Neurology December 2012 Volume 2 Issue 4

Summary: Nonconvulsive status epilepticus (NCSE) is a state of continuous seizure activity for at least 30 minutes, with cognitive or behavioral changes. It may be classified according to EEG evidence of focal or generalized epileptic activity, but may be further categorized by etiology and level of consciousness, both with prognostic weight. There have been several attempts to define the electrographic characteristics of NCSE. Clinical challenges arise from the frequent subtle clinical manifestations, the need for EEG confirmation of ongoing epileptic activity, and physicians' lack of awareness of the possibility of NCSE. This underdiagnosis may have deleterious consequences. This review encompasses epidemiologic, clinical, diagnostic, and prognostic aspects of NCSE in adults, and delineates strategies for management.(C)2012AAN Enterprises, Inc.

Summary: Neurotoxic disease can mimic many common neurologic disease states, including parkinsonism, myelopathy, neuropathy, and encephalopathy. Accurate diagnosis and appropriate treatment may result in a favorable outcome. This review highlights 5 areas of neurotoxicology for which there is an emerging understanding of disease processes or patterns of exposure, including 3 specific metal toxicities (manganism, zinc-induced copper deficiency, and cobalt-chromium neuropathy). Toxin-induced posterior reversible encephalopathy syndrome is more widely recognized and reported in association with an ever-growing list of drugs. Two new categories of street drugs, synthetic cathinones and cannabinoids, have been identified as public health threats due to their popularity, availability, and severity of toxicity.(C)2012AAN Enterprises, Inc.

Summary: Neurohospitalists represent a new approach to inpatient neurologic care. In order to characterize this practice, we surveyed both a general neurology sample as well as a sample of pertinent American Academy of Neurology sections. Of the section sample, 42% defined themselves as neurohospitalists, compared to 16% of the general sample. The majority of neurohospitalists are in an academic setting and share call responsibilities with non-neurohospitalists. Many are concerned about the possibility of burnout in their current practice setting. This representative sample of neurohospitalists reveals a diverse group facing a number of unanswered questions and challenges, including concerns for burnout, ideal practice setting, and defining the core curriculum for a neurohospitalist.(C)2012AAN Enterprises, Inc.

Summary: To identify gaps in physician practice of epilepsy care, an online survey was sent to members of a Web-based epilepsy community to ascertain whether their physician performed 8 quality measures for epilepsy care. A total of 221 of 348 recently active epilepsy patients (64%) completed the survey. More than 80% of patients agreed they knew their seizure type, epilepsy syndrome, current seizure frequency, and had an EEG and neuroimaging. Fewer (60%) recalled being asked about medication side effects at each visit and safety issues annually. Only 48% report referral to an epilepsy surgery specialist and only 46% of appropriate patients had discussed reproductive issues with epilepsy. This demonstrates some potential gaps in epilepsy care and these data have been submitted to the American Academy of Neurology and the National Quality Forum.(C)2012AAN Enterprises, Inc.

Summary: Donepezil 10 mg/day has been a modestly successful therapeutic agent for the palliative treatment of Alzheimer disease dementia. In 2011, seeking greater efficacy and an extension of the Aricept brand, a 23-mg formulation of donepezil was introduced. A large-scale trial, organized by Eisai, the sponsor, failed to show superiority in their primary analyses of donepezil 23 mg/day in patients with moderate to severe Alzheimer disease dementia vs 10 mg, but the published report used post hoc analyses to claim "statistically significant benefits." There was greater than a 3 times higher rate of gastrointestinal side effects with 23 mg of donepezil compared to 10 mg. Thus, not only does donepezil 23 mg/day increase the likelihood of unacceptable gastrointestinal side effects, it provides no clinical benefits. Aricept 23 mg is about 10 times more costly per pill than donepezil 10 mg.(C)2012AAN Enterprises, Inc.