A nationwide survey on clinical neurophysiology education in Italian schools of specialization in neurology

Introduction Clinical neurophysiology deals with nervous system functions assessed with electrophysiological and ultrasound-based imaging techniques. Even though the need for highly specialized neurophysiologists has increased, residency training rarely takes today’s requirements into account. This study aimed to snapshot the neurophysiological training provided by Italian specialization schools in neurology. Methods A single-page web-based survey comprising 13 multiple-choice categorical and interval scale questions was sent via e-mail to neurology specialization school directors. The survey addressed the programs’ structural neurophysiology organization, time dedicated to each clinical neurophysiology subspecialty, and descriptors assessing the discipline’s importance (e.g., residents who attempted residential courses, gained certifications, or awards gained). Results The most studied neurophysiological techniques were electroencephalography (EEG) and electromyography (EMG). Most specialization schools devoted less than 3 months each to multimodal evoked potentials (EPs), ultrasound sonography (US), and intra-operative monitoring. Of the 35 specialization schools surveyed, 77.1% reported that four students, or fewer, participated in the Italian Society of Clinical Neurophysiology Examination in Neurophysiology. Of the 35 specialization centers surveyed, 11.4% declared that the final evaluation required students to discuss a neurophysiological test. Discussion Our survey underlined the poorly standardized technical requirements in postgraduate neurology specialization schools, wide variability among training programs, and limited training on multi-modal evoked potentials, intraoperative monitoring, and sonography. These findings underline the need to reappraise and improve educational and training standards for clinical neurophysiology during postgraduate specialization schools in neurology with an international perspective.

Fact retrieval or compacted procedures in arithmetic – a neurophysiological investigation of two hypotheses

ABSTRACTThere is broad consensus that adults solve single-digit multiplication problems almost exclusively by fact retrieval (i.e., retrieval of the solution from an arithmetic fact network). In contrast, there has been a long-standing debate on the cognitive processes involved in solving single-digit addition problems. This debate has evolved around two theoretical accounts. The fact-retrieval account postulates that these are solved through fact retrieval, just like multiplications, whereas the compacted-procedure account proposes that solving very small additions (i.e., problems with operands between 1 and 4) involves highly automatized and unconscious compacted procedures. In the present electroencephalography (EEG) study, we put these two accounts to the test by comparing neurophysiological correlates of solving very small additions and multiplications. A sample of 40 adults worked on an arithmetic production task involving all (non-tie) single-digit additions and multiplications. Afterwards, participants completed trial-by-trial strategy self-reports. In our EEG analyses, we focused on induced activity (event-related synchronization/desynchronization, ERS/ERD) in three frequency bands (theta, lower alpha, upper alpha). Across all frequency bands, we found higher evidential strength for similar rather than different neurophysiological processes accompanying the solution of very small addition and multiplication problems. This was also true when n + 1 and n × 1 problems were excluded from the analyses. In two additional analyses, we showed that ERS/ERD can differentiate between self-reported problem-solving strategies (retrieval vs. procedure) and even between n + 1 and n + m problems in very small additions, demonstrating its high sensitivity to cognitive processes in arithmetic. The present findings clearly support the fact-retrieval account, suggesting that both very small additions and multiplications are solved through fact retrieval.HIGHLIGHTSNeurophysiological test of fact retrieval and compacted procedures accountInduced EEG data are sensitive to cognitive processes in arithmetic problem solvingBoth very small additions and multiplications are solved through fact retrieval

Other and other waters in the river: Autism and the futility of prediction

Autism has been described as a neural deficit in prediction, people with autism manifest low perceptual construal and are impaired at traversing psychological distances, and Gilead et al.'s hierarchy from iconic to multimodal to fully abstract, socially communicated representations is exactly the hierarchy of representational impairment in autism, making autism a natural behavioural and neurophysiological test case for the prediction–abstraction relationship.

Making an objective diagnosis of tetanus—utility of a simple neurophysiological test

Tetanus remains a significant cause of mortality especially in the developing world. Early diagnosis and institution of treatment is critical to prevent fatal complications. The diagnosis is made on clinical grounds, which may sometimes be difficult, especially in case of localised tetanus. Being able to diagnose tetanus objectively is invaluable in such cases. In this regard, masseter inhibitory reflex (MIR) is a simple neurophysiological test that can be performed at the bedside. Herein, we report a case of craniocervical tetanus that was objectively diagnosed using MIR and adequately treated.

Influence of Learning Disabilities on the Neurophysiological and Neuropsychological Health in Athletes with a History of Concussion

ObjectiveThe aim of present study was to investigate the role of LD on neuropsychiatric and neurophysiological recovery following concussion.BackgroundIt is estimated that roughly 20% of athletes suffer from a neurodevelopmental disorder (ND). Although concussion research has primarily focused on attention deficit hyperactivity disorder (ADHD), the influence of other NDS, such as learning disorder (LD) on concussion outcomes remains relatively unknown.Design/MethodsSeventy-five athletes (24 healthy control, 24 concussed, and 27 concussed-LD) completed a neuropsychiatric and neurophysiological test battery; including the Beck Depression Inventory (BDI), profile of mood states (POMS), and modified CogState Brain Injury Test battery. Additionally, event-related potentials were recorded during an experimental odd ball task. All athletes were matched based on age, education, BMI, and sport played. Athletes with a history of concussion were further matched on time since injury and number of previous injuries.ResultsConcussion-LD athletes reported significantly greater depressive symptoms compared to matched concussed and healthy control athletes (p < 0.05). When decomposed, the group differences in depressive symptoms were driven by cognitive and affective depression sub-scales (p’s < 0.05), not somatic depression (p > 0.05). Additionally, concussion-LD athletes demonstrated greater cognitive deficits characterized by increased learning errors and decreased working memory (p’s < 0.05). Furthermore, neurophysiological analyses revealed that Concussed-LD athletes exhibited significantly delayed P3b latency (p < 0.05). Finally, irrespective of LD status, athletes with a history of concussion reported increased overall mood disturbances, as well as ratings of anger and hostility compared to controls (p < 0.05).ConclusionsOur results suggest that athletes with concussed athletes with LD may exhibit chronic neuropsychiatric and neurophysiological deficits beyond that of their concussed counterparts (without LD). Further research is needed to better understand the relationship between LD and concussion outcomes.

Parkinsonism with a Hint of Huntington’s from 29 CAG Repeats in HTT

Huntington’s disease is caused by at least 36 cytosine-adenine-guanine (CAG) repeats in an HTT gene allele, but repeat tracts in the intermediate range (27–35 repeats) also display a subtle phenotype. This patient had a slightly elongated CAG repeat tract (29 repeats), a prominent family history of Parkinson’s disease (PD), and a clinical phenotype mostly consistent with PD, but early dystonia and poor levodopa response. Neurophysiological test results were more consistent with Huntington’s disease (HD) than PD. It is suggested that the intermediate allele modulated the clinical phenotype of PD in this patient.

Utility of neurophysiology in the diagnosis of tethered cord syndrome

OBJECT The diagnosis of tethered cord syndrome (TCS) remains difficult, and the decision to operate is even more complex. The objective of this study was to examine how detailed examination of neurophysiological test results can affect the diagnosis for patients undergoing a surgical cord release. METHODS Patients undergoing tethered spinal cord releases were matched by age and sex with control patients undergoing scoliosis correction in the absence of spinal cord pathology. The latency and width of the P37 peak of the posterior tibial nerve somatosensory evoked potential (SSEP) and the motor evoked potential (MEP) latencies were examined. Immediate changes as a result of the surgical procedure were reported. RESULTS The width of the P37 response differed significantly between TCS and control patients and changed significantly during the surgical procedure. Nonsignificant trends were seen in SSEP and MEP latencies. CONCLUSIONS The width of the P37 response may be a useful marker for TCS and may play a role in presurgical decision making.