Neurology Corner tag:blog.lib.umn.edu,2011-09-09:/jbkoffel/neurology//14266 2012-02-03T15:20:10Z Jonathan Koffel, jbkoffel@umn.edu, 612-626-5454 Movable Type Enterprise 4.31-en Seizure vs. Syncope tag:blog.lib.umn.edu,2012:/jbkoffel/neurology//14266.336611 2012-02-03T15:14:09Z 2012-02-03T15:20:10Z In response to a request for an overview of differentiating seizure and syncope, I found the following nice review from Lancet Neurology, 5(2) 171-180. ">Seizure versus Syncope There are many articles available. One place to start a search is to... jbkoffel In response to a request for an overview of differentiating seizure and syncope, I found the following nice review from Lancet Neurology, 5(2) 171-180.

Seizure versus Syncope

There are many articles available. One place to start a search is to enter (seizures[mesh] syncope[mesh] differential diagnosis[mesh]) into PubMed. You can broaden the search by removing the ddx portion.

]]> MedlinePlus tag:blog.lib.umn.edu,2012:/jbkoffel/neurology//14266.334947 2012-01-25T20:55:25Z 2012-01-25T21:03:51Z MedlinePlus is one of the best sources for consumer health information on the web. Created by the National Library of Medicine, it provides short summaries on a wide range of conditions and then links out to high quality information created... jbkoffel MedlinePlus is one of the best sources for consumer health information on the web.

Created by the National Library of Medicine, it provides short summaries on a wide range of conditions and then links out to high quality information created by non-profits, government groups, and other organizations. They also include links to information in other languages when possible. A Spanish version of the site is also available.

MedlinePlus also includes drug and supplement information, news alerts, and anatomy and surgery videos.

]]> PatientsLikeMe tag:blog.lib.umn.edu,2012:/jbkoffel/neurology//14266.334938 2012-01-25T20:41:12Z 2012-01-25T20:54:34Z PatientsLikeMe is a site that lets patients with a wide range of conditions record their symptoms, medications (and adverse effects), and disease progression and talk to other people with the same condition and share information. Membership is free and is... jbkoffel PatientsLikeMe is a site that lets patients with a wide range of conditions record their symptoms, medications (and adverse effects), and disease progression and talk to other people with the same condition and share information. Membership is free and is also open to physicians, though you have to promise not to survey or recruit patients through the service.

I think this is a fascinating tool and, from the researcher standpoint, one that provides a novel way to gather information on disease progression, symptom prevalence, treatment effectiveness, and drug adverse effects. From a patient standpoint, I think it would be good to talk others, see what has worked for them and what hasn't, and develop a sense of community.

So here is the wrinkle. PatientsLikeMe is very open that they sell their data, it is how they get funded. So before using it or recommending it, I would make sure to read the privacy policy and understand what they do with the data.

]]> Hashimoto Encephalopathy tag:blog.lib.umn.edu,2012:/jbkoffel/neurology//14266.332178 2012-01-20T19:24:24Z 2012-01-20T21:11:33Z There was recently a patient on rounds with suspected Hashimotos encephalopathy, but the team had questions about diagnostic criteria. I pulled a few articles and wanted to share them: Hashimoto's Encephalopathy 2008 - nice review article which focuses on diagnosis... jbkoffel There was recently a patient on rounds with suspected Hashimotos encephalopathy, but the team had questions about diagnostic criteria. I pulled a few articles and wanted to share them:

Hashimoto's Encephalopathy 2008 - nice review article which focuses on diagnosis (and specifically relevant auto-antibodies)
Hashimoto's Encephalopathy: Systematic Review of the Literature and an Additional Case 2011 - case report and systematic review which includes summary of symptoms associated with HE
High prevalence of serum autoantibodies against the amino terminal of alpha-enolase in Hashimoto's encephalopathy 2007 - discusses the use alpha-enolase autoantibodies in diagnosing HE. While there there have not been many studies, they appear to have good sensitivity and specificity.

]]> Neurological manifestations of Sjögren's tag:blog.lib.umn.edu,2012:/jbkoffel/neurology//14266.332137 2012-01-20T18:34:55Z 2012-01-20T19:19:40Z There was a question this morning about what the various neurological manifestations of Sjögren's Syndrome are. Here are a few overviews of neurologic symptoms: Neurological manifestations of primary Sjogren's syndrome 2010 Involvement of nervous system pathways in primary Sjögren's syndrome... jbkoffel There was a question this morning about what the various neurological manifestations of Sjögren's Syndrome are.

Here are a few overviews of neurologic symptoms:
Neurological manifestations of primary Sjogren's syndrome 2010
Involvement of nervous system pathways in primary Sjögren's syndrome 2008 (Dr. Walk is co-author)
Peripheral neuropathies in Sjogren syndrome: a new reappraisal 2011

If you want to search further, here are some searches to get you started:
High specificity search
Lower specificity search

]]> Neurological Exam Videos tag:blog.lib.umn.edu,2012:/jbkoffel/neurology//14266.328737 2012-01-06T01:18:02Z 2012-01-06T01:20:57Z Here are a few videos from AccessMedicine (primarily Harrison's) that cover neuro-ophthalmology and the neurological exam. Let me know if there are any other sources for exam videos that you like.... jbkoffel Here are a few videos from AccessMedicine (primarily Harrison's) that cover neuro-ophthalmology and the neurological exam.

Let me know if there are any other sources for exam videos that you like.

]]> Getting full text when browsing tag:blog.lib.umn.edu,2011:/jbkoffel/neurology//14266.327817 2011-12-19T18:55:28Z 2011-12-19T19:06:31Z While the best way to get to full-text of articles is to use our special link to PubMed or find the journal in our ejournal list, it is often easier just to Google the journal. If you are on-campus (ie.... jbkoffel While the best way to get to full-text of articles is to use our special link to PubMed or find the journal in our ejournal list, it is often easier just to Google the journal. If you are on-campus (ie. PWB) a lot of journal websites will recognize that and automatically give you access to full-text. From off-campus, though, this does not work.

If you have browsed to a journal and want to get to the full-text, try using our proxy bookmarklet. It will not work for all journals (some we buy from non-publisher sources), but it should work for many.

]]> Neurology iPad Apps tag:blog.lib.umn.edu,2011:/jbkoffel/neurology//14266.327521 2011-12-15T14:22:12Z 2011-12-15T14:56:06Z For those of you with iPads, I wanted to point out that you can read both Neurology and Neurology Clinical Practice (new journal from AAN) on your iPad. Just download the following apps and enter in your AAN credentials to... jbkoffel For those of you with iPads, I wanted to point out that you can read both Neurology and Neurology Clinical Practice (new journal from AAN) on your iPad. Just download the following apps and enter in your AAN credentials to get full access.

Neurology
Neurology Clinical Practice

You can download the full text of each journal (and can read it without an internet connection), easily access supplemental materials, post comments on articles, and even email, tweet, or post to Facebook about the articles.

They hope to add more videos and additional content in the future. All in all, it is pretty slick.

]]> Stiff Person Syndrome tag:blog.lib.umn.edu,2011:/jbkoffel/neurology//14266.327001 2011-12-09T17:06:47Z 2011-12-09T18:27:16Z Stiff person syndrome is a rare (estimated 1-2 cases per million) disorder, "characterized by progressive muscle stiffness, rigidity, and spasm involving the axial muscles, resulting in severely impaired ambulation." ("Stiff person syndrome," UpToDate) 60-80% of patients have autoantibodies against glutamic... jbkoffel Stiff person syndrome is a rare (estimated 1-2 cases per million) disorder, "characterized by progressive muscle stiffness, rigidity, and spasm involving the axial muscles, resulting in severely impaired ambulation." ("Stiff person syndrome," UpToDate)

60-80% of patients have autoantibodies against glutamic acid decarboxylase (GAD), though amphiphysin and gephyrin autoantibodies may also be present in the paraneoplastic variant.

A recent and concise review (with images, differential, and treatment) can be found at Stiff Person Syndrome.

Two additional case reports (with MRI and photographs respectively), can be found at:
Sudden spasms following gradual lordosis--the stiff-person syndrome
Stiff person syndrome presenting with sudden onset of shortness of breath and difficulty moving the right arm: a case report

]]> SMART Syndrome tag:blog.lib.umn.edu,2011:/jbkoffel/neurology//14266.321546 2011-11-11T15:58:42Z 2011-11-11T16:49:12Z There was a question last week about SMART Syndrome and potential therapies. While there have not been any experimentally tested treatments, in most of the case reports, patients are treated (if treatment is reported) with anti-epileptics. I have included a... jbkoffel There was a question last week about SMART Syndrome and potential therapies. While there have not been any experimentally tested treatments, in most of the case reports, patients are treated (if treatment is reported) with anti-epileptics. I have included a few of the more recent studies below, though there are also additional reports (cited in the below documents) from before the syndrome was proposed in 2003.

SMART syndrome: a late reversible complication after radiation therapy for brain tumours
SMART syndrome involves transient, reversible neurological dysfunction which may include migrainous headache, at times preceded by aura, prolonged hemispheric neurological impairment and sometimes seizure activity. Neuroimaging studies of patients with SMART syndrome typically show focal gyral thickening of the affected cortex and gyriform contrast enhancement.

Neurocognitive recovery in SMART syndrome: a case report

SMART: stroke-like migraine attacks after radiation therapy
Proposed diagnostic criteria:
SMART Criteria.jpg

Reversible, strokelike migraine attacks in patients with previous radiation therapy
Original article that first proposed the syndrome

]]> Quetiapine (Seroquel) for psychosis in PD tag:blog.lib.umn.edu,2011:/jbkoffel/neurology//14266.318300 2011-10-28T19:00:57Z 2011-10-28T19:46:38Z I was doing some searching about drug therapy for psychosis in Parkinson's today and came across a few articles which demonstrate the complicated balancing act between evidence and practice. First, in the article Patterns and trends in antipsychotic prescribing for... jbkoffel I was doing some searching about drug therapy for psychosis in Parkinson's today and came across a few articles which demonstrate the complicated balancing act between evidence and practice.

First, in the article Patterns and trends in antipsychotic prescribing for Parkinson disease psychosis, it is reported that 66% of studied PD patients with psychosis seen between 2002 and 2008 were prescribed quetiapine and 2% received clozapine (the additional 30% were represented mainly by risperidone (17%), aripiprazole (12%), and olanzapine (11%)). Quetiapine is clearly the most prescribed antipsychotic for this population and clozapine the least, even though clozapine has been shown to be clearly effective (albeit the need for monitoring makes it less attractive).

As pointed out in that article, and in greater detail in the review Quetiapine in the treatment of psychosis in Parkinson's disease, the evidence for quetiapine's efficacy is mixed. Unblinded studies found it to be effective, it compared similarly to clozapine (though was less effective), yet 4/5 placebo controlled trials did not show a significant difference between it and placebo. Larger and better designed RCTs are needed to determine its true effectiveness. Despite the the mixed evidence, it may provide the best balance of safety, convenience, and efficacy.

Finally, I just wanted to point out the article Pimavanserin, a Serotonin2A Receptor Inverse Agonist, for the Treatment of Parkinson's Disease Psychosis. Pimavanserin is currently in phase III trials (no locations in Minnesota) and the study shows significant improvements over placebo in some measures, trends for other measures, and no significant differences for adverse effects. It seems like a good drug to keep an eye on.

]]> Neurological manifestations of Henoch-Schönlein purpura tag:blog.lib.umn.edu,2011:/jbkoffel/neurology//14266.316481 2011-10-22T01:42:26Z 2011-10-22T02:05:38Z While there are numerous case reports out there talking about specific manifestations, I was only able to find two reviews that attempted to pull them together. Nervous system dysfunction in Henoch-Schonlein syndrome: systematic review of the literature While this review... jbkoffel While there are numerous case reports out there talking about specific manifestations, I was only able to find two reviews that attempted to pull them together.

Nervous system dysfunction in Henoch-Schonlein syndrome: systematic review of the literature
While this review is the more recent, I am not impressed by their search strategy and they missed some of the articles the much older review (below) caught.

Neurologic manifestations of Schoenlein-Henoch purpura: report of three cases and review of the literature

HSP 1.JPG
From Nervous system dysfunction in Henoch-Schonlein syndrome: systematic review of the literature

HSP2.JPG
From Neurologic manifestations of Schoenlein-Henoch purpura: report of three cases and review of the literature

]]> Posttransplantation Lymphoproliferative Disorder tag:blog.lib.umn.edu,2011:/jbkoffel/neurology//14266.316399 2011-10-21T19:41:47Z 2011-10-21T20:01:42Z PTLDs came up during rounds today. While there are many articles about PTLD, it can be hard to find ones specifically related to CNS complications, since these appear to be comparatively rare. Here are a few articles that I found.... jbkoffel PTLDs came up during rounds today. While there are many articles about PTLD, it can be hard to find ones specifically related to CNS complications, since these appear to be comparatively rare. Here are a few articles that I found.

Primary central nervous system post-transplantation lymphoproliferative disorder: an International Primary Central Nervous System Lymphoma Collaborative Group Report

Primary central nervous system posttransplant lymphoproliferative disorders

Posttransplant lymphoproliferative disorder: significance of central nervous system involvement

Posttransplant primary CNS lymphoma

]]> Online Books tag:blog.lib.umn.edu,2011:/jbkoffel/neurology//14266.316312 2011-10-21T14:18:15Z 2011-10-21T19:18:16Z The library subscribes to thousands of online biomedical textbooks. They can be somewhat hard to find, however, since they come from many different packages and lack a unified interface. Here are a few tips and tricks for finding them. As... jbkoffel The library subscribes to thousands of online biomedical textbooks. They can be somewhat hard to find, however, since they come from many different packages and lack a unified interface. Here are a few tips and tricks for finding them.

As a note, all ebooks are available from on or off campus using your university ID and password. Some books can only be read in your browser while others can be downloaded as PDFs (exact copy of what appeared in the print version). If you have questions about a particular book, please let me know.

We have a general listing of ebooks at http://hsl.lib.umn.edu/ebooks. This page only lists highlights in each specialty. There is a search box at the top of the page, but this also only searches a subset of available online books (we hope to fix this shortly). To find the full set of available books, you need to go to each ebook package and search within it. The packages are at the bottom of the page under "EBook Collections."

Here are some links to take you directly to the neurology books within each package:
Springer (green titles are available)
Wiley (unlocked titles are available)
R2 Library
Books@Ovid
ebrary

Selected neurology textbooks:
Adams and Victor's Principles of Neurology
Clinical Neurology
Clinical Neuroanatomy
Current Protocols in Neuroscience
Neurobiology of Disease (2007)
Neurology Board Review: An Illustrated Study Guide (2007)
Neurology in Clinical Practice

Please let me know if there are any other books you think should be added to the above listing.

]]> UpToDate via Smartphone tag:blog.lib.umn.edu,2011:/jbkoffel/neurology//14266.311196 2011-09-30T17:34:21Z 2011-09-30T17:44:35Z Fairview subscribes to UpToDate and with a few tweaks, you can access it from your iPhone or Android device. Here is what to do: 1. Turn on Wifi in your phone's settings. By default your smartphone may only be set... jbkoffel Fairview subscribes to UpToDate and with a few tweaks, you can access it from your iPhone or Android device. Here is what to do:

1. Turn on Wifi in your phone's settings. By default your smartphone may only be set to use a cellular connection, but we need to connect to the Fairview wireless network.
2. Connect to FV_WLAN1 using your Fairview username and password (same as you use to log into Epic). iPhone is pretty straightforward. Android will ask you to set a password for the connect (use whatever password you like) and then take you to the screen where you can enter your Fairview username and password.
3. Go to www.uptodate.com and you should be good to go.

As a reminder, all UMN resources (except UpToDate) can be accessed from anywhere using your UMN username and password (you will be prompted when you need to enter it).

We also have a number of mobile apps available. You can either look at the general list or the Neurology specific one I created.

You can always contact me with any questions that come up.

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