Notable in Neurology
This issue features an article that investigates the oral motor, speech, and language phenotype in Dravet syndrome associated with mutations in SCN1A and another that determines the prevalence of epileptic seizures in elderly nursing home residents. A featured article characterizes the temporal and spatial pattern of cerebral microbleeds after cranial irradiation in patients with medulloblastoma.
ARTICLES
Predictors of unintended pregnancy in women with epilepsy
Family planning is important for women with epilepsy (WWE) in order to prevent congenital malformations. This survey found that unintended pregnancy is common and varies by contraceptive category and antiepileptic drugs (AEDs) used. Given the interactions among hormones, seizures, and AEDs, neurologists have an important role in guideline development for safe and effective contraception.
See p. 728
From editorialists Meador and Lindhout: “Unintended pregnancies are common in WWE and may exceed the risk in the general population. Given their high risk for unintended pregnancies, WWE need to be informed of issues related to differential AED risks of teratogenesis when the AED is first prescribed rather than waiting until the woman is considering pregnancy.”
See p. 724
Natural course of mild cognitive impairment in Parkinson disease: A 5-year population-based study
This study evaluated patients with incident Parkinson disease (PD) over 5 years to investigate the course and outcome of baseline and incident mild cognitive impairment (MCI). Patients with PD-MCI, including those who reverted to normal cognition, had a high risk of dementia, suggesting that early PD-MCI has prognostic value.
See p. 767
Ischemic lesions, blood pressure dysregulation, and poor outcomes in intracerebral hemorrhage
Acute ischemic lesions are common in primary intracerebral hemorrhage and are associated with poor outcomes. The authors investigated the association between imaging findings and blood pressure fluctuations in patients with primary intracerebral hemorrhage. Aggressive blood pressure reductions may precipitate ischemia in patients with blood pressure dysregulation and lead to worse outcomes.
See p. 782
Burnout, career satisfaction, and well-being among US neurologists in 2016
Burnout compromises patient care by impairing physicians' well-being and contributing to workforce attrition. The authors' survey of US neurologists found that burnout was common in all practice settings and identified factors associated with burnout and career satisfaction. Optimizing workload and autonomy and decreasing regulatory and clerical burdens could mitigate neurologist burnout.
See p. 797
From editorialist Bernat: “The finding of Busis et al. that practicing neurologists have higher rates of burnout than academic neurologists may result from their greater clinical demands and less protection from market forces than their academic colleagues…The creation of means of greater professional recognition for practicing neurologists can enhance their engagement and should become a component of any physician burnout prevention program.”
See p. 726
NB: “Multiple clinical manifestations of a ganglionic sympathetic defect,” p. e67. To check out other Resident & Fellow Teaching NeuroImages, point your browser to Neurology.org and click on the link to the Resident & Fellow Section. At the end of the issue, check out the NeuroImage discussing findings in Collet-Sicard syndrome. This week also includes a Clinical/Scientific Note titled “Transient smartphone blindness: Relevance to misdiagnosis in neurologic practice.”
- © 2017 American Academy of Neurology
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