Journal of Clinical Neurology and Neurosurgery

The association between central hypersomnia and mood, anxiety, or hyperactivity disorders is common. In addition to a psychotic episode or schizophrenia, NT1 is rarer in the national narcolepsy database and may present with distinct diagnostic and therapeutic challenges. We examined the frequency of NT1 patients diagnosed with psychosis and/or schizophrenia and sought to look for signs of narcolepsy and psychotic illness. Three (4%) NT1 patients were diagnosed with a psychotic episode at age 18. In the re-evaluation (mean duration of 9.8 years), we observed one case with a dual diagnosis of NT1 and schizophrenia. In addition to NT1 and a psychotic episode, two NT1 patients were diagnosed with NT1 and a psychosis. We found that NT1 patients diagnosed before the age of 18 were at a higher risk for psychotic episodes (mean 14.4 years), compared to those that were diagnosed after the age of 18 (mean 8.8 years).

Our research on the use of multimodal intraoperative neurophysiological monitoring (IONM) during intradural spinal tumor surgery will be presented in this abstract. The intraspinal tumor surgery that was performed at the Vajira Center of Excellence in Neurosurgery was the subject of this cohort's retrospective review; from 2005 to 2020. For IONM with alarm criteria, transcranial motor evoked potentials, somatosensory evoked potentials, and free run electromyography were utilized. Reviews of the patient's records included measurements of neurological outcomes both before and after surgery; Frankel Grading, McCormick Score, Karnofsky Performance Status (KPS) Scale, American Spinal Injury Association (ASIA) Grading, and The Japanese Orthopedic Association (JOA) Score at 1, 6, 12, and 24 months after surgery 104 patients were operated on in total. IONM was used in 77.4% of the operations. 70.2 and 16.7% of tumors were found in the intradural extramedullary (IDEM) space, respectively. All follow-up time in the IONM group showed a statistically significant improvement (p-value 0.050) between preoperative and postoperative neurological outcomes. Alarm IONM had a sensitivity of 66.7 percent and a specificity of 88.7 percent, respectively, for predicting early worsening of the neurological outcome following surgery. Surgery for IDEM spinal cord tumors is linked to a favorable neurological outcome (OR 0.187, 95% CI 0.05–0.71); p-value of 0.014 The use of IONM in intradural spinal tumor surgery resulted in a statistically significant improvement in neurological outcomes and a decrease in neurological deficits following the procedure. With fair sensitivity and high specificity, IONM can identify neurological deficits and poor outcomes following surgery. In particular, using IONM in IDEM results in better neurological outcomes after surgery.