Understanding post-stroke spasticity (PSS) treatment in everyday clinical practice may guide improvements in patient care.

This was a retrospective cohort study that used population-level administrative data. Adults (aged ≥18 years) who initiated PSS treatment (defined by the first PSS clinic visit, focal botulinum toxin injection, or anti-spasticity medication dispensation [baclofen, dantrolene and tizanidine] with none of these treatments occurring during the 2 years before the stroke) were identified between 2012 and 2019 in Alberta, Canada. Spasticity treatment use, time to treatment start and type of prescribing/treating physician were measured. Descriptive statistics were performed.

Within the cohort (n = 1,079), the most common PSS treatment was oral baclofen (initial treatment: 60.9%; received on/after the initial treatment date up to March 31, 2020: 69.0%), largely prescribed by primary care physicians (77.6%) and started a median of 348 (IQR 741) days after the stroke. Focal botulinum toxin (23.3%; 37.7%) was largely prescribed by physiatrists (72.2%) and started 311 (IQR 446) days after the stroke; spasticity clinic visits (18.6%; 23.8%) were also common.

We found evidence of gaps in provision of spasticity management in persons with PSS including overuse of systemic oral baclofen (that has common adverse side effects and lacks evidence of effectiveness in PSS) and potential underuse of focal botulinum toxin injections. Further investigation and strategies should be pursued to improve alignment of PSS treatment with guideline recommendations that in turn will support better outcomes for those with PSS.

Meningiomas are common brain neoplasms that can significantly influence health-related quality of life (HRQOL), yet the factors influencing HRQOL in adult patients remain unclear. We aimed to bridge this knowledge gap by determining these key factors.

We conducted a systematic review, searching EMBASE, MEDLINE, CINAHL, Scopus and PsycINFO up to February 2024. We included original, peer-reviewed studies focusing on adult patients (>18 years) with current or past meningioma at any stage of treatment that measured HRQOL or its proxies in relation to patient-, tumour- and treatment-related factors. Two independent reviewers screened abstracts and full-texts, selecting studies with an acceptable risk of bias for data extraction and narrative synthesis. The protocol of this review was registered on PROSPERO (# CRD42023431097).

Of N = 3002 studies identified, N = 31 studies were included. Key factors found to influence HRQOL in adult meningioma patients include surgery, radiotherapy, neurological function, functional status, comorbidities, sleep quality, psychological impairment, age and employment. Factors related to tumour characteristics yielded inconsistent findings. Heterogeneity and inconsistencies in HRQOL measurement across studies hindered definitive conclusions about the impact of factors on HRQOL.

Our review elucidates the multifaceted influences on HRQOL in meningioma patients, with significant variability due to patient-, tumour- and treatment-related factors. We emphasize the need for standardized, disease-specific HRQOL assessments in meningioma patients. Collaborative efforts towards consistent, large-scale, prospective research are essential to comprehensively understand and improve HRQOL, thereby enhancing tailored care for this population.

Migraine can affect adults during their most productive years, yet few studies in Canada have examined the relationship between migraine-related disability and productivity loss. In particular, the impact of migraine on unpaid productivity loss has not been quantified.

In this cross-sectional study, employed adults living with migraine were recruited from across Canada to complete a web-based questionnaire. Migraine-related disability was assessed using the Migraine Disability Assessment questionnaire, and productivity loss was evaluated using the Valuation of Lost Productivity questionnaire. Multiple regression models were used to quantify the association between migraine-related disability level and productivity loss after adjusting for relevant clinical, occupational and sociodemographic covariates.

There were 441 participants, of which 60.1% were female, and the mean (SD) age was 37.7 (10.9). Compared to participants with little to no migraine-related disability, hours of total productivity loss were higher among those with moderate disability (54.1 [95% CI: 10.2–98.1] adjusted hours per 3 months) and severe disability (110.5 [95% CI: 65.5–155.6] adjusted hours per 3 months); paid productivity loss was higher among participants with moderate disability (32.4 [95% CI: 3.1–61.8] adjusted hours per 3 months) and severe disability (61.6 [95% CI: 31.5–91.7] adjusted hours per 3 months); and unpaid productivity loss was greater in those with severe disability (43.5 [95% CI: 12.7–74.3] adjusted hours per 3 months).

Greater migraine-related disability was associated with more total, paid and unpaid productivity loss among employed adults. These data will be valuable when evaluating the cost-effectiveness of emerging migraine therapies.

Self-management practices can contribute to the lives of patients with multiple sclerosis. The aim of this study is to improve patients’ self-management abilities through a multidisciplinary developed module.

This prospective, randomized controlled trial was conducted between January 2020 and November 2021 at a university hospital in Ankara, Turkiye. The self-management module was implemented by a clinical pharmacist with the aim of enhancing self-management capabilities through an educational approach, with a focus on medication adherence, management of drug-related problems, follow-ups and self-directed activities. The intervention group completed the self-management module, while the control group received usual outpatient care. To evaluate the impact of the module, the Multiple Sclerosis Self-Management Revised scale was administered to the patients. Interviews were conducted at 4-month intervals.

Study (n = 102) and control group (n = 98) patients were followed up for 8 months, and the median duration of intervention was 11 minutes. The mean (± SD) self-management scores of the study group increased from 68.9 (± 9.3) to 79.0 (± 9.4) at the end of the interviews, and this increase was found to be significant compared to the control group (p < 0.001). The self-management module has been shown to improve self-management, medication adherence, perception of care and patient engagement in treatment (p < 0.001).

This single-center randomized controlled trial suggests that a pharmacist-implemented self-management module increased patient engagement and medication adherence. The self-management interventions could be tailored to groups that tend to have lower self-management abilities, such as older individuals, and those who have lower educational attainment, health engagement or medication adherence.

Most patients with internuclear ophthalmoplegia (INO) are orthotropic, although a subset is exotropic. When INO is bilateral, this is termed wall-eyed bilateral internuclear ophthalmoplegia (WEBINO). In 1979, Sharpe described his “first case” of wall-eyed monocular internuclear ophthalmoplegia (WEMINO) as “a unique clinical syndrome” characterized by unilateral INO and ipsilateral exotropia.

WEMINO was clinically identified in seven patients, with oculographic correlation in six and neuropathological confirmation in one. Oculographic features of exotropic INO patients were compared with those of six orthotropic INO patients using magnetic search coil and infrared oculography.

All clinically defined WEMINO patients showed slowed, hypometric ipsilateral saccades by oculography. Six patients had ipsilateral exotropia, and three had ipsilateral hypertropia. Ipsilateral abducting saccades had faster peak velocities for smaller saccades, more so for orthotropic patients. Exotropic patients had normal sinusoidal mean vestibulo-ocular reflex (VOR) gains and phases; orthotropic patients had subnormal mean VOR gains and phase leads.

WEMINO is a clinical ocular motor syndrome characterized by unilateral slow, hypometric adducting saccades with exotropia and hypertropia of the ipsilateral eye. We propose that it results from discrete unilateral damage to burst-tonic fibers in the medial longitudinal fasciculus (MLF) with sparing of the adjacent extrafascicular pathways. Paradoxically, orthotropic INO results from more extensive damage to ascending pathways lateral, ventral and caudal to the MLF. Direct injury to the medial rectus subnucleus is not required. This manuscript was in preparation at the time of Dr Sharpe’s death in 2013 and is an acknowledgement of his forward-thinking, as his hypotheses have stood the test of time.