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Next in clinical practice: Automated real-time detection of seizures via wearable EMG devices

(A) The wear­able device placed on the brachial biceps mus­cles. (B, C) The wear­able device, which is con­nect­ed to the self-adhe­sive patch, con­tain­ing the record­ing elec­trodes and the ground elec­trode. (D) Remote con­trol of the device. (Epilep­tic seizure Detec­tor Devel­oped by Ictal­Care). Cred­it: Neu­rol­o­gy.

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Wear­able EMG Found to Detect Seizures (Neu­rol­o­gy Today):

A new study demon­strates the fea­si­bil­i­ty of using a wear­able elec­tromyo­g­ra­phy device to detect ton­ic-clonic seizures…The Neu­rol­o­gy paper was among the first to demon­strate its results prospec­tive­ly, using a pre-spec­i­fied cut-off for deter­min­ing that a GTCS is occur­ring. And at nine sec­onds, its laten­cy in doing so (from the time of onset as mea­sured by an inde­pen­dent observ­er) is also among the fastest described so far, the study authors and inde­pen­dent experts not­ed… Read the rest of this entry »

Study: Brain imaging not accurate or sensitive enough (yet) to detect Alzheimer’s disease in primary care settings

dementia_pet_imagingAccu­ra­cy of demen­tia brain imag­ing must improve (Uni­ver­si­ty of East Anglia release):

A report pub­lished today in The Lancet Neu­rol­o­gy eval­u­ates for the first time how well dif­fer­ent types of brain imag­ing tests work to detect Alzheimer’s and pre­dict how the dis­ease will progress.

The results show that the accu­ra­cy of brain imag­ing must be improved before it can be rolled out Read the rest of this entry »

Sensible and perplexing changes in ADHD diagnostic criteria (DSM-V)

Taking a Closer Look at ADHD Attention Deficit DisorderThe Amer­i­can Psy­chi­atric Asso­ci­a­tion recent­ly pub­lished DSM-V, the first major revi­sion to the diag­nos­tic man­u­al for psy­chi­atric dis­or­ders since 1994. In DSM-V, ADHD is includ­ed in the sec­tion on Neu­rode­vel­op­men­tal Dis­or­ders, rather than being grouped with the dis­rup­tive behav­ior dis­or­ders, i.e., Oppo­si­tion­al Defi­ant Dis­or­der and Con­duct Dis­or­der. This change bet­ter reflects the way ADHD is cur­rent­ly con­cep­tu­al­ized.

Below I review changes that have been made to the actu­al diag­nos­tic cri­te­ria for ADHD. Read the rest of this entry »

Shall we question the brand new book of human troubles

With three years still left until pub­li­ca­tion, the fights over the new ver­sion of the psy­chi­atric diag­nos­tic man­u­al, the DSM-V, are hot­ting up and The New York Times has a bookcon­cise arti­cle that cov­ers most of the main point of con­tention.

- “What you have in the end,  Mr. Short­er said, “is this process of sort­ing the deck of symp­toms into syn­dromes, and the out­come all depends on how the cards fall.

- Psy­chi­a­trists involved in prepar­ing the new man­u­al con­tend that it is too ear­ly to say for sure which cards will be added and which dropped.

Although I doubt the DSM com­mit­tee are using that exact metaphor, it cer­tain­ly illus­trates the point that the process requires a cer­tain degree of val­ue-judge­ment.

It’s inter­est­ing, how­ev­er, that the pub­lic debate is cur­rent­ly focused on whether cer­tain diag­noses should be includ­ed or not, rather than whether diag­no­sis itself is use­ful for psy­chi­a­try.

We’ve had psy­cho­met­rics for a good 100 years that allow us to mea­sure dimen­sions of human expe­ri­ence and per­for­mance with a much greater degree of accu­ra­cy than Read the rest of this entry »

Cognitive screenings and Alzheimer’s Disease

The Alzheimer’s Foun­da­tion of Amer­i­ca just released a thought­ful report advo­cat­ing for wide­spread cog­ni­tive screen­ings after the age of 65 (55 giv­en the right con­di­tions).

Accord­ing to the press release,

- “The report shat­ters unsub­stan­ti­at­ed crit­i­cism and instead empha­sizes the safe­ty and cost-effec­tive­ness of these tools and calls on Con­gress to devel­op a nation­al demen­tia screen­ing pol­i­cy.”

- “Lift­ing the bar­ri­ers to ear­ly detec­tion is long over­due, Hall said. “Con­ver­sa­tions about brain health are not tak­ing place. We must edu­cate and empow­er con­sumers to talk open­ly about mem­o­ry con­cerns, par­tic­u­lar­ly with pri­ma­ry care providers, so they get the atten­tion and qual­i­ty of life they deserve.

- “Demand for screen­ings is evi­denced by the suc­cess of AFA’s recent sixth annu­al Nation­al Mem­o­ry Screen­ing Day held on Novem­ber 18, dur­ing which an esti­mat­ed 50,000 peo­ple were giv­en free con­fi­den­tial mem­o­ry screen­ings at near­ly 2,200 com­mu­ni­ty sites nation­wide. Dur­ing last year’s event, approx­i­mate­ly 16 per­cent of indi­vid­u­als who had a face-to-face screen­ing scored pos­i­tive and were referred to their pri­ma­ry care providers for fol­low-up. An AFA sur­vey of par­tic­i­pants revealed that few­er than one in four with self-report­ed mem­o­ry com­plaints had pre­vi­ous­ly dis­cussed them with their physi­cians despite recent vis­its.”

Excel­lent report avail­able: here

Please note that the Alzheimer’s Asso­ci­a­tion recent­ly argued in the oppo­site direc­tion (no screen­ings) — which prob­a­bly trig­gered this response.

We see emerg­ing trends that sug­gest the posi­tion in favor of cog­ni­tive assess­ments may in fact gath­er momen­tum over the next few years: wide­spread com­put­er­ized cog­ni­tive screen­ings in the US Army, insur­ance com­pa­nies like OptumHealth adding such tools to its clin­i­cal deci­sion-mak­ing sys­tems, polls such as the Amer­i­can Soci­ety of Aging’s a cou­ple of years ago indi­cat­ing a very strong demand for an “annu­al men­tal check-up”, the avail­abil­i­ty of use­ful assess­ment tools and research-based pre­ven­tive advice.

The start­ing point is to under­stand what those assess­ments are NOT: they are not diag­nos­tic tools. When used prop­er­ly, they can be used as a base­line to track per­for­mance in a vari­ety of cog­ni­tive domains over time, so that both the indi­vid­ual AND the physi­cian are not blind­ed by a one-time assess­ment, com­par­ing an indi­vid­ual with his or her peers (instead of his or her past per­for­mance) when seri­ous symp­toms have fre­quent­ly already been going on for a while.

Our con­trib­u­tor  Dr. Joshua Sil­ver­man, from Albert Ein­stein Col­lege of Med­i­cine, recent­ly gen­er­at­ed a nice debate on the top­ic by ask­ing our read­ers their reac­tion to these 3 ques­tions: Read the rest of this entry »

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