News in brief: MRI defines Friedreich ataxia progression; Three tests double ER vertigo diagnoses; Doctors hit the bottle to relieve pandemic distress

6 Sep 2021

Tracking neuroanatomical changes could help clinicians stage FRDA

Neuroanatomical changes could help clinicians track Friedreich ataxia (FRDA) progression and treatment efficacy, according to an Australian-led study.

Neuroscientists at Monash University assessed regional brain volume in 248 FRDA patients and 262 healthy controls via MRI.

Their study found significant differences in FRDA patients’ brain stem, dentate nucleus and superior and inferior cerebellar peduncle volume versus controls, with greater volume deficits in those with longer or more severe disease.

“Subgrouping showed these to be robust and early features of FRDA, and strong candidates for further biomarker validation,” the authors wrote in Annals of Neurology.

Cerebral white matter abnormalities, particularly in corticospinal pathways, emerged as intermediate disease features, while cerebellar and cerebral grey matter loss preferentially occurred in motor and sensory systems (lobules I–IV and precentral gyri), in later disease.

“FRDA is defined by an evolving spatial profile of neuroanatomical changes beyond primary pathology in the cerebellum and spinal cord, in line with its progressive clinical course,” the authors said.

“The design, interpretation, and generalisation of research studies and clinical trials must consider neuroanatomical staging and associated inter-individual variability in brain measures,” they suggested

More work is needed to validate superior cerebellar peduncle and dentate nucleus volumetric changes as biomarkers of disease progression and treatment monitoring, the authors concluded.

Three tests double ER vertigo diagnoses

Three tools helped double an emergency department’s vertigo diagnosis rate, according to Australian researchers.

Their prospective observational study of 539 patients showed a structured history and examination, nystagmus video-oculography in all patients and video head-impulse testing for acute-vestibular-syndrome allowed blinded assessors to diagnose vertigo in 86% of patients versus 41% on standard management.

“Many patients attending the emergency room (ER) with vertigo, leave without a diagnosis,” the authors wrote in the Journal of Neurology.

These tools helped improve vertigo diagnosis in the ER, they concluded.

Doctors hit the bottle to relieve pandemic distress

Alcohol is one of the main coping strategies used by Australian healthcare workers in response to the pandemic, a national survey has revealed.

Conducted in September 2020, the survey on wellbeing and coping strategies elicited responses from 7846 frontline healthcare workers including more than 2400 medical staff, and showed that over a quarter (26.3%) reported increased alcohol use.

The most commonly reported adaptive coping strategies were exercise (45%), social connections (32%) and yoga or meditation (26%), whereas few used workplace support programs (6%) or sought help from a doctor or psychologist (18%).

Use of alcohol was associated with poor mental health and worse personal relationships, the study found.

The study investigators said the widespread use of maladaptive coping strategies by healthcare workers during the second wave highlighted an urgent need to improve access and uptake of professional support services for psychological distress.

Read more in General Hospital Psychiatry

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