Notes

Brainstem and limbic encephalitis using paraneoplastic neuromyelitis optica.
Bupropion has not been associated with an increase in adverse events in smoking cessation trials. More research is needed on the long-term effectiveness and safety of bupropion in this population.
To review the literature about cycling and health, and to provide an overview and discussion of the available evidence.

The MeSH terms
and
were searched in PubMed. Clinical trials, practice reviews, and systematic reviews were included. All reference lists were reviewed for additional articles.

Climate change is a threat to health. In Canada alone, transportation is the second largest source of greenhouse gas emissions. Active transportation, which is any form of human-powered transportation, can mitigate the health effects of the climate crisis while simultaneously improving the health of people. Physical activity improves overall well-being, as well as physical and mental health. Active transportation, particularly cycling, is a convenient way to meet physical activity targets, reduce risk of disease and all-cause mortality, and derive mental health and social benefits. Family physician advocacy for active transportation has been shown to increase cycling levels in patients compared with no physician advocacy.

Family physicians can help to increase the level of active transportation at the individual patient level through patient education and behaviour change counseling; at the community level through community education and political advocacy; and at the policy level through partnerships with larger organizations.
Family physicians can help to increase the level of active transportation at the individual patient level through patient education and behaviour change counseling; at the community level through community education and political advocacy; and at the policy level through partnerships with larger organizations.
Many previous studies, mostly performed in Western countries, on the effects of lifestyle factors on Parkinson's disease, used baseline lifestyle characteristics without directly accounting for changes in covariate values over time. The objective of this study was to evaluate the association of repeatedly measured lifestyle factors with Parkinson's disease risk in Korean population.

We conducted a nationwide population-based cohort study. Among 512,836 Koreans in the national health checkup database, we selected individuals who underwent health screening ≥ 3 times between 2002 and 2015 and followed up until December 31, 2015. Parkinson's disease was defined using the International Classification of Diseases, Tenth Revision code G20 (with ≥ 3 times clinic visits for PD, to increase the diagnostic validity). Data on lifestyle factors such as smoking, alcohol consumption, and physical activity were collected using self-reported questionnaires. Logistic regression analysis with time-dependent covariates usingtors in those without regular health screening had a decreased relationship with PD, even smoking habit.

Analysis using repeatedly measured lifestyle factors showed an association between lifestyle factors and Parkinson's disease development. Characteristics of lifestyle data including repeated measurements, timing, or regularity might influence results, and future studies with appropriate lifestyle factors could increase Parkinson's disease risk prediction.

This study provides Class II evidence that smoking, alcohol use, and physical activity are associated with reduced risk of Parkinson's disease in a Korean population.
This study provides Class II evidence that smoking, alcohol use, and physical activity are associated with reduced risk of Parkinson's disease in a Korean population.
To characterize the association of onset to puncture time (OPT) with clinical outcomes among patients with acute basilar artery occlusion receiving endovascular therapy (EVT) in clinical practice.

Using the EVT for Acute Basilar Artery Occlusion (BASILAR) study, we identified consecutive patients with acute basilar artery occlusion receiving EVT in 47 comprehensive stroke centers in China from January 2014 to May 2019. The primary outcome was favorable functional outcome (defined as modified Rankin Scale score [mRS] 0-3) at 90 days. Secondary outcomes included function independence (mRS 0-2), mortality, and symptomatic intracerebral hemorrhage. The associations of OPT with clinical outcomes were analyzed using multivariable logistic regression (OPT as a categorical variable) and restricted cubic spline regression (OPT as a continuous variable).

Among 639 eligible patients, the median age was 65 years, and median OPT was 328 min (interquartile range, 220-490). Treatment within 4-8 hours and 8-12 hours werbetter outcomes.
This study provides Class II evidence that for patients with acute ischemic stroke due to basilar artery occlusion, earlier endovascular treatment is associated with better outcomes.
We compared heart rate variability (HRV) in sudden unexpected death in epilepsy (SUDEP) cases and living epilepsy controls.

This international, multicenter, retrospective, nested case-control study examined patients admitted for video-EEG monitoring (VEM) between January 1, 2003 and December 31, 2014, and subsequently died of SUDEP. Time-domain and frequency-domain components were extracted from five-minute interictal electrocardiogram recordings during sleep and wakefulness from SUDEP cases and controls.

We identified 31 SUDEP cases and 56 controls. Normalized low-frequency power (LFP) during wakefulness was lower in SUDEP cases (median 42.5, IQR 32.6-52.6) than epilepsy controls (55.5, IQR 40.7-68.9;
=0.015, critical value=0.025). In the multivariable model, normalized LFP was lower in SUDEP cases compared to controls (contrast -11.01, 95% CI -20.29--1.73;
=0.020, critical value=0.025). There was a negative correlation between LFP and the latency to SUDEP, where each 1% incremental reduction in normalized LFP conferred a 2.7% decrease in the latency to SUDEP (95% CI 0.95-0.995;
=0.017, critical value=0.025). Increased survival duration from VEM to SUDEP was associated with higher normalized high-frequency power (HFP;
=0.002, critical value=0.025). The survival model with normalized LFP was associated with SUDEP (C-statistic 0.66, 95% CI 0.55-0.77), which non-significantly increased with the addition of normalized HFP (C-statistic 0.70, 95% CI 0.59-0.81;
=0.209).

Reduced short-term LFP, which is a validated biomarker for sudden death, was associated with SUDEP. S961 Increased HFP was associated with longer survival and may be cardioprotective in SUDEP. HRV quantification may help stratify individual SUDEP risk.

This study provides Class III evidence that in patients with epilepsy, some measures of heart rate variability are associated with SUDEP.
This study provides Class III evidence that in patients with epilepsy, some measures of heart rate variability are associated with SUDEP.ObjectiveTo test the hypothesis that CT hypoperfusion-hypodensity mismatch identifies patients with ischemic stroke within 4.5 hours of symptom onset.MethodsWe therefore performed the "retrospective multicenter hypoperfusion-hypodensity mismatch for the identification of patients with stroke within 4.5 hours study" of patients with acute ischemic stroke and known time of symptom onset. The predictive values of hypoperfusion-hypodensity mismatch for the identification of patients with symptom onset within 4.5 hours were the main outcome measure.ResultsOf 666 patients, 548 (82.3 %) had multimodal CT within 4.5 hours and 118 (17.7%) beyond. Hypoperfusion-hypodensity mismatch was visible in 516 (94.2%) patients with symptom onset within and in 30 (25.4%) patients beyond 4.5 hours. CT hypoperfusion-hypodensity mismatch identified patients within 4.5 hours of stroke onset with 94.2% (95% CI 91.9-95.8%) sensitivity, 74.6% (95% CI 66.0-81.6%) specificity, 94.5% (95% CI 92.3-96.1%) positive predictive value, and 73.3% (95% CI 64.8-80.4%) negative predictive value. Interobserver agreement for hypoperfusion-hypodensity mismatch was substantial (κ=0.61, 95% CI 0.53-0.69).ConclusionsIn conclusion, patients with acute ischemic stroke with absence of a hypodensity on native CT within the hypoperfused core lesion on perfusion CT (hypoperfusion-hypodensity mismatch) are likely to be within the time window of thrombolysis. Applying this method may guide the decision to use thrombolysis in patients with unknown time of stroke onset.Classification of EvidenceThis study provides Class III evidence that CT hypoperfusion-hypodensity mismatch identifies patients with stroke within 4.5 hours of onset.
Cognitive impairment in multiple sclerosis (MS) is associated with functional connectivity abnormalities. While there have been calls to use functional connectivity measures as biomarkers there remains to be a full understanding of why they are affected in MS. In this cross-sectional study we tested the hypothesis that functional network regions may be susceptible to disease-related 'wear-and-tear' and that this can be observable on co-occuring abnormalities on other MR metrics. We tested whether functional connectivity abnormalities in cognitively impaired MS patients co-occur with either 1) overlapping, 2) local, or 3) distal changes in anatomical connectivity and cerebral blood flow abnormalities.

Multimodal 3T MRI and assessment with the Brief Repeatable Battery of Neuropsychological tests was performed in 102 relapsing-remitting MS patients and 27 healthy controls. MS patients were classified as cognitively impaired if they scored ≥1.5 standard deviations below the control mean on ≥2 tests (n=55), orare accompanied with local cerebral blood flow and structural connectivity abnormalities but also demonstrate that these effects do not occur in exactly the same location. Our findings suggest a possibly shared pathological mechanism for altered functional connectivity in brain networks in MS.
We provide the first evidence that FC abnormalities are accompanied with local cerebral blood flow and structural connectivity abnormalities but also demonstrate that these effects do not occur in exactly the same location. Our findings suggest a possibly shared pathological mechanism for altered functional connectivity in brain networks in MS.
To determine the significance of patent foramen ovale (PFO) in childhood stroke, we compared PFO prevalence, PFO features, and stroke recurrence risk in 25 children with cryptogenic arterial ischemic stroke (AIS), 54 children with AIS from a known etiology, and 209 healthy controls.

We performed a case-control analysis of a 14-year prospectively enrolled single-center cohort of children with AIS who underwent transthoracic echocardiogram (TTE) and compared them to TTEs of otherwise healthy children evaluated for benign cardiac concerns. Stroke patients aged 29 days to 18 years at stroke ictus with confirmed acute AIS on imaging, availability of complete diagnostic studies of stroke risk factors including TTE images available for central review, and at least one follow-up evaluation after index stroke were included.Presence of PFO and high risk PFO features were assessed by 2 independent, blinded reviewers and compared between groups using Fisher's exact test. Stroke/TIA recurrence risk was determined using Cox proportional hazards models.
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