVIg doses. In BC there has been
a 36% increase in neuromuscular patients treated with IVIg (377 in 2013/14
to 512 in 2016/17). Despite this, IVIg the program has effectively reduced
the annual grams/patient from 516 gm/patient in 2013/14 to 489 gm/patient in
2016/17. Conclusions: The BC Neuromuscular IVIg
Review confirms that the majority of IVIg use is appropriate. Following
yearly cohorts of chronic and high dose users helps optimize IVIg use, which
may lead to improved patient care.
P.057 Multidisciplinary Care for Optimal Management of Complex Nerve
Injuries In Canada
Authors: Chapman K , Doherty C , Bristol SG , O’Connor R , Berger MJ
Published: January 2022

Background: Recent advances in management of
peripheral nerve injuries is leading to a paradigm shift in the treatment of
Canadian patients. Multi-disciplinary care models provide diagnostic,
surgical and rehabilitative consultations within a single clinical
encounter. Involvement of allied health care professionals has been shown to
improve outcome. The purpose of this study was to ascertain the distribution
and composition of multidisciplinary teams, and identify regional
disparities. Methods: Representatives from clinics
across Canada were invited to participate in a survey at the Annual Canadian
Peripheral Nerve Symposium in London, Ontario in November 2019, with
telephone follow up. Results: Delegates from 17
programs responded to the survey (12 academic centre and 5 community
setting). Program provides electrodiagnostic testing, neuromuscular,
rehabilitation and surgical assessment. Access to the following services was
reported: occupational therapy=53% (9/17), physiotherapy 29% (5/17),
research assistant=17% (3/17), social work=12% (2/17), mental health=6%
(1/17). Conclusions: Complex nerve injury clinics are
being established throughout Canada. Allied health care and research support
are limited in many multi-disciplinary complex nerve injury programs. There
is variable access, likely resulting in disparities in patient care across
Canada. This data will be valuable for lobbying for resources for resources
to improve the care of these complex patients.
P.071 Focused cardiac ultrasound in stroke: a feasibility study
Authors: Leis B , Akhtar J , Whelan K , Graham B , Hunter G
Published: January 2022

Background: Canadian Stroke Best Practice
Recommendations recommend both cardiac monitoring and transthoracic
echocardiography (TTE) to assess for cardioembolic sources of stroke. TTE
has a diagnostic yield which is historically low at 5-10%. The goal of this
project was to evaluate the practicality of a bedside, focused approach to
TTE in ischemic stroke. Methods: This is a
cross-sectional study evaluating patients undergoing echocardiography for
evidence of possible cardioembolic stroke. It compared the standard and
focused TTE imaging approaches. Of the 61 patients reported, data is
currently available for 15 participants. Independent samples t-test were
performed to compare measurements. Results: Mean time
to finish image acquisition for the focused TTE was significantly shorter
than the complete TTE (12 min or less vs 30 min or more) (p<0.0001). No
cardiac sources of stroke were found by either mechanism in this cohort,
representing 100% agreement between the two modalities.
Conclusions: Focused echocardiography studies are
quicker to execute and employ more affordable, portable, digital TTE
devices. The test is done at bedside, reducing the need for patient
transport. Image acquisition takes approximately half the time to obtain.
This potentially allows for more rapid clinical decision making and can
facilitate discharge from the hospital.
P.074 Management, timing of anticoagulation and outcomes of patients with
cerebral venous sinus thrombosis: a single centre chart review
Authors: Mak G , Chan N , Perera K
Published: January 2022

Background: Cerebral venous sinus thrombosis
(CVST) accounts for <1% of all strokes. Our objectives were to describe
the clinical features and examine the association between timing of
anticoagulation therapy and outcomes in CVST patients.
Methods: We conducted a retrospective chart
review of patients admitted to Hamilton Health Sciences from 2015 – 2020
with imaging confirmed CVST. Results: We included 96
patients, mean age of 47.9 (SD 18.1). The most common clinical presentation
was headache (43.8%). Brain trauma was the most common identified risk
factor (15.6%), while 27% of individuals had no identified cause. Most
patients (57.3%) received anticoagulation within 24hrs of identified CVST,
while 26% had a delay (≥48hrs) and 16.7% were not anti-coagulated. The
rationale for delaying or not starting anticoagulation included traumatic
brain injury (31.8%), neurosurgical procedure (9.1%), presence of venous
infarct and/or haemorrhage (27.1%) and unclear rationale (31.8%). At a
median of 8 days, more patients without clear indications for delayed or no
anticoagulation were disabled (defined by modified Rankin Scale, mRS, score
≥ 2) or dead (mRS 6), compared to those anti-coagulated in 24hrs (87.5%
versus 31.8%; RR 2.75; 95% CI 1.74 – 4.35).
Conclusions: Unjustified delay in anticoagulation
may result in poorer clinical outcomes in CVST patients.
P.075 Incidence of Stroke Associated With Antithrombotic Agent
Interruption
Authors: Snyder HE , Cao A , Rana R , Li L , Masood F
Published: January 2022

Background: Antithrombotic medications are used
in the primary and secondary prevention of ischemic stroke. Previous studies
have identified that up to 5.2% of ischemic strokes are associated with
antithrombotic interruption, leading to significant mortality and healthcare
burden. Our study aims to identify the prevalence of ischemic strokes
presenting to a regional stroke centre associated with antithrombotic
interruption, and to understand common reasons for medication interruption.
Methods: A retrospective chart review was
performed, which included 193 patients with ischemic stroke presenting to
Greater Niagara General Hospital from January 2018-December 2019. Baseline
demographics were recorded and patient medical records were reviewed for
evidence of antithrombotic interruptions. Results:
Table 1. Conclusions: Our cohort identified a
significant proportion (8.3%) of ischemic strokes with documented
antithrombotic interruption. Most common reasons for interruption were
non-adherence and discontinuation due to previous adverse event. The results
identify possible areas for improvement within patient education and safe
re-initiation of antithrombotics following adverse events.
P.080 Cognitive Profile, Disease Characteristics, and Neuroimaging
Findings in Susac Syndrome: A Case Series of Seven Participants from British
Columbia
Authors: Chivukula P , Chan J , Johnson P , Bower G , Li D , Lee J , Vavasour I , Traboulsee A , Laule C , Kolind S , Woolfenden A , Carruthers R
Published: January 2022

Background: Susac Syndrome (SuS) is a rare
autoimmune disorder of the cerebral, retinal, and inner ear
microvasculature. One of the cardinal manifestations of central nervous
system (CNS) involvement is encephalopathy, however the cognitive profile in
SuS is poorly characterized in the literature.
Methods: In this cross-sectional case series of
seven participants diagnosed with Susac Syndrome in remission in British
Columbia, we use a battery of neuropsychological testing, subjective disease
scores, and objective markers of disease severity to characterize the
affected cognitive domains and determine if any disease characteristics
predict neuropsychological performance. We also compare this battery of
tests to neuroimaging markers to determine if correlation exists between
radiographic markers of CNS disease and clinical evaluation of disease
severity. Results: There were a variety of cognitive
deficits, with memory and language dysfunction being the most common.
Despite the variability, performance on some neuropsychological tests (MoCA)
correlated to markers of functional disability (EDSS). Additionally, MoCA
and EDSS scores correlated with neuroimaging findings of both corpus
callosum and white matter changes. Finally, psychiatric scores correlated
with participant reported scores of disease severity.
Conclusions: There is a relationship between
cognitive deficits, subjective and objective disease disability, and
neuroimaging findings in Susac Syndrome.
P.081 Epidemiology of Neurological and Cardiac Complications of COVID-19
among Ontario Visible Minorities: A Retrospective Study of Chinese and South
Asian Canadians
Authors: Chu JY , Chen R , Chow C , Ko D , Liu P , Moe G , Koh M , Kaliwal Y
Published: January 2022

Background: This is a population-based
retrospective study of neurological and cardiac complications of COVID-19
among Ontario visible minorities: Chinese and South Asian Canadians
Methods: From January 1, 2020 to September 30,
2020, using the last name algorithm, rates and types of cardiac and
neurological complication of these two cohorts along with the general
population in Ontario with COVID-19 were analysed by Institue of Clinical
Evaluative Sciences. Results: Preliminary results
show that Chinese-Canadians (N= 1,186) with COVID-19 are older with a mean
age of 50.74 years old compared to general population (N= 42,547) of 47.57
years old (P< .001), while South Asians (N= 3,459) have a younger mean
age of 42.08 years old (P< .001). Total cardiac and neurological
complication rates, hospitalization rates and ICU admission rates are all
higher for Chinese-Canadians while they are lower in South Asians and all
achieving statistical significance (P < .001). Overall mortality rate is
significantly higher for Chinese-Canadians at 8.1% vs 5.0% general
population (P < .001). Conclusions:
Chinese-Canadians with COVID-19 in Ontario were much older and have higher
cardiac and neurological complication rates and overall mortality rate than
the general population. These data have significant implications for proper
prevention and appropriate management for these vulnerble elderly
Chinese-Canadians.
P.221 Frailty is an Important Predictor of 30-day Morbidity in Patients
Treated for Lumbar Spondylolisthesis Using a Posterior Surgical
Approach
Authors: Chan V , Witiw C , Wilson J , Fehlings MG
Published: January 2022

Background: A non-operative approach has been
favoured for elderly patients with lumbar spondylolisthesis due to a
perceived higher risk with surgery. However, most studies have used an
arbitrary age cut-off to define “elderly.” We hypothesized that frailty is
an independent predictor of morbidity after surgery for lumbar
spondylolisthesis. Methods: The American College of
Surgeons National Surgical Quality Improvement Program (NSQIP) database for
years 2010 to 2018 was used. Patients who received posterior lumbar spine
decompression with or without posterior fusion instrumented fusion for
degenerative lumbar spondylolisthesis were included. The primary outcome was
major complication. Secondary outcomes were readmission, reoperation, and
discharge to location other than home. Logistic regression analysis was done
to investigate the association between outcomes and frailty.
Results: There were 15 658 patients in this
study. The mean age was 62.5 years (SD 12.2). Frailty, as measured by the
Modified Frailty Index-5 was significantly associated with increased risk of
major complication, unplanned readmission, reoperation, and non-home
discharge. Increasing frailty was associated with increasing risk of
morbidity. Conclusions: Frailty is independently
associated with higher risk of morbidity after posterior surgery in patients
with lumbar spondylolisthesis. These data are of significance to clinicians
in planning treatment for these patients.
P.096 Optimizing the Use of Continuous EEG Monitoring in Neonatal
Encephalopathy
Authors: Din F , MacFarland S , Wilson D , Hahn CD
Published: January 2022

Background: Newborns with hypoxic-ischemic
encephalopathy (HIE) are at high risk for seizures, the majority of which
have no clinical signs and therefore require continuous
electroencephalographic (cEEG) monitoring for their detection. We sought to
determine which neonates are at highest risk for seizures in order to
optimize allocation of scarce cEEG resources.
Methods: We identified term neonates diagnosed
with HIE who underwent at least 24 hours of protocol-based cEEG monitoring
between 2016 and 2019. We quantified seizure incidence, timing and burden,
and correlated these with potential risk factors such as HIE severity, use
of therapeutic hypothermia, preceding suspected clinical seizures,
amplitude-integrated EEG (aEEG) background and patterns suspicious for
seizures, and use of anti-seizure drugs. Results:
cEEG monitoring was completed in 218 neonates with HIE, of whom 164 (75%)
underwent therapeutic hypothermia. Preceding clinical/aEEG seizures occurred
in 147 (67%), 99 (67%) of whom had been cooled but only 22 (10%) had
cEEG-confirmed seizures. Characterization of seizure burden and correlation
with potential risk factors is ongoing. Conclusions:
Although seizures are commonly suspected in neonates with HIE, they are
infrequently confirmed during cEEG monitoring, creating opportunities for
more efficient risk-based allocation of cEEG resources.
P.097 Adrenal Insufficiency among Children treated with Hormonal Therapy
for Infantile Spasms
Authors: Doré-Brabant G , Laflamme G , Millette M , Osterman B , Chrestian N
Published: January 2022

Background: Hormonal therapy is a standard
treatment for infantile spasms. The high doses given and long treatment
duration expose patients to the risk of adrenal insufficiency (AI). This
study aims to quantify the incidence of AI among children with infantile
spasms treated with corticosteroids and/or adrenocorticotropic hormone
(ACTH). Methods: A retrospective chart review of
patients treated for infantile spasms was performed between January 2009 to
March 2020 in one pediatric specialized hospital. Variables collected
included patient and treatment characteristics, risk factors of AI and
adrenal function testing. Analysis included descriptive statistics.
Results: Thirty-one patients met the inclusion
criteria and received a total of 33 separated courses of treatment. Adrenal
function following each course of treatment was evaluated in all patients.
AI occurred in 25/33 (76% [95CI 58-89]) children. There was no predictive
factor of AI. No drug regimen was deemed safe. The two patients (6%) with an
acute adrenal crisis were the youngest of the cohort.
Conclusions: Adrenal suppression is frequent and
can lead to adrenal crisis after standard hormonal therapy for infantile
spasms. A routine laboratory assessment of adrenal function should be done
for all patients. Hydrocortisone replacement therapy should be given until
testing results are obtained, particularly for younger infants.
P.102 Childhood Absence Epilepsy: Prevalence of treatment resistance and
neuropsychiatric comorbidity.
Authors: Lagacé M , Nicholas A , Connolly M
Published: January 2022

Background: Seizures in childhood absence
epilepsy (CAE) are usually easily controlled with anti-seizure medications
(ASMs). Factors predictive of treatment resistance remain unclear. Our
objectives were to assess prevalence of neuropsychiatric problems and
factors influencing refractoriness in a cohort of CAE at a single centre.
Methods: We retrospectively reviewed patients
with CAE (ILAE 2017 classification) diagnosed between January 1999 and
December 2016 with at least 1-year follow-up. Treatment resistance was
defined as failure to respond to two or more appropriate ASMs. Exclusion
criteria included eyelid myoclonia with absence, myoclonic absence, and
generalized tonic-clonic (GTC) seizure before developing absences.
Results: The study population comprised 164
patients (65 males) 6.25-year-old on average at absence onset. 22% had
treatment-resistant seizures. The first ASM was Ethosuximide in 63.4%,
Valproic acid in 23.2%, and Lamotrigine in 6.7%. Statistical differences
between response groups included developing a second seizure type
specifically GTC, the second and third ASM, and absence of EEG
normalization. At last follow-up, 43.3% of children were seizure-free off
ASMs. 32.9% of children had learning disabilities, 28% ADHD, and 12.8 %
anxiety. Conclusions: 22% of children with CAE had
treatment-resistant seizures. Photoparoxysmal response was not predictive of
treatment resistance. Neuropsychiatric problems were common with learning
disabilities increased with refractory absences.
P.103 Midline Spikes and Intractable Seizures in Pediatric
Epilepsy
Authors: Luan K , Mailo J , Liu N , Kassiri J , Sinclair DB
Published: January 2022

Background: Epileptic discharges localized to the
midline vertex are rare. However, they have been associated with intractable
seizures and severe long-term consequences in the developing brain. Our
study aimed to understand the etiology of pediatric midline seizures and
define post-surgical seizure outcomes. Methods: We
reviewed charts, electroencephalography (EEG), and neuroimaging studies of
ten pediatric patients with epileptic discharges localized to the midline
vertex in the Comprehensive Epilepsy Program. The seizures were classified
according to the International League Against Epilepsy criteria, patient
age, sex, neuroimaging results, seizure etiology and outcomes were obtained.
Results: Age of seizure onset was within the
first 10 years of life in 90% of patients, with focal seizures being the
most prevalent. Focal cortical dysplasia (FCD) was the most common etiology
present in 50% of patients. These children had normal neuroimaging studies
and intractable epilepsy. However, seizure freedom was achieved following
surgical resection of the epileptogenic zone.
Conclusions: We demonstrated that patients with
midline epileptic discharges are associated with intractable focal seizures
and early seizure onset. Despite normal neuroimaging reports, FCD was the
most common pathology. Thus our study suggests early localization and
resection of the epileptogenic zone may be beneficial for achieving seizure
freedom in children with this electroclinical syndrome.
P.121 Leading the Way to the Future: Implementing Novel Therapeutics for
Rare Pediatric Neurological Disorders
Authors: Nigro E , Law E
Published: January 2022

Background: Children and Adolescents with rare
neurogenetic disorders often have no known cure or disease modifying
treatments. Recent advancements in treatments are offering much needed hope
to these patients and families. However, these treatments are extremely
costly, have complex administration requirements and have many unknown
long-term risks and outcomes. Methods: In this
presentation, we will discuss our experiences with the implementation
process, including developing intricate care pathways, collaborating with
multiple disciplines and services, supporting and advocating for our
patients and families, and interacting with government agencies and
pharmaceutical companies. Case studies will highlight the positive impact
these treatments are making on the lives of children and adolescents with
rare neurological disorders. Results: Spinal muscular
atrophy and Neuronal Ceroid Lipofuscinosis Type 2 are both rare and
devastating neurodegenerative conditions with significant morbidity and
mortality. Health Canada and government funding agencies recently approved
Nusinersen, Onasemnogene abeparvovec for the treatment of SMA and
Cerliponase alfa for the treatment of CLN2, leading us to swiftly integrate
these treatments into our standard of care.
Conclusions: While implementing these novel
therapies into clinical practice can be both challenging and rewarding,
neuroscience nurses are positioned at the forefront to be leaders in this
process at both organizational, national, and international levels.
P.127 Ultra-high field 7-Tesla magnetic resonance imaging and
electroencephalography findings in epilepsy
Authors: Salehi F , Kwan BY , Mirsattari SM , Lee DH , Burneo JG , Steven D , Hammond R , Peters TM , Khan AR
Published: January 2022

Background: Assessment of patients for temporal
lobe epilepsy (TLE) surgery requires multimodality input, including EEG to
ensure optimal surgical planning. Often EEG demonstrates abnormal foci not
detected on clinical MRI. 7T MRI provides improved resolution and we
investigated its utility to detect potential abnormalities associated with
EEG. Methods: Images were acquired on 7T MRI scanner
(N=13) in oatients with TLE. Evaluation of 7T imaging for focal
abnormalities was performed. Correlation of 7T MRI findings with EEG of
focal slowing or interictal epileptic spikes (IEDs) and seizures was
performed. Results: Assessment of 7T MRI demonstrated
concordance with TLE in 8/13 cases. Three cases exhibited abnormal 7T MRI
abnormalities not detected by 1.5 T MRI. Eleven out of 13 cases had EEG
findings without anatomic correlates on MRI, with IEDs localizing to
contralateral temporal, frontal, and parieto-occipital lobes. 7T images did
not reveal focal anatomical abnormalities to account for the EEG findings in
these patients. Conclusions: To our knowledge, this
is the first study to investigate the role of 7T MRI in relation to EEG
abnormalities. 7T RI findings show concordance with clinical data. 7T MRI
did not reveal anatomical findings to account for EEG abnormalities,
suggesting that such changes may be functional rather than
anatomical.
P.129 Bi-insular Responsive Neurostimulation Artifact on Scalp
Electroencephalogram
Authors: Paredes-Aragón EM , Chávez-Castillo M , Barkley GL , Burneo JG , Suller-Martí A
Published: January 2022

Background: Background: Responsive
Neurostimulation (RNS) has proven efficacy in treating medically resistant
epilepsy as an intracranial system detecting, recording and treating
seizures automatically. No information exists pertaining to artifact
characteristics of RNS findings in scalp EEG.
Methods: A 30 year-old female was diagnosed using
intracranial electroencephalography(iEEG), with bi-insular epilepsy, of
unknown cause. She presented large number of focal unaware non-motor
seizures and seizures with progression to bilateral tonic-clonic. She was
implanted with bi-insular RNS. Results: During scalp
EEG recordings, a prominent artifact was seen corresponding to an
automatized discharge suspectedly evoked by the RNS trying to minimize the
frequent epileptiform activity in her case. Figure 1 and 2 depict these
findings. Conclusions: Artifact seen by the RNS in
scalp EEG has not been previously described in scientific literature. These
findings must be identified to better characterize the role of the RNS in
EEG and treatment of seizure activity visible on scalp recordings.
P.133 ‘Building Your Neurology Acumen’: a flipped classroom approach to
strengthen Internal Medicine residents’ neurological skills
Authors: Zaeem Z , Smyth P , Daniels V
Published: January 2022

Background: Rotating internal medicine (IM)
residents do not feel adequately prepared to approach patients with
neurologic issues. The purpose of this project was to conduct a needs
assessment to determine the optimal components and delivery of a neurology
curriculum for internal medicine residents. Methods:
We utilized a mixed-methods design and recruited participants through a
combination of purposive and convenience sampling. We conducted interviews
with IM residents (n=12) and focus groups with neurology residents (n=7) and
neurology staff (n=8). IM residents completed entry- and post-call surveys
while on a neurology rotation. Results: Themes
according to Kern’s framework for curriculum development: 1. Problem:
Discomfort and perception of under-preparedness amongst IM trainees 2. Needs
Assessment: What the learners (stakeholders) think they need to know vs.
what their teachers want them to know vs external requirements (Royal
College) 3. Goals/objectives: What content is relevant for clinical
requirements vs assessments? 4. Methods and setting: Didactic vs bedside vs
virtual 5. Implementation of the curriculum 6. Evaluation and feedback
Conclusions: Our findings illustrate a possible
mismatch between internal medicine residents’ needs and neurologist
teachers’ expectations in teaching neurology. Addressing learners’ needs
could enhance neurology knowledge and sense of preparedness when
encountering patients with neurologic issues.
P.149 Spinal Cord Stimulation for Refractory Angina
Authors: Osborn J , Sahjpaul R , Varshney V
Published: January 2022

Background: Refractory angina is defined as a
chronic condition characterized by the presence of angina due to coronary
insufficiency which cannot be controlled by a combination of medical
therapy, angioplasty and coronary bypass surgery. Prevalence in the United
States is estimated to be between 300,000-900,000. Spinal cord stimulation
for refractory angina pain relief was first described in 1987 but is still
not widely used in North America. We report our experience with this
treatment. Methods: A retrospective review of
patients referred to the St Pauls Hospital neuromodulation program for
consideration of SCS for refractory angina was conducted. Patients underwent
implantation using a either a two stage approach (percutaneous or permanent
lead trial followed by full system implantation) or full system
implantation. Results: Bewtween 2004-2020 36 patients
underwent full system implantation (2 patients failed the trial and were not
implanted). Of the 36 patients undergoing full system implantation, 33 (92%)
experienced significant reduction of angina, increased exercise tolerance
and/or medication reduction and were considered successful implantation.
Most common lead placement location was at C7 T1.
Conclusions: Spinal cord stimulation is an
effective therapy for patients suffering from crippling angina pain despite
medical optimization.
P.163 Predictors of survival in elderly patients undergoing surgery for
GBM
Authors: Voisin MR , Sasikumar S , Zadeh G
Published: January 2022

Background: An increasing number of elderly
patients are being diagnosed with GBM and undergoing surgery. These patients
often present with multiple medical comorbidities and have significantly
worse outcomes compared to adult patients. The goal of this study was to
determine clinical predictors of survival in elderly patients undergoing
surgery for GBM. Methods: A retrospective chart
review of all consecutive patients 65 years of age and older that underwent
surgery for newly diagnosed GBM from 2005-2018 was performed. A total of 150
patients were included, and subdivided into two age categories; 65-74 and 75
or older. Results: Advanced age and medical
comorbidities were not associated with decreased survival (p = 0.07 and p =
0.09, respectively). Postoperative complication was associated with worse
survival for all patients (HR = 2.34, p = 0.01) and occurred in patients
with longer lengths of stay (p < 0.0001) and discharge destination other
than home (p = 0.001). Conclusions: The presence of
medical comorbidities and advanced age are not reasons to exclude patients
with GBM from surgical consideration. Postoperative complication is the most
significant predictor of survival in elderly patients and can be avoided by
a short length of stay and discharge home.
P.167 Application of the Anatomical Fiducials Framework to a Clinical
Dataset of Patients with Parkinson’s Disease
Authors: Abbass M , Gilmore G , Taha A , Chevalier R , Jach M , Peters TM , Khan AR , Lau JC
Published: January 2022

Background: Establishing spatial correspondence
between subject and template images is necessary in neuroimaging research
and clinical applications. A point-based set of anatomical fiducials (AFIDs)
was recently developed and validated to provide quantitative measures of
image registration. We applied the AFIDs protocol to magnetic resonance
images (MRIs) obtained from patients with Parkinson’s Disease (PD).
Methods: Two expert and three novice raters
placed AFIDs on MRIs of 39 PD patients. Localization and registration errors
were calculated. To investigate for unique morphometric features, pairwise
distances between AFIDs were calculated and compared to 30 controls who
previously had AFIDs placed. Wilcoxon rank-sum tests with Bonferroni
corrections were used. Results: 6240 AFIDs were
placed with a mean localization error (±SD) of 1.57mm±1.16mm and mean
registration error of 3.34mm±1.94mm. Out of the 496 pairwise distances, 40
were statistically significant (p<0.05/496). PD patients had a decreased
pairwise distance between the left temporal horn, brainstem and pineal
gland. Conclusions: AFIDs can be successfully applied
with millimetric accuracy in a clinical setting and utilized to provide
localized and quantitative measures of registration error. AFIDs provide
clinicians and researchers with a common, open framework for quality control
and validation of spatial correspondence, facilitating accurate aggregation
of imaging datasets and comparisons between various neurological
conditions.
P.223 Correlating the pre- and post-operative subjective experience of
myelopathic impairments with the objective clinical exam
Authors: Friesen AC , Detombe SA , Doyle-Pettypiece P , Ng W , Gurr K , Bailey C , Rasoulinejad P , Siddiqi F , Bartha R , Duggal N
Published: January 2022

Background: Degenerative cervical myelopathy is a
debilitating condition of the spinal column resulting in a progressive,
clinically measurable loss of motor and sensory function secondary to spinal
cord compression. We sought to correlate the patient’s subjective experience
of specific myelopathic impairments with components of the objective
clinical exam, to determine if the latter provides any clinically-relevant
information postoperatively. Methods: Thirty-eight
myelopathy patients consented to complete the mJOA questionnaire and receive
a physical exam preoperatively, and 6-weeks and 6-months postoperatively.
mJOA components were correlated with the physical exam using Spearman
correlations with an alpha of 0.05. Results: mJOA
scores for sensation and lower limb motor function correlated with the
sensory and lower limb motor exams respectively, both preoperatively and
6-weeks postoperatively. mJOA scores for upper limb motor function did not
correlate with the upper limb motor exam at either timepoint.
Conclusions: At baseline and immediately
postoperatively, patients self-report sensation and lower limb motor
function accurately. However, the patients’ subjective experience of upper
limb motor function does not align with clinical exam findings, suggesting
either a continued need for this component of the physical exam or a need
for tools that better correlate with the patient’s experience of upper limb
motor impairment.
P.175 Direct Visualization of Thalamic Nuclei using 7 Tesla MRI and
quantification in patients with temporal lobe epilepsy.
Authors: Santyr B , Lau JC , Khan AR
Published: January 2022

Background: Most individual thalamic nuclei
cannot be directly visualized on routine clinical MRI. Stereotactic
targeting techniques are indirect, relying on histological atlases and
electrophysiological recording. We investigate whether high-field MRI can
directly visualize the thalamic nuclei in vivo and allow for analysis of
disease-related changes. Methods: Thirty-two healthy
individuals were imaged with 7T MRI at a resolution of
0.7mm3. To obtain a high-resolution composite
image, these were registered across subjects and averaged together. Three
thalamic structures closely integrated in seizure propagation, the anterior
thalamic nucleus (ATN), mammillothalamic tract (MTT), and centromedian
nucleus (CM) were manually segmented in a subset of healthy subjects and
patients with temporal lobe epilepsy (TLE). Results:
There is sufficient resolution within the thalamus at 7T for visualization
of the ATN, CM, and MTT. In the small subset of 5 controls and 5 TLE
patients examined, there was no significant difference (p>0.05) in volume
or mean T1map for the three thalamic sturctures of interest.
Conclusions: MRI at 7T provides a method of
direct visualization of thalamic nuclei, uncovering substructures not
previously identifiable in vivo. These advances will enable quantitative
analysis of disease-related changes to these structures and improved
clinical targeting as demonstrated in this initial ‘proof-of-concept’ subset
analysis.