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After Covid

Dear Colleagues!

Have You noticed remarkable changes after Covid-era? I know there other modifying factors, too, wars next and far to us, globalisation, new rules etc , but Covid made a strong fingerprint on all of us,

Have your and coworkers and patients attitude, feelings or healthcare indicators changed?

We meet more younger ones and older patients with highrisk comorbidity requiring polihistiric attitude in mean stream internal medicine, neurology and psychiatry, more emergency occurances and more difficoult social problems .

I feel all around exhaustion, anxiety, the loss of presumed safty.

What about You?

Best regards

Cumulative Epilepsy Risk Higher After Neonatal Seizures

The highest risk for epilepsy after neonatal seizures appears to be within the first year of life, according to a study published online Feb. 19 in Developmental Medicine & Child Neurology.

Jeanette Tinggaard, Ph.D., from Copenhagen University Hospital in Denmark, and colleagues estimated the cumulative risk for epilepsy after neonatal seizures and identified subpopulations at increased risk in a register-based cohort study involving all children born in Denmark between 1997 and 2018.

A total of 1,294,377 children were followed, and 1,998 neonatal survivors of neonatal seizures were identified. The researchers found that the cumulative risk for epilepsy was 20.4 and 1.15 percent among children with and without neonatal seizures, respectively. Among children with neonatal seizures, epilepsy was diagnosed before 1 year of age in 11.4 percent, between 1 and 5 years in 4.5 percent, between 5 and 10 years in 3.1 percent, and between 10 and 22 years in 1.4 percent. Compared with children with seizures of unknown etiology, the etiologies of cerebral infarction, hemorrhage, or malformations and low Apgar score were associated with the highest risk for epilepsy (adjusted hazard ratios, 2.49 and 1.49, respectively).

"Our study confirms a substantial risk of epilepsy after neonatal seizures in neonatal survivors, with the highest risk observed in the first year of life but persisting into adolescence," the authors write.

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Smoking Linked to Cryptogenic Ischemic Stroke in Young Adults

Smoking and high-intensity smoking are associated with cryptogenic ischemic stroke (CIS) among adults aged 18 to 45 years, according to a study published online Feb. 19 in Neurology Open Access.

Phillip Ferdinand, M.B.Ch.B., from University Hospitals of North Midlands NHS Trust in the United Kingdom, and colleagues prospectively recruited patients aged 18 to 49 years with CIS within two weeks of symptom onset from 19 European stroke centers to determine the association between smoking and young CIS.

The analysis included 546 young patients with CIS and matched controls. The researchers found a significant difference between patients and controls in low education status, hypertension, obesity, physical inactivity, smoking, and heavy alcohol use. In the whole cohort, there was an association between smoking and young CIS after adjustment (odds ratio, 2.39), with stronger associations seen in men (odds ratio, 3.34). The association was seen in all age groups and was highest in the 45- to 49-year-old age group (odds ratio, 3.77). The strongest association was seen for those with >20 pack-years (odds ratio, 4.30), especially in men and in the 45- to 49-year-old age group.

"We found a clear association between smoking and CIS in the young even after adjustment for low education status and well-known vascular risk factors," the authors write. "This association was strong in men but was not significant in women."

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Epidural Steroid Injections Reviewed for Radicular Pain, Spinal Stenosis

There is some evidence for epidural steroid injections (ESIs) reducing pain and disability in cervical and lumbar radiculopathies and possibly in lumbar spinal stenosis, according to a study published online Feb. 12 in Neurology.

Carmel Armon, M.D., from Loma Linda University School of Medicine in California, and colleagues conducted a systematic review to evaluate the use of ESIs in cervical and lumbar spinal stenosis and radiculopathies. Due to the variability in efficacy measures, differences based on any measure of success were reported as the success rate difference (SRD).

Ninety randomized controlled trials met the inclusion criteria. The researchers found that ESIs probably reduced short-term pain (SRD, −24.0 percent; number needed to treat [NNT], 4) and disability (SRD, −16.0 percent; NNT, 6) and possibly reduced long-term disability (SRD, −11.1 percent; NNT, 9) in cervical and lumbar radiculopathies. The evidence was insufficient to determine whether ESIs reduced long-term pain in radiculopathies. ESIs possibly reduced short-term (SRD, −26.2 percent; NNT, 4) and long-term (SRD, −11.8 percent; NNT, 8) disability in lumbar spinal stenosis, but there was no reduction in short-term pain; insufficient evidence was seen for determining whether ESIs reduced long-term pain. The evidence was insufficient for determining the effectiveness of ESIs in cervical spinal stenosis.

"The systematic review found evidence that ESIs are probably effective in reducing short-term pain and disability caused by radiculopathy and possibly effective in reducing short-term disability, but not pain, in lumbar spinal stenosis," the authors write.

Several authors disclosed ties to industry.

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NIH Research Funding Drops $1B Under Trump Administration

Federal funding for medical research has dropped by roughly $1 billion this year, raising alarm among universities, medical centers and lawmakers who warn the shortfall could slow progress in cancer, diabetes and heart disease research.

The National Institutes of Health's (NIH) grant review process was also disrupted when the Trump administration suddenly canceled scheduled funding meetings due to a temporary communications freeze.

Some of those meetings have since resumed, but experts warn that delays could impede new research projects.

The drop in funding comes amid administrative delays and policy changes under the Trump administration, including a controversial move to cut NIH payments for research facility and administrative costs.

A federal judge in Massachusetts temporarily blocked those cuts, pending upcoming hearings.

The NIH awarded about $2.5 billion in grants in the first six weeks of 2024, federal records show. This year, that number has plummeted to $1.4 billion -- hundreds of millions of dollars lower than the amount awarded in the same timeframe over the past six years.

“The president has completely stopped funding for research that discovers cures for diseases that devastate families across the country, like cancer and Alzheimer’s disease, all so he can give tax breaks to billionaires and big corporations,” U.S. Sen. Tammy Baldwin (D-Wis.), said in a statement.

“Make no mistake, their efforts to rob Peter to pay Paul means crushing families’ hopes and dreams of having cures,” she added.

The NIH typically distributes roughly $36 billion in grants annually. The funding supports groundbreaking research in such areas as gene therapy, immune-based cancer treatments, cystic fibrosis and sickle cell disease.

Without full funding, experts warn that vital projects could be delayed or stopped altogether.

U.S. Sen. Patty Murray (D-Wash.) attempted to restore NIH funding to previously agreed-upon levels through a budget bill, but the effort failed on a party-line vote.

“Trump and Elon -- either through sheer ignorance or a genuine lack of caring -- are putting lifesaving research in America on life support,” Murray said in a statement, referring to billionaire Elon Musk and his reported influence on White House budget decisions.

Musk heads the Trump-created U.S. Department of Government Efficiency, or DOGE, which has slashed funding and staff in several federal departments and agencies.

What's more, the administration has also faced internal turmoil at the NIH, with two high-ranking officials suddenly resigning and the agency still lacking a permanent director.

Meanwhile, Trump's nominee to head the NIH, Stanford professor Dr. Jay Bhattacharya, is preparing for Senate confirmation hearings in the coming weeks.

The uncertainty at the NIH comes as Robert F. Kennedy Jr., the new secretary of health and human services (HHS), has suggested he wants to back off on infectious disease research and focus more on chronic conditions like diabetes and heart disease. NIH is part of Kennedy's department.

The New York Times reported that the proposed cuts in medical research have raised deep concerns among recipient institutions.

“If the federal government cuts its investment, we will have to scale back on research, and cutting-edge science will be cut short,” Dean Madden, the vice provost for research at Dartmouth’s medical school, said at a news conference Friday, according to The New York Times.

“You don’t know what discoveries won’t be made as a result, but they might include a cure for some childhood cancer or treatment for Alzheimer’s or dozens of other diseases that are afflicting patients across our country,” Madden added.

More information

SOURCES: The New York Times, media report, Feb. 14, 2025; U.S. Sen. Tammy Baldwin, statement, Feb. 14, 2025: U.S. Sen. Patty Murray, statement, Feb. 15, 2025

Offspring of Women With Epilepsy Experience Decreased Bone Metabolism

Women with epilepsy may have offspring with decreased bone metabolism and lower birth weight, according to a study published online Feb. 3 in the Annals of Clinical and Translational Neurology.

Huali Luo, from Zhejiang University in China, and colleagues retrospectively analyzed data from 83 parturients with epilepsy receiving antenatal care (2012 through 2021) and a control group of 249 parturients without epilepsy.

The researchers found that women with epilepsy were significantly more likely to undergo a cesarean section with a lower abortion rate (55.4 versus 37.3 percent). Offspring femoral length in women with epilepsy was significantly reduced versus the control group (6.812 versus 6.923 cm) when adjusting for potential confounding variables. Compared with offspring whose mothers used a single antiseizure medication (ASM) or none, those born to mothers using multiple ASMs had significantly reduced femoral and biparietal lengths. Additionally, using multiple ASMs was associated with significantly lower birth weight in offspring versus women not using ASMs.

"The application of a single ASM during pregnancy is the optimal choice for pregnant women with epilepsy and their offspring, as it can not only control the seizures to reduce the harm caused by seizures during pregnancy but also minimize the restriction of ASMs on the growth and development of offspring," the authors write.

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Ethnoracial Disparities Seen in Access to Genetic Testing in Pediatric Neurology

For pediatric neurology patients, there are marked ethnoracial disparities in genetic testing completion, according to a study published online Feb. 12 in Neurology.

Jordan Janae Cole, M.D., from the University of Colorado in Aurora, and colleagues examined whether social determinants of health (SDOH) are associated with genetic testing among pediatric neurology outpatients in a retrospective observational study using electronic health record data. Genetic testing requests, insurance denials, and test completion rates were compared for non-Hispanic single-racial or multiracial Black versus non-Hispanic single-racial White patients.

Data were included for 11,371 patients, of whom 4.9 percent completed one or more genetic test in the study interval. The researchers found that compared with Black patients, White patients were significantly more likely to have completed one or more genetic test (adjusted odds ratio, 1.88). The most common specialty through which testing was completed was outpatient pediatric neurology. There was no difference seen in neurology provider request rates for genetic testing by patient ethnoracial identity; lower insurance denial rates after neurology request were seen for White versus Black patients (relative rate ratio, 0.44); the likelihood of completing genetic testing after it was requested through neurology was lower for those with public insurance (adjusted odds ratio, 0.59). Insurance type was significantly associated only with multipanel gene completion when considering individual genetic test types (public versus private: odds ratio, 0.56).

"Recognizing ethnoracial inequities and the barriers to genetic testing due to SDOH are essential for developing interventions to eliminate testing disparities, such as improving insurance coverage and increasing availability of point-of-care genetic testing," the authors write.

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Early Childhood Sun Exposure Linked to Lower Risk for Pediatric MS Relapse

Greater prenatal and early childhood sun exposure is associated with a lower risk for relapse among children with multiple sclerosis (MS), according to a study published online Feb. 12 in Neurology: Neuroimmunology & Neuroinflammation.

Gina Chang, M.D., M.P.H., from The Children's Hospital of Philadelphia, and colleagues conducted a multicenter cohort study involving 334 children with pediatric-onset MS recruited from 18 pediatric MS clinics between Nov. 1, 2011, and July 1, 2017, to examine the correlation between time spent in the sun in early childhood and risk for relapse. Relapses were identified prospectively after enrollment; those preceding study enrollment were entered retrospectively.

The researchers found that from disease onset to the end of the follow-up period, 206 children (62 percent) experienced at least one relapse. Compared with <30 minutes, ≥30 minutes of daily sun exposure during the first summer of life was associated with a lower risk for relapse after adjustment (adjusted hazard ratio, 0.67). There was also an association seen between greater time spent in the sun during the first trimester of pregnancy and a reduced risk for relapse (adjusted hazard ratio, 0.68). No significant associations were seen for ultraviolet radiation dose and time spent in the sun later in life with relapse risk.

"Our findings suggest that sun exposure in early childhood may have long-lasting benefits on the progression of childhood-onset MS," Chang said in a statement.

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Study Finds Exenatide Not Beneficial for Parkinson Disease

The glucagon-like peptide-1 receptor agonist exenatide does not yield improvement in measures of Parkinson disease severity, according to a study published online Feb. 4 in The Lancet.

Nirosen Vijiaratnam, M.D., from the University College London Queen Square Institute of Neurology, and colleagues conducted a phase 3, multicenter trial at six research hospitals in the United Kingdom involving patients aged 25 to 80 years with a diagnosis of Parkinson disease who were randomly assigned to receive extended-release exenatide 2 mg by subcutaneous pen injection once per week over 96 weeks or visually identical placebo (97 patients in each group).

The analyses included 92 patients in the exenatide group and 96 in the placebo group with at least one follow-up visit. The researchers found that the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale part III score, off dopaminergic medication at 96 weeks, increased (worsened) by a mean of 5.7 and 4.5 points in the exenatide and placebo groups, respectively (adjusted coefficient for the effect of exenatide, 0.92; 95 percent confidence interval, −1.56 to 3.39; P = 0.47). Nine and 11 participants in the exenatide and placebo groups, respectively, had at least one serious adverse event.

"The results of this trial are discordant with previous laboratory and epidemiology data and previous trial results," the authors write. "We aim to do further post-hoc analyses to try and explain the reasons for this inconsistency."

Several authors disclosed ties to biopharmaceutical companies. AstraZeneca provided exenatide for the study.

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Minority Children Less Likely to Be Diagnosed With Migraine in Emergency Department

Compared with non-Hispanic White (NHW) children, non-Hispanic Black (NHB) and Hispanic/Latino (HL) children with a headache diagnosis in the emergency department have lower rates of migraine diagnosis, undergo less testing, and receive less intensive treatment, according to a study published online Feb. 5 in Neurology.

Danielle Kellier, from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, and colleagues examined racial and ethnic disparities in the diagnosis, testing, and treatment of pediatric patients (age 5 to 21 years) presenting to the emergency department with headache in a cross-sectional study of visits from 49 children's hospitals between 2016 and 2022.

Of the 160,466 eligible visits, 41.0, 24.8, and 26.0 percent were by NHW, NHB, and HL children, respectively. The researchers found that NHW children were more often diagnosed with migraine compared with NHB and HL children (45.5 percent versus 28.2 and 28.3 percent, respectively). Compared with NHW children, NHB and HL children received less testing, including brain magnetic resonance imaging scans (adjusted odds ratios, 0.56 and 0.54, respectively). The proportion of visits without administration of headache-related medications did not differ between the groups (23.3, 24.6, and 23.4 percent for NHW, NHB, and HLs, respectively). Compared with NHWs, NHB and HL children were more likely to receive only oral medications (adjusted odds ratios, 1.37 and 1.54, respectively) and less likely to be admitted as inpatients (adjusted odds ratios, 0.80 and 0.65, respectively).

"Further research is necessary both to understand how disparities in headache management affect outcomes and to develop interventions to reduce inequity in the management of headache, one of the most common concerns seen in the pediatric emergency department," the authors write.

Several authors disclosed ties to the pharmaceutical industry.

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Variability in Total Cholesterol, LDL Cholesterol Linked to Dementia

Variability in total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) is associated with dementia and cognitive impairment, according to a study published online Jan. 27 in Neurology.

Zhen Zhou, Ph.D., from Monash University in Melbourne, Australia, and colleagues examined the association between year-to-year intraindividual lipid variability and the subsequent risk for cognitive decline and dementia in community-dwelling older adults in the ASPirin in Reducing Events in the Elderly randomized trial of aspirin. This post-hoc analysis included participants with lipid levels measured at baseline and in years 1, 2, and 3 and quantified year-to-year variability in TC, LDL-C, high-density lipoprotein cholesterol (HDL-C), and triglycerides.

The analysis included 9,846 individuals. The researchers identified 509 incident dementia events and 1,790 cognitive impairment with no dementia (CIND) events during a median follow-up of 5.8 and 5.4 years after assessment of variability. Comparing the highest and lowest quartiles of TC and LDL-C variability, respectively, the hazard ratios were 1.60 and 1.48 for dementia and 1.23 and 1.27 for CIND. Associations were also seen for higher TC and LDL-C variability with faster decline in global cognition, episodic memory, psychomotor speed, and the composite score for changes in four cognitive function domains. There was no strong evidence for an association of HDL-C and triglyceride variability with dementia and cognitive change.

"These results suggest that fluctuating cholesterol, measured annually, may be a new biomarker for identifying people at risk of dementia, providing more information than the actual cholesterol levels measured at a single time point," Zhou said in a statement.

Several authors disclosed ties to the biopharmaceutical industry.

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Intensive BP Control Linked to Long-Term Cognitive Benefits

In an extended follow-up study, intensive blood pressure control is associated with reductions in the rate of cognitive impairment, according to a study published in the Feb. 11 issue of Neurology.

David M. Reboussin, Ph.D., from Wake Forest University School of Medicine in Winston-Salem, North Carolina, and colleagues conducted a prespecified analysis of a randomized clinical trial (the Systolic Blood Pressure Intervention Trial [SPRINT]) to estimate the effect of intensive versus standard systolic blood pressure (SBP) lowering on the longer-term incidence of cognitive impairment. Patients aged 50 years and older with hypertension and increased cardiovascular risk were recruited between 2010 and 2013 and were randomly assigned to an SBP goal of <120 or <140 mm Hg (intensive or standard treatment, respectively) and treated for 3.3 years.

Overall, 7,221 of the 9,361 randomized participants were eligible to be recontacted. The cognitive status of 4,232 participants was ascertained. The researchers found that during a median follow-up of seven years, 248 and 293 participants in the intensive and standard treatment groups were adjudicated with probable dementia (8.5 versus 10.2 per 1,000 person-years; hazard ratio, 0.86; 95 percent confidence interval [CI], 0.72 to 1.02). The rates of both mild cognitive impairment (MCI) and a composite of MCI or probable dementia were lower with intensive treatment, consistent with earlier results from the trial (hazard ratios, 0.87 [95 percent CI, 0.76 to 1.00] and 0.89 [95 percent CI, 0.79 to 0.99], respectively).

"Over a median of almost seven years of follow-up, we observed that the previously reported statistically significant reduction in the rate of cognitive impairment (composite of MCI or probable dementia) was maintained," the authors write.

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Multiple Sclerosis May Worsen With Menopause Transition

The menopausal transition may represent an inflection point for worsening of multiple sclerosis (MS) in women, according to a study published online Dec. 23 in Neurology.

Hannah E. Silverman, from the University of California San Francisco, and colleagues assessed the trajectory of objective functional outcomes and disease biomarkers in women with MS before and after menopause. The analysis included 184 postmenopausal women with MS followed for a median of 13 years.

The researchers found that the median age at natural menopause was 50 years (range, 33 to 60 years) and that 17 percent of participants used any systemic menopausal hormone therapy. The Multiple Sclerosis Functional Composite (MSFC) reached a worsening inflection point with menopause (slope difference, 0.08) and an increase in serum neurofilament light chain (slope difference, −0.95). For the Expanded Disability Status Scale (EDSS), the opposite was found (slope difference, 0.05). Significant findings persisted when adjusting for multiple covariates. Similar inflection points were found (within three years of the final menstrual period) for serum neurofilament light chain and EDSS but not MSFC when using additional nonlinear regression modeling.

"These findings suggest that further inquiry into the possible neurobiological effects of this major hormonal transition is warranted. Indeed, our results imply that changes in gonadal hormones may be associated with changes in functional and biological markers in MS," the authors write. "Further research should investigate possible clinical implications, including need for more targeted disease, symptom, and rehabilitation management around the time of menopause."

This analysis was supported through an investigator-initiated study sponsored by Genentech.

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Incidence, Prevalence of Peripartum Mental Illness Increased for Mothers With MS

Mothers with multiple sclerosis (MS) have an elevated incidence and prevalence of peripartum mental illness, according to a study published online Jan. 22 in Neurology.

Ruth Ann Marrie, M.D., from Dalhousie University in Halifax, Nova Scotia, Canada, and colleagues used linked population-based administrative health data to conduct a cohort study of mothers with MS, epilepsy, inflammatory bowel disease (IBD), and diabetes, as well as mothers without these diseases (comparators), who had a live birth between 2002 and 2017. The incidence and prevalence of mental illness was estimated during the prenatal period (PN) and three years postpartum.

Data were included for 894,852 mothers (1,745 with MS; 5,954 with epilepsy; 4,924 with IBD; 13,002 with diabetes; and 869,227 comparators). The researchers found that any incident mental illness affected 8.4 and 14.2 percent of mothers with MS prenatally and during the first postpartum year, respectively; the most common incident disorders were depression and anxiety. Compared with the PN period, the first postpartum year was a higher risk period (any mental illness incidence ratio, 1.27). Mothers with MS had an increased incidence of any mental illness during the PN and postpartum periods relative to comparator mothers (incidence ratios, 1.26 and 1.33 [during first postpartum year], respectively). Relative to comparator mothers, mothers with MS had an increased incidence of all specific mental illnesses except suicide attempt during the PN period. Any prevalent mental illness affected 42 and 50.3 percent of mothers with MS prenatally and in the first postpartum year, respectively.

"Given the potential adverse consequences for maternal and child health, clinicians caring for mothers with these diseases should be aware of these risks and ensure that recommended screening occurs, followed by appropriate treatment as needed," the authors write. "Greater attention to preventive interventions is also needed."

Several authors disclosed ties to the pharmaceutical industry.

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Sex Disparities Identified in Natural History of Tourette Syndrome

Females with Tourette syndrome (TS) are less likely than males to be formally diagnosed, with symptom onset and diagnosis occurring at a later age for females, according to a study published online Jan. 15 in Neurology.

Marisela E. Dy-Hollins, M.D., from Massachusetts General Hospital in Boston, and colleagues examined the relationship between sex and clinical measures in 2,403 participants (2,109 with TS and 294 with persistent motor or vocal tic disorders [PMVT]) from the Tourette Association of America International Consortium for Genetics dataset.

The researchers found that compared with males, female participants with TS had 0.46 times lower odds of being formally diagnosed clinically with TS before the research study, and they had a later age at symptom onset, later age at diagnosis, longer time to diagnosis, and lower tic severity. Earlier age at onset was seen for female versus male participants with PMVT.

"We demonstrated sex disparities in diagnosis of TS and sex differences in individuals with TS/PMVT," the authors write. "Because results may not be generalizable across all patients (including lack of diversity), future research efforts are focused on examining sex and gender as well as racial and ethnic differences in larger administrative datasets for TS/PMVT."

Two authors disclosed ties to the publishing industry.

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Higher Intake of Red Meat Linked to Increased Risk for Dementia

Higher intake of red meat, especially processed red meat, is associated with an increased risk for developing dementia and subjective cognitive decline (SCD), according to a study published online Jan. 15 in Neurology.

Yuhan Li, from the Harvard T.H. Chan School of Public Health in Boston, and colleagues conducted a prospective cohort study to examine the association between red meat intake and cognitive outcomes. Participants free of dementia at baseline from two nationwide cohort studies were included; a validated semiquantitative food frequency questionnaire was used to assess diets.

The researchers found that the risk for dementia and SCD was increased for participants with processed red meat intake ≥0.25 versus <0.1 serving per day (hazard ratio of 1.13 and relative risk of 1.14, respectively). Accelerated aging in global cognition and in verbal memory was seen in association with higher processed red meat intake (1.61 and 1.69 years per one serving per day increment, respectively). A higher risk for SCD was seen in association with unprocessed red meat intake of ≥1.00 versus <0.5 serving per day (relative risk, 1.16). Replacing processed red meat with one serving per day of nuts and legumes was associated with a lower risk for dementia (hazard ratio, 0.81), 1.37 fewer years of cognitive aging, and a lower risk for SCD (relative risk, 0.79).

"Replacing processed red meat with healthier protein sources such as fish, poultry, eggs, low-fat dairy, nuts, and legumes may have substantial benefits for maintaining cognitive health," the authors write.

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Automated Analysis of 2D Camera Recordings Improves Detection of Isolated REM Sleep Behavior Disorder

Automated analysis of two-dimensional (2D) camera recordings can improve performance for detecting isolated rapid eye movement (REM) sleep behavior disorder (iRBD), according to a study published online Jan. 9 in the Annals of Neurology.

Mohamed Abdelfattah, from École Polytechnique Fédérale de Lausanne in Switzerland, and colleagues evaluated the effectiveness of automated analysis of movements recorded on a 2D conventional camera to detect iRBD. The analysis included 172 video-polysomnogram recordings from a clinical sleep center (81 patients with iRBD and 91 non-RBD healthy controls [63 with a range of other sleep disorders and 28 healthy sleepers]).

The researchers found that patients with iRBD showed a higher number of shorter movements and immobility periods. Accuracies for detecting iRBD ranged from 84.9 percent (with two features) to 87.2 percent (with five features). The highest accuracy was seen by combining all five features but only analyzing short (0.1- to 2-second duration) movements (91.9 percent). Seven of the 11 patients with iRBD without noticeable movements during video-polysomnogram were correctly identified.

"This approach could be implemented in clinical sleep laboratories to facilitate and improve the diagnosis of iRBD," the authors write. "Coupled with automated detection of REM sleep, it should also be tested in the home environment using conventional infrared cameras to detect and/or monitor RBD."

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Medicare Patients Wait Average of 34 Days to See Neurologist After Referral

After being referred by their physician, Medicare patients wait an average of 34 days to see a neurologist, according to study published online Jan. 8 in Neurology.

Chun Chieh Lin, Ph.D., from The Ohio State University in Columbus, and colleagues conducted a cross-sectional study using a 2018 to 2019 Medicare sample of patients with a new visit to a neurologist. The primary outcome was wait time between the last visit with a referring physician and the first visit with a neurologist. A total of 163,313 Medicare beneficiaries who had a new patient visit with a neurologist in 2018 to 2019 after being referred by their physician were identified.

The researchers found that the median wait time to the index neurologist visit was 34 days; 18 percent of patients waited more than 90 days. Compared with patients with back pain, those with multiple sclerosis (MS), epilepsy, and Parkinson disease (PD) had to wait an average of 29.4, 10.4, and 9.3 days longer, respectively. No significant differences were seen in wait times across race/ethnicity and sex. No significant differences were seen in wait times across regions with varying levels of neurologist availability. The wait time was extended by an average of 11 days when patients visited a neurologist located outside of their residential or referring physician's hospital referral region.

"Patients with MS, epilepsy, and PD had to wait longer to see neurologists despite requiring complicated care best provided by neurologists," the authors write. "We need innovative approaches to improve timely access to neurologists."

Several authors disclosed ties to the medical device industry.

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