Components of Mid-clerkship Feedback in a Neurology Clerkship and their Impact on Subsequent Student Performance.

Feedback during clinical rotations can be valuable in improving medical student education, but it is unclear what effect such feedback has on subsequent clinical performance and also which feedback topics are the most important in student growth and education. We compared medical student clinical performance before and after mid-clerkship feedback in a Neurology clerkship, with evaluators at the mid-clerkship and at the end blinded to the others' comments. We found that the most important areas holding back student clinical performance were communication, interpersonal interactions, and work ethic rather than textbook knowledge, or the ability to take a history, and do a physical and neurologic examination.

Drooling in Parkinson's disease: A randomized controlled trial of incobotulinum toxin A and meta-analysis of Botulinum toxins.

Introduction: Botulinum toxins are a therapeutic option for drooling in Parkinson's Disease (PD). The aims of this study were to: 1. evaluate the efficacy of incobotulinum toxin A for drooling in PD.

Disorders of the cauda equina.

Purpose Of Review: Cauda equina syndrome is an important neurologic disorder characterized by lower back pain, sciatica, perineal numbness, and sphincter dysfunction. This article reviews the anatomy, clinical presentation, evaluation, and treatment of cauda equina dysfunction, focusing on diskogenic cauda equina syndrome.

Recent Findings: Assessment of suspected cauda equina syndrome is hampered by modest diagnostic accuracy of any one clinical feature.

Quantifying muscle asymmetries in cervical dystonia with electrical impedance: a preliminary assessment.

Objective: Cervical dystonia (CD) lacks an objective quantitative measure. Electrical impedance myography (EIM) is a non-invasive assessment method sensitive to changes in muscle structure and physiology. We evaluate the potential role of EIM in quantifying CD, hypothesizing that patients would demonstrate differences in the symmetry of muscle electrical resistance compared to controls, and that this asymmetry would decrease after botulinum neurotoxin (BoNT) treatment.

Electrical impedance myography in the assessment of disuse atrophy.

Unlabelled: Tarulli AW, Duggal N, Esper GJ, Garmirian LP, Fogerson PM, Lin CH, Rutkove SB. Electrical impedance myography in the assessment of disuse atrophy.

Objective: To quantify disuse atrophy using electrical impedance myography (EIM), a noninvasive technique that we have used successfully to study neurogenic and myopathic atrophy.

Clinical utility of electrodiagnostic studies in the inpatient setting.

Although nerve conduction studies/electromyograms are often requested to evaluate hospitalized patients (inpatients) with suspected neuromuscular diseases, their clinical utility has not been studied. They can be technically challenging, especially in intensive care units. We studied the contribution of inpatient electromyograms (IP-EMGs) to the management of patients with suspected neuromuscular disorders.

Effect of newly proposed CK reference limits on neuromuscular diagnosis.

The objective was to determine the effect of a proposed increase in the upper reference limits of serum creatine kinase (CK) on neuromuscular disease diagnosis. This was a retrospective study of 94 Caucasian subjects (49 women and 45 men) in whom a neuromuscular physician ordered a CK as part of their evaluation. The patients were divided into two groups: those with diagnoses that either should or could elevate serum CK, and those with diagnoses that should not elevate serum CK.

Localized muscle impedance abnormalities in amyotrophic lateral sclerosis.

Objectives: To assess changes in electrical impedance myography (EIM) parameters in amyotrophic lateral sclerosis (ALS).

Methods: Ten patients with ALS and a cohort of normal subjects underwent EIM testing of tibialis anterior. Montages using voltage and current electrodes placed at a distance (far) and in close proximity (near) were compared.

Reference values for 50-kHZ electrical impedance myography.

Electrical impedance myography (EIM) is a method for non-invasively and quantitatively assessing muscle health, in which the major outcome parameter, phase (theta), decreases in diseased states. In order to create a set of normal reference values, we performed 50-kHZ EIM in 5 muscles of 87 healthy individuals, using theta as the major outcome variable. Because the distributions of data were mostly skewed, logarithmic transformations were performed, and the resulting data were fitted to quadratic functions.

Lumbosacral radiculopathy.

Lumbosacral radiculopathy is one of the most common disorders evaluated by neurologists and is a leading referral diagnosis for the performance of electromyography. Although precise epidemiologic data are difficult to establish, the prevalence of lumbosacral radiculopathy is approximately 3% to 5%, distributed equally in men and women. Degenerative spondyloarthropathies are the principal underlying cause of these clinical syndromes and are increasingly commonplace with age.

Electrical impedance in bovine skeletal muscle as a model for the study of neuromuscular disease.

Electrical impedance myography (EIM) consists of a set of bioimpedance methods configured for neuromuscular disease assessment, in which high-frequency electrical current is applied to a limb and the consequent surface voltage pattern over a muscle is evaluated. Prior human work has shown that the EIM parameters of resistance, reactance and phase change in different neuromuscular disease states including neurogenic and myopathic conditions. These parameters are also sensitive to the angle at which current is applied and measured relative to muscle fiber direction, a characteristic known as anisotropy.

Lumbosacral plexitis.

Lumbosacral plexitis (LSP) is an uncommon idiopathic disorder characterized by the acute onset of severe lower extremity pain followed by wasting and weakness of leg muscles with variable sensory loss. Muscles innervated by multiple roots and multiple nerves are affected, and other causes of lumbosacral plexopathy such as mass lesions and trauma must be excluded. Postulated causes of LSP include vasculitis with subsequent axonal injury and autoimmune-related demyelination, although evidence is accumulating that the former pathophysiology is more likely.

Central neurogenic hyperventilation: a case report and discussion of pathophysiology.

Background: Central neurogenic hyperventilation is a rare condition with poorly understood pathophysiology.

Objective: To describe a patient with central neurogenic hyperventilation caused by an infiltrative brainstem lymphoma.

Conclusion: Based on analysis of this patient and other case reports, we propose that central neurogenic hyperventilation is uniquely the result of infiltrative tumors that stimulate pontine respiratory centers and central chemoreceptors.