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Fundamentals of the Neurologic Exam and Other Considerations in the Setting of Progressive Neurological Disease

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Urological Care for Patients with Progressive Neurological Conditions

Abstract

The neurologic exam plays a critical role in the care of patients with progressive neurological conditions. It is through an exam that the degree of progression can be determined and the foundations of care plans be established. Key elements of the neurologic exam include the mental status exam (cognition, language, and speech), evaluation of cranial nerves I to XII, tests of motor, sensory, and cerebellar systems, reflexes, and gait. The clinician should also be wary of other non-neurologic medical conditions which can confound the neurologic exam.

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References

  1. Lublin FD, Reingold SC, Cohen JA, et al. Defining the clinical course of multiple sclerosis: the 2013 revisions. Neurology. 2014;83:278–86.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Noonan CW, Williamson DM, Henry JP, Indian R, Lynch SG, et al. The prevalence of multiple sclerosis in 3 US communities. Prev Chronic Dis. 2010;7:A12.

    PubMed  Google Scholar 

  3. Noonan CW, Kathman SJ, White MC. Prevalence estimates for MS in the United States and evidence of an increasing trend for women. Neurology. 2002;58:136–8.

    Article  PubMed  Google Scholar 

  4. Katz Sand I, Krieger S, Farrell C, Miller AE. Diagnostic uncertainty during the transition to secondary progressive multiple sclerosis. Mult Scler Journal. 2014;20:1654–7.

    Article  Google Scholar 

  5. Bove R, Chitnis T. Sexual disparities in the incidence and course of MS. Clin Immunol. 2013;149:201–10.

    Article  CAS  PubMed  Google Scholar 

  6. Verghese, A. The Stanford Medicine 25: Gait Abnormalities. 2019. Retrieved from https://stanfordmedicine25.stanford.edu/the25/gait.html

    Google Scholar 

  7. Hausdorff JM. Gait dynamics in Parkinson’s disease: Common and distinct behavior among stride length, gait variability, and fractal-like scaling. CHAOS. 2009;19:026113. https://doi.org/10.1063/1.3147408.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Burn D. Parkinsonism, International Parkinson and Movement Disorder Society. 2019. Retrieved from https://www.movementdisorders.org/MDS/About/Movement-Disorder-Overviews/Parkinsons-Disease%2D%2DParkinsonism.html.

  9. Casella G, Santilli I, Bella C, Crisafuli V, Villanacci V, Baldini V, Bassotti G. Cerebellar Ataxia, Celiac Disease and Non-Celiac Gluten Sensitivity. Archives of Neuroscience. 2017;4(2):e44187. https://doi.org/10.5812/archneurosci.44187.

    Article  Google Scholar 

  10. Ebraheim, N. Trendelenberg Gait-Everything you need to know, Jan 23, 2014, Retrieved from https://www.youtube.com/watch?v=HE0lk5MVFEg.

    Google Scholar 

  11. Abnormal Gait Demonstration: Choreiform Gait Demonstration, June 10, 2010, online medical video Retrieved from [https://www.youtube.com/watch?v=QORlwMeWOeU].

  12. Topical diagnosis in neurology. 3rd revised edition. Peter Duus Thieme. 1998.

    Google Scholar 

  13. Miller A, editor. Handbook of relapsing remitting multiple sclerosis: Springer; 2017. ISBN 978-3-319-40628-2.

    Google Scholar 

  14. Deloire M, Ruet A, Hamel D, et al. Early cognitive impairment in multiple sclerosis predicts disability outcome several years later. Multiple Sclerosis Journal. 2010;16(5):581–7.

    Article  PubMed  Google Scholar 

  15. Planche V, Gibelin M, Cregut D, Pereira B, Clavelou P. Cognitive impairment in a population-based study of patients with multiple sclerosis: differences between late relapsing−remitting, secondary progressive and primary progressive multiple sclerosis. European journal of neurology. 2016;23(2):282–9.

    Article  CAS  PubMed  Google Scholar 

  16. Amato MP, Ponziani G, Siracusa G, Sorbi S. Cognitive dysfunction in early-onset multiple sclerosis: a reappraisal after 10 years. JAMA Neurol. 2001;58:1602–6.

    CAS  Google Scholar 

  17. Langdon DW, Thompson AJ. Multiple sclerosis: a preliminary study of selected variables affecting rehabilitation outcome. Mult Scler. 1999;5(2):94–100.

    Article  CAS  PubMed  Google Scholar 

  18. Rao SM, et al. Cognitive dysfunction in multiple sclerosis. II. Impact on employment and social functioning. Neurology. 1991;41(5):692–6.

    Article  CAS  PubMed  Google Scholar 

  19. Wilkins A, editor. Progressive multiple sclerosis. 2nd ed: Springer. ISBN 978-3-319-65921-3.; 2018.

    Google Scholar 

  20. Mills EA, Mirza A, Mao-Draayer Y. Emerging Approaches for Validating and Managing Multiple Sclerosis Relapse. Front Neurol. 2017;8:116.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Marrie RA, Fisk JD, Tremlett H, et al. Differences in the burden of psychiatric comorbidity in MS vs the general population. Neurology. 2015;85:1972–9.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Sabanagic-Hajric S, Suljic E, Sulejmanpasic-Arslanagic G. Depression during multiple sclerosis relapse: relation to disability and relapse severity. Med Glas Off Publ Med Assoc Zenica-Doboj Cant Bosnia Herzeg. 2016;13:44–9.

    Google Scholar 

  23. Bombardier CH, Blake KD, Ehde DM, Gibbons LE, Moore D, Kraft GH. Alcohol and drug abuse among persons with multiple sclerosis. Mult Scler Houndmills Basingstoke Engl. 2004;10:35–40.

    Article  CAS  Google Scholar 

  24. Merlino G, Fratticci L, Lenchig C, et al. Prevalence of “poor sleep” among patients with multiple sclerosis: an independent predictor of mental and physical status. Sleep Med. 2009;10:26–34.

    Article  CAS  PubMed  Google Scholar 

  25. Najafi MR, Toghianifar N, Etemadifar M, Haghighi S, Maghzi AH, Akbari M. Circadian rhythm sleep disorders in patients with multiple sclerosis and its association with fatigue: A case-control study. J Res Med Sci Off J Isfahan Univ Med Sci. 2013;18:S71–3.

    Google Scholar 

  26. Bamer AM, Johnson KL, Amtmann DA, Kraft GH. Beyond fatigue: Assessing variables associated with sleep problems and use of sleep medications in multiple sclerosis. Clin Epidemiol. 2010;2010:99–106.

    Article  PubMed  Google Scholar 

  27. Marrie RA, Rudick R, Horwitz R, et al. Vascular comorbidity is associated with more rapid disability progression in multiple sclerosis. Neurology. 2010;74:1041–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Negrotto L, Farez MF, Correale J. Immunologic Effects of Metformin and Pioglitazone Treatment on Metabolic Syndrome and Multiple Sclerosis. JAMA Neurol. 2016;73:520–8.

    Article  PubMed  Google Scholar 

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Disclosures/Conflict of Interest

CD and MS have no conflicts of interest to disclose. YMD has received consulting and/or speaker fees from Biogen, Bayer Pharmaceutical, Novartis, Celgene, Teva, Genentech, Sanofi-Genzyme, and EMD Serono. YMD has also received research support from NIH NINDS R01-NS080821, NIAID Autoimmune Center of Excellence UM1-AI110557, PCORI, Sanofi-Genzyme, Novartis, and Chugai.

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This paper did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Correspondence to Yang Mao-Draayer .

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Mao-Draayer, Y., Dowling, C., Singh, M. (2020). Fundamentals of the Neurologic Exam and Other Considerations in the Setting of Progressive Neurological Disease. In: Stoffel, J.T., Dray, E.V. (eds) Urological Care for Patients with Progressive Neurological Conditions. Springer, Cham. https://doi.org/10.1007/978-3-030-23277-1_5

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  • DOI: https://doi.org/10.1007/978-3-030-23277-1_5

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-23276-4

  • Online ISBN: 978-3-030-23277-1

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