Faculty Bibliography

OBJECTIVE:To examine the current headache medicine fellowship application process and to propose recommendations for a more unified, systematic, and transparent process. METHODS:We identified 42 headache fellowship programs using the United Council for Neurologic Subspecialties certification database. After an initial contact via e-mail, we conducted individual telephone interviews with program directors. Qualitative data coding allowed identification of emerging themes. Quantitative data were summarized with descriptive statistics. RESULTS:Forty (95%) program directors (34 adult, 6 pediatric) responded. Emerging themes included the following. (1) There are benefits and disadvantages to having a match. (2) If the match were reinstated, programs would participate only if all programs participated. (3) There should be consequences for programs that do not participate. If the match were reinstated, 37.5% of program directors responded that their program would participate without conditions; 37.5% would participate only if every program were required to participate. Fifteen percent would not participate, and 10% were not sure if they would participate. Forty percent supported sanctions against programs that did not participate in the match. CONCLUSION/CONCLUSIONS:The fellowship match potentially makes the process more systematic for both programs and applicants; however, it does not currently appear to be a feasible option for the field of headache medicine. Until the number of applicants exceeds the number of programs, we recommend instituting a universal timeline for applications and offers.

Asymmetries in visual performance at isoeccentric locations are well-documented and functionally important. At a fixed eccentricity, visual performance is best along the horizontal, intermediate along the lower vertical, and poorest along the upper vertical meridian. These performance fields are pervasive across a range of visual tasks, including those mediated by contrast sensitivity. However, contrast performance fields have not been characterized with a systematic manipulation of stimulus spatial frequency, eccentricity, and size; three parameters that constrain contrast sensitivity. Further, individual differences in performance fields measurements have not been assessed. Here, we use an orientation discrimination task to characterize the pattern of contrast sensitivity across four isoeccentric locations along the cardinal meridians, and to examine whether and how this asymmetry pattern changes with systematic manipulation of stimulus spatial frequency (4 cpd to 8 cpd), eccentricity (4.5 degrees to 9 degrees), and size (3 degrees visual angle to 6 degrees visual angle). Our data demonstrate that contrast sensitivity is highest along the horizontal, intermediate along the lower vertical, and poorest along the upper vertical meridian. This pattern is consistent across stimulus parameter manipulations, even though they cause profound shifts in contrast sensitivity. Eccentricity-dependent decreases in contrast sensitivity can be compensated for by scaling stimulus size alone. Moreover, we find that individual variability in the strength of performance field asymmetries is consistent across conditions. This study is the first to systematically and jointly manipulate, and compare, contrast performance fields across spatial frequency, eccentricity, and size, and to address individual variability in performance fields.

The first aim of this study was to explore the aetiology of phenotypic relationships between different measures of executive functions. The second objective was to examine sources of the covariation between different measures of executive functions and the measure of general cognitive ability. The study sample consisted of 468 twins (154 pairs of monozygotic twins and 80 pairs of dizygotic twins) of the same and different gender who grew up together. Executive functions were evaluated by the Wisconsin Card Sorting Test, the Trail Making Test "“ form B, and verbal fluency tests. Raven's Advanced Progressive Matrices were used as a measure of general cognitive ability. The study results suggest a primarily genetic origin of the mutual covariation of different executive measures and their covariation with the general cognitive ability construct. While the shared genetic variance primarily lies in the bases of similarity/unity of the used cognitive measures, their particularity/difference is determined by a specific unshared environment. The obtained result on the presence of a single general genetic factor, which can be singled out in the case of different executive measures, at least partially speaks in favor of the thesis about the unity of various executive measures and the existence of a common basic ability. Together with the specific unshared environment, the specific genetic influence speaks in favor of a difference between each of the individual measures.

Objective: Cognitive dysfunction is prevalent amongst individuals who have undergone neurosurgical intervention, significantly impacting daily functioning and quality of life. The aim of this pilot study was to investigate the impact of Cogmed Working Memory Training (CWMT), a five-week, home-based, computerized cognitive rehabilitation intervention, within a neurosurgical population. Method: Thirty adult participants who underwent neurosurgical intervention, regardless of etiology, were included in this study. Participants were administered a neuropsychological battery at three time points post-neurosurgical intervention: (a) at baseline, prior to engaging in CWMT; (b) within two weeks of completing the training; and (c) after three months of completing the training. Results: Following CWMT, participants demonstrated significant improvement on measures of attention, working memory, processing speed, verbal learning, and memory. In addition, participants reported significant improvement in quality of life (i.e., physical, social, emotional, and functional well-being), mood (i.e., anxiety and depression), and neurobehavioral functioning (i.e., apathy). Implications: Results suggest that CWMT may improve aspects of cognitive and functional outcomes for neurosurgical patients.

Incomplete relapse recovery contributes to disability accrual and earlier onset of secondary progressive multiple sclerosis. We sought to investigate the effect of age on relapse recovery. We identified patients with multiple sclerosis from two longitudinal prospective studies, with an Expanded Disability Status Scale (EDSS) score within 30 days after onset of an attack, and follow-up EDSS 6 months after attack. Adult patients with multiple sclerosis (n = 632) were identified from the Comprehensive Longitudinal Investigations in Multiple Sclerosis at Brigham study (CLIMB), and paediatric patients (n = 132) from the US Network of Paediatric Multiple Sclerosis Centers (NPMSC) registry. Change in EDSS was defined as the difference in EDSS between attack and follow-up. Change in EDSS at follow-up compared to baseline was significantly lower in children compared to adults (P = 0.001), as were several functional system scores. Stratification by decade at onset for change in EDSS versus age found for every 10 years of age, EDSS recovery is reduced by 0.15 points (P < 0.0001). A larger proportion of children versus adults demonstrated improvement in EDSS following an attack (P = 0.006). For every 10 years of age, odds of EDSS not improving increase by 1.33 times (P < 0.0001). Younger age is associated with improved recovery from relapses. Age-related mechanisms may provide novel therapeutic targets for disability accrual in multiple sclerosis.