[Neurological and psychiatric expert assessment of post-COVID syndrome].

Infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can lead to a multiorgan disease and subsequently to very different clinical manifestations of coronavirus disease 2019 (COVID-19). In addition to acute symptoms, the long-term complaints in the context of the infection, known as long or post-COVID syndrome, are increasingly attracting attention. With respect to social insurance systems, expert opinions of such problems will become more and more important, whereby neurological and psychiatric symptoms are the most frequent complaints.

[New AWMF guidelines for medicolegal assessment of mental and psychosomatic disorders].

The guidelines, which were first published in 2012, were fundamentally revised by a panel of experts from 9 medical and psychological societies and published on the website of the Association of the Scientific Medical Societies in Germany in December 2019 (AWMF registration number 051-029). The guidelines contribute to interdisciplinary quality assurance when assessing applicants for insurance or other compensation benefits who claim psychological or psychosomatic illnesses with resulting functional disorders. The guidelines are divided into 3 separate parts: part I describes specific aspects of the expert examination, part II describes the criteria for assessing occupational performance capacity in terms of different legal fields and part III deals with questions of causality in cases of claimed posttraumatic mental disorders.

Position paper: ability to drive in cerebrovascular diseases.

The regulations for fitness to drive after a cerebrovascular accident in the German Driving License Regulations (FeV) and the German Evaluation Guidelines for Driving Ability (BGL). are not up to date with the current medical knowledge and not consistent with regulations regarding cardiovascular diseases. This position paper presented by six medical and neuropsychological societies in Germany provides a guideline for the assessment of driving ability after diagnosis of a cerebrovascular disease and addresses three major questions: If there is a functional limitation, how can it be compensated for? What is the risk of sudden loss of control while driving in the future? Are there behavioral or personality changes or cognitive deficiencies interfering with safety while driving? Recommendations for the assessment of driving ability in different cerebrovascular diseases are presented.

[Ability to drive with cerebrovascular diseases : Position paper of the German societies DGNB, DGN, DGNC, DGNR, DSG and GNP].

The regulations for ability to drive with cerebrovascular diseases in the German Driving License Regulations (Fahrerlaubnisverordnung, FeV) and German Guidelines for the Evaluation of Driving Ability of the Federal Highway Research Institute (BASt) are not up to date with the current medical knowledge and are not consistent with comparable regulations regarding cardiovascular diseases. This is particularly true for the assessment of future risks for a sudden loss of control during driving. The present position paper of six medical and neuropsychological societies in Germany presents the current conditions for the assessment of driving ability of patients a cerebrovascular diesease and recommends an estimation of the ability to drive founded on the current state of scientific knowledge.

[Guideline "Legal evaluation after closed brain injury in adulthood"].

In 2005 and 2013, the "Deutsche Gesellschaft für Neurowissenschaftliche Begutachtung" (German Society for Neuroscientific Evaluation) together with other societies developed and consented guidelines fort the legal evaluation of patients with closed head injuries and published them trough the National Working Group of Scientific Medical Societies and in this journal. Five years later, a revision was necessary, this was developed on the higher S2 k level of consent through a Delphi conference.

[Clinical tests for symptom validity assessment].

Assessing symptom validity is essential both in the clinical and medicolegal contexts. If neurological symptoms are demonstrated and/or a patient complains of pain that is not or cannot be fully explained by an underlying disease, it is necessary to recognize reliably a possible psychological cause in order to avoid further unnecessary examinations. In the medicolegal context, malingering or exaggeration of complaints for obtaining financial benefit is to be differentiated in a further step.

[Medicolegal Assessment of Psychic Sequelae after Minor Traumatic Events].

The majority of medicolegal assessments in claimed psychic sequelae after accidents concerns minor traumatic events. In this case, the focus is on three questions: Was the event appropriate to cause a traumatic disturbance according to current psychiatric classification systems (especially current DSM-5)? Which psychical or physical initial injury can be proven beyond reasonable doubt ("full proof") according to German law? What is the impact of personality characteristics and competing life events in the development and maintenance of the mental disorder? Causality between mental disorders and minor traumatic events is to be confirmed especially in the case of persistent physical accident sequelae, but attention has to be paid to the differences in the various legal requirements.

[Principles of evaluating driving ability for neurological and psychiatric diseases].

If attending physicians and psychologists recognize restricted or a lack of driving ability they are obliged to inform their patients appropriately. In Germany the legal basis for assessing driving ability is the "Fahrerlaubnis-Verordnung" (FeV, driving licence act), supplemented by guidelines for evaluating driving ability. In each individual case it has to be clarified whether and to what extent permanent or paroxysmally occurring disorders affect driving ability and whether lack of insight ability or personality defects are a threat to driving safety.

[The German guideline "legal evaluation after closed head injury"].

In 2005, the "Deutsche Gesellschaft für Neurowissenschaftliche Begutachtung" (German Society for Neuroscientific Legal Evaluation) together with other Societies published a guideline for the legal evaluation of patients with closed head injuries. Meanwhile, not only scientific progress in imaging techniques but also in other fields such as neuropsychology has necessitated a revision, which is presented here. In the mean time, the handling of guidelines has been systematised in Germany so that a registration with the Cooperation of German Medical Learned Societies is applied for and publication in the German Guideline Registry is expected.

Cognitive performance following spontaneous subarachnoid haemorrhage versus other forms of intracranial haemorrhage.

Objective: The exact cause of cognitive deficits following intracranial haemorrhage is unclear. This prospective study examines the abilities after spontaneous subarachnoid haemorrhage (SAH), intracerebral haemorrhage (ICH) and chronic subdural haematoma (SDH) to elucidate the cognitive outcome.

Patients And Methods: Ninety-nine patients with SAH (N = 60), ICH (N = 25), and SDH (N = 14) were followed up for an average of 6 and 12 months post-haemorrhage.

[Expert opinions in German statutory accident insurance].

German statutory accident insurance covers employees and trainees against occupational accidents, employers bear the inherent charges. Expert opinion is obtained, in particular, for discussing causality questions and for rating accidental health disorders. Causality has to be estimated based on the "theory of essential condition", health disorders have to be substantiated without any reasonable doubt.

[Assessment of psychological consequences of trauma].

After accidents psychological consequences are often asserted. This may be due to the traumatic experience itself, the experience of severe physical injury or to the experience of a traumatic hospital treatment. The pivotal point of the medicolegal assessment is the evidence of primary mental or physical damage that has to be documented beyond a reasonable doubt in all areas of law.

[Symptom validity tests in psychiatric assessment: a critical review].

Neuropsychological symptom validity testing is increasingly used even in psychiatric expert assessment. Low scores on symptom validity tests can only demonstrate exaggerated symptoms. However, symptom validity tests do not address the question of whether the result is intentionally produced or motivated by internal incentives.

[Revision of DEGUM ultrasound criteria for grading internal carotid artery stenoses and transfer to NASCET measurement].

Since 1986, German ultrasound criteria for grading carotid stenosis have followed the local diameter reduction percentage consistent with the definition used in the European Carotid Surgery Trial (ECST) definition. To overcome the confusion caused by the coexisting grading method used in the North American Symptomatic Carotid Endarterectomy Trial (NASCET), a German interdisciplinary council on carotid artery stenosis has recommended the implementation of the NASCET grading system (distal diameter reduction percentage) as the standard. The multi-parametric German "DEGUM ultrasound criteria" consisting of combined Doppler and imaging criteria have consequently been revised and transferred to the NASCET definition.

[Radicular low back pain: is there a relationship between the treatment regimen and outcome?].

Objective: To identify a possible relationship between the non-surgical treatment regimen and outcome.

Methods: In a sample of 170 patients with sciatica due to a herniated disk the intensity of a conservative multimodal inpatient treatment in a neurological department was extracted. The outcome was examined using two prospective cohorts (183 patients).

Teleneurology to improve stroke care in rural areas: The Telemedicine in Stroke in Swabia (TESS) Project.

Background And Purpose: Assessing both stroke patients and their CT scans by using a conventional videoconference system offers an interesting opportunity to improve stroke care in rural areas. However, until now there have been no studies to suggest whether this method is feasible in routine stroke management.

Methods: Seven rural hospitals in the southern part of Germany in Swabia were connected to the stroke unit of Günzburg with the use of a videoconference link (Telemedicine in Stroke in Swabia [TESS] Project).