“Palatucci Advocacy Leadership Forum”—An Important Opportunity for Professional Development in Leadership and Advocacy that is now open to non-US applicants!

Program Overview

Effective leadership and advocacy are critical across the globe and in all disciplines. But there are often limited opportunities for formal professional development on this front and the routine training track undertaken by neurologists simply doesn’t prepare one for major leadership and advocacy roles. In the US, the Palatucci Forum has long served as an incubator of young talent and as developed some of our finest leaders. This year, they are expanding this opportunity to non-US neurologists. Applications are due March 4, 2019. Global Neurology needs global leaders. Apply now or forward this on to someone you think this would help develop.

The Palatucci Advocacy Leadership Forum teaches neurologists the following skills:

Action Planning: Create an effective plan that identifies your issue and resolves the problem

Media Relations: Sharpen your on-camera interview skills, work with reporters, and improve your confidence

Grassroots Advocacy: Get an inside look at how governments work and how to get results

Understanding HIV’s complex interplay with other health conditions in tropical settings

In a recent issue of Neuroimmunology & Neuroinflammation, work by Kamtchum-Tatuene et al’s Blantyre-Liverpool collaboration further reinforce existing concerns that even with excellent access to antiretroviral medications in sub-Saharan Africa, there will be a public price to pay in comorbid health conditions exacerbated by HIV infection1. The researchers accessed biobanked samples from Dr. Laura Benjamin’s previously completed START study—a case-control study designed to identify risk factors for stroke in Malawi2. Taking advantage of the ~10% HIV prevalence in the population, they evaluated traditional serum markers for endothelial activation and injury among stroke vs. non-stroke patients stratified by HIV status. Surprisingly, despite relatively small numbers for analysis, they found an odds ratio of 3.6 (CI 1.3-10.6) for higher plasma levels of ICAM-1 (a biomarker of endothelial activation) among HIV-infected individuals regardless of their stroke status and even when they were on HIV treatments with good viral suppression. Chronic endothelial activation might be expected to increase all cardiovascular risks in the long run for HIV infected individuals who are otherwise doing well in terms of their infection. Additional concerns would be for increased risks of vascular dementia and peripheral neuropathies associated with diabetes or other metabolic problems. Further evaluations are also needed to determine how HIV-associated endothelial activation might impact the risks and neurologic injuries associated with severe malaria, whose effects are largely mediated by endovascular dysfunction.

  1. Kamtchum-Tatuene J, Mwandumba H, Al-Bayati Z et al. HIV is associated with endothelial activation despite ART, in a sub-Saharan African setting. Neurology 2018 Dec 21
  2. Benjamin LA, Allain, TJ,  Mzinganjira H, et al. The Role of Human Immunodeficiency Virus–Associated Vasculopathy in the Etiology of Stroke. The Journal of Infectious Diseases 2017;216:545-553

Use of continuous EEG in the ICU leads to favorable outcomes

by Nathalie Jetté, MD, MSc, FRCPC and Churl-Su Kwon, MD, MPH

The use of continuous EEG (cEEG) in the Intensive Care Unitis increasing. As indicated by the American Clinical Neurophysiology Society, current indications for this non-invasive tool include: monitoring/diagnosis of seizures and/or status epilepticus, detecting cerebral ischemia, measuring sedation, providing post-arrest prognostication1. However, research has been rather sparse in the past decade regarding specific use of cEEG and clinical outcomes in the critically ill.

With the variability in cEEG practices seen across health systems (timing, length, when to start ensuing treatment) and the fact that it is resource intense, there is much need to define its optimal use. This will diminish inconsistencies in cEEG application as well as curtail avoidable costs, especially with health in the USA experiencing much policy transformation with linkage of traditional health-care services to value-based care and highlighting population health and novel mechanisms of health-care delivery.

The authors used 2004-2013 data from the National Inpatient Sample which is the largest cross-sectional, all-payer inpatient healthcare nationwide database, consisting of information on patient and hospital level factors for more than seven million hospital discharges annually2. In this study, mechanically-ventilated adults in intensive care units were sampled and patients who underwent cEEG were compared to those who did not. cEEG use was associated with lower in-hospital deaths, as were larger bed size and urban teaching hospitals. Subgroup analysis showed similar results in patients who had subarachnoid/intracerebral hemorrhage and altered consciousness unless they had seizures/status epilepticus likely due to a disease severity confounding effect. Proportions of critically ill patients who underwent cEEG varied across hospitals, suggesting discrepancies in hospital resources and expertise. Longer hospital stays and total hospitalization costs were associated with cEEG utilization, but justifiable in the setting of decreased mortality of nearly 20%.

This study has many strengths, including the large population and adjustment for important confounders such as comorbidity. Though it is carefully designed and the authors are to be congratulated for this important work, this study is not without limitations, most of which are highlighted by the authors. These include issues related to the validity of diagnostic coding which is lacking for NIS-specific data, low sensitivity of ICD coding for mechanical ventilation, under-ascertainment of cEEG use and lack of cost-effectiveness data.

This study highlights that cEEG use for critically ill patients is associated with lower in-hospital deaths and suggests possible under-utilization of cEEG (0.3% of critically ill, though utilization increased more than tenfold from 0.06% in 2004 to 0.8% in 2013). Although these data may warrant continued expansion of cEEG use, explicit cost-analysis quantifying the value of cEEG in the critically ill is essential in future studies to elicit cost-effective strategies. Since survival is seen to differ across diagnoses, rigorous investigation is necessary to develop cEEG evidence-based practices to improve outcomes, decrease variability in care and enhanced cost-benefit frameworks across different populations.  

  1. Herman ST, Abend NS, Bleck TP, et al. Consensus Statement onContinuous EEG in Critically Ill Adults and Children, Part I. J ClinNeurophysiol. 2015;32:87–95.
  2. Hill CE, Blank LJ, Thibault D, et al. Continuous EEG is associated with favorable hospitalization outcomes for critically ill patients. Neurology Epub 2018 November 30.

Without Borders Latest Interview: Dr. Benjamin Warf and Practice in Africa

Advances in Neurosurgical Capacity and Practice in Africa are improving options for patients while also informing care and offering training opportunities for neurosurgeons in the US. To learn more, listen to our interview with Dr. Benjamin Warf. Dr. Warf is the Director of the Neonatal and Congenital Anomaly Neurosurgery and Professor of Neurosurgery at Harvard Medical School. Early in his career, he moved his family to Uganda to direct a neurosurgical hospital for children funded by CURE. In 2012, he was awarded a MacArthur (‘genius’) Fellowship.

Resident & Fellow Section Author Guides

Scientific writing is a critical part of medical training.  We use case reports, clinical trials, and basic research to advance the practice of medicine and to share new ideas across the field of neurology.  However, writing a manuscript can be a daunting task and a novice writer may not know where to start.  For a resident or fellow, the first manuscript is often a case report which means the first step is to find a great case.  What makes a great case?  Atypical presentations of common illnesses are worth publishing so that all clinicians can recognize the full spectrum of the diagnosis.  For similar reasons, rare entities, particularly if there is a new genetic diagnosis, should be published.  Case reports that include a series of patients are more impactful and can often be accompanied by an analysis of trends or varied responses to treatment. When trying to decide if your patient case should be considered for publication, it is important to review existing literature.  How many case reports have already been published on that disease?  How is your case different from previously published cases?

Continue Reading “Resident & Fellow Section Author Guides”

Fumbled Priorities and Lost Perspectives: Epilepsy in LMICs Today

Three cheers for Dr. Mamta Bhushan Singh whose candid editorial in the November issue of Seizure really sums up the problems of epilepsy research and care in the developing world today. 1  Such a maddening paradox—70% of epilepsy cases would respond to basic treatment, if provided. And rather than expending efforts to assure we put systems in place to roll out sustainable care to the masses, we in the global epilepsy arena continue to focus most of our attention and resources on the 30% of patients with treatment resistant epilepsy. This approach might make sense in developed settings, but certainly not in low and middle income settings where the treatment gap really hasn’t budged in more than two decades.

Continue Reading “Fumbled Priorities and Lost Perspectives: Epilepsy in LMICs Today”

Resident & Fellow Section Mentored Peer Review Program

Are you interested in reviewing for the Resident & Fellow Section of Neurology?

Do you need help getting involved in the review process?

The Resident & Fellow Section (RFS) of Neurology is pleased to announce that we will be piloting a mentored peer review program to help support resident and fellows who are interested in reviewing articles submitted to the RFS, but who feel that they have not had sufficient prior training or exposure to peer review. Continue Reading “Resident & Fellow Section Mentored Peer Review Program”

Starting antiepileptic medication after a first unprovoked seizure

While 10% of the population will have a single seizure in their lifetime, the challenge is determining for which patients the risk and repercussions of recurrent seizure are great enough to warrant starting antiepileptic therapy. Although immediate treatment after a first unprovoked seizure may decrease seizure risk over the next few years, there is no evidence that early treatment improves longer-term prognosis.

Continue Reading “Starting antiepileptic medication after a first unprovoked seizure”

Future of Neurology & Technology

With machine learning, jobs ranging from caring for the elderly to identifying abnormalities on radiological images may soon lie in the hands of robots or artificial intelligence, as Dr. Siddartha Mukherjee has pointed out in his essay, A.I. Versus M.D., for The New Yorker. How will advances in technology, like seizure alert devices, impact the field of neurology? What aspects of our profession will become automated, if any? How should we prepare for the future?

Continue Reading “Future of Neurology & Technology”