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.
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?
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.
Paraneoplastic neurological disorders target diverse areas of the nervous system. Commercially available panels of antibody tests are comprised of tests for clinically distinct disorders, but physicians may be tempted to order comprehensive panels with the thought that this will improve diagnostic sensitivity.
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”
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.
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?
An anthropologist-friend some years ago described the average international student elective as “an experience of inflicting the unprepared upon the unsuspecting.” Thankfully, as US global health programs have expanded in number with many becoming formally incorporated into existing training programs, a growing body of knowledge and academic thought about what should be included in a global neurology curriculum is starting to emerge.1-4
I read with some interest the description of the recent development of not one, but two epilepsy surgery programs in Peru. There are certainly laudable aspects of the work including that, as described, it represents a true transfer of technical and medical capacity and not a “mission trip” with external experts dropping in briefly to declare victory over disease.
VanderPluym et al report post-hoc analyses from 2 clinical trials to evaluate the effects of fremanezumab on patient’s functional status on their headache free days1. Neurology characterizes the evidence as level 2 that fremanezumab increases normal functional performance on headache free days. The results were robust to multiple functional measures and to both migraine subsets, episodic (8-14 days of headache per month) and chronic (>15 days of headache per month). The authors rightfully describe their findings as exploratory given that these results were not the pre-specified outcomes of these trials. They also point out that the increase in functional performance on headache free days might be just because of the increase in headache free days overall rather than any additional effect on function.