Resident & Fellow Section

Featured Commentaries

The Remote Evaluation of Vertigo in the era of Teleneurology

January 13, 2021 | Katherine Fu, MD

The COVID-19 pandemic has catalyzed an increased adoption of teleneurology in lieu of in-person clinic visits.¹ There are multiple benefits of teleneurology, including increasing access to neurologic expertise in areas where neurologic subspecialists may be limited and decreasing physician and patient travel time, among others.² However, teleneurology likewise has limitations, and many neurologists have had to adapt to the new interface.

[Continued]

By Katherine Fu, MD | January 13, 2021

Training in Neurology

The COVID-19 pandemic affects neurologic care and how clinicians treat conditions during this time. We plan to highlight blogs from residents and fellows on their experiences during the pandemic, and we hope these will be useful teaching tools for other residents and fellows around the globe.

Additional Invited Commentaries

Ricardo Lopez Castellanos, MD
Neurology Residents as Frontline Workers – When it All Comes Down to Priorities

Daniel G. Di Luca, MD
COVID-19 and Guillain-Barré Syndrome: Expanding the Clinical Phenotype
[Read Post]

Stephanie Reyes, MS4, University of Michigan Medical School
Reflections on Virtual Interviews for Neurology Residency Applicants in the era of COVID-19
[Read Post]

Ariel Lyons-Warren, MD, PhD; Robert Hurford, MD; Roy Strowd, MD
Training in Neurology: A renewed subsection
[Read Post]

Aaron S. Zelikovich, Eric C. Lawson, and Matthew S. Robbins
The Role of Twitter in Neurology Residency Recruitment in 2020 and Beyond
[Read Post]

Other Residents & Fellows News

Roy Strowd
Welcoming a New Team: excited for a new team of RFS resident editors
[Read Post]

Jens Witsch
Invited Commentary: Rule out this, rule in that: strokes and stroke mimics
[Read Post]

December 28, 2020

View All Featured Commentaries

January 19 e-Pearl of the Week: Cramp Fasciculation Syndrome
e-Pearls archive: Now Searchable! | Submit an e-Pearl

Cramp Fasciculation Syndrome

Cramp-fasciculation syndrome (CFS) is a rare, benign condition within the spectrum of peripheral nerve hyperexcitability(PNH) disorders. CFS presents with spontaneous cramps, fasciculation, stiffness and pain, ^[1] most commonly in the leg with no associated dysautonomia or encephalopathy. The underlying pathogenesis is the instability of distal motor axon^[1]. While 24% of CFS patients had autoantibodies against voltage-gated potassium channels, ^[3][4] the target antigen is unknown^[2] as opposed to antigens CASPR2 and less likely LGI1 that are involved in the PNH spectrum disorders like Morvan and Issac syndromes. CFS is also seen accompanying genetic or autoimmune dysfunction of ion channels, peripheral neuropathy, anterior-horn-cell disease, metabolic abnormalities or tumours (most commonly thymoma). ^[4]Needle EMG shows localized fasciculation potentials with normal motor unit and recruitment pattern^.[5][6]Myokymic discharges are absent in CFS. Laboratory work may show elevation of creatine kinase up to twice the normal upper limit in some patients.^[1] CFS is usually self-limiting with an excellent prognosis. Refractory cases require pharmacological interventions with membrane stabilizers such as carbamazepine for idiopathic cases^[1]while steroids or plasmapheresis are used for autoimmune etiologies.^[2]

References
1. Tahmoush AJ, Alonso RJ, Tahmoush GP, Heiman-Patterson TD. Cramp,fasciculation syndrome. Neurology 1991; 41: 1021. doi: 10.1212/WNL.41.7.1021
2. Lagueny, A. Cramp-fasciculation syndrome. Revue Neurologique 2005;161 (12 Pt 1): 12606.
3. Hart I, Maddison P, Newsom-Davis J, Vincent A, Mills KR. Phenotypic Variants of Autoimmune Peripheral Nerve Hyperexcitability. Brain 2002; 125:1887-1895.
4. Liewluck T, Klein CJ, Jones LK Jr. Cramp-fasciculation syndrome in patients with and without neural autoantibodies. Muscle Nerve 2014; 49:351-356.
5. Harrison TB, Benatar M. Accuracy of repetitive nerve stimulation for diagnosis of the cramp-fasciculation syndrome. Muscle Nerve 2007; 35:776-780.
6. Poyraz M, Matur Z, Aysal F, Tuzun E, Hanoglu L, Oge AE. Clinical, Electrophysiological, and Serological Evaluation of Patients with Cramp-Fasciculation Syndrome. Noro Psikiyatr Ars 2017;54:183-186. doi:10.5152/npa.2016.14816
Submitted by Schweta Rane, MBBS, University of Texas Medical Branch, Texas and Faisal Khan, MD, DABSM, DABPN, Consultant Neurologist, Sugar Land Neurology and Sleep, Texas

Dr Rane and Dr Khan report no disclosures.