Virtual care is here to stay. The explosive expansion of telehealth caused by the SARS-CoV-2 pandemic is more than a necessary measure of protection. The key drivers of this transition in healthcare delivery to a virtual setting are changes in patient behavior and expectations and societal attitudes, and prevailing technologies that are impossible to ignore. The younger population - Generation Z - is increasingly connected and mobile-first. We are heading to a world where we expect to see healthcare in general and neurology, in particular, delivered virtually. The medical community should prepare for this overhaul; proper implementation of virtual care from the ground up is the need of the hour. In an era of virtualization, it is up to the medical community to ensure a well-informed patient population, overcome cultural differences and build digital infrastructure with enhanced access and equity in care delivery, especially for the aging neurological patient population, which is not technologically savvy. Virtual care is a continuum of care that needs deeper integration at systematic levels. The design principles of a patient’s journey need to be incorporated while simultaneously placing physician satisfaction with a better user experience at the center of implementation. In this paper, we discuss common challenges and pitfalls of virtual care implementation in neurology - logistical, technical, medicolegal, and those faced in incorporating health and medical education into virtual care - intending to provide solutions and strategies.

Medical education faces a difficult challenge today; an exponential increase in knowledge and the rise and rise of disruptive technologies are making traditional education obsolete. As the world nears the era of Industry and Healthcare 4.0, the medical community needs to keep up and prepare physicians for a hyperconnected digital world. Virtual neurological care is poised to be at the forefront of care delivery claims, yet the virtual communication of neurological knowledge is still in its infancy. This increasing digitalization of care and education is both an opportunity and a challenge. With this paper, the authors aim to bridge the gap between technology and neurological education. After a thorough review of recent literature and assessing current trends, the authors propose that contemporary medical education must adhere to the following tenets: Hybrid, Mobile, Mixed-reality, Open Access, Collaborative, Peer-reviewed, Intelligent, Game-based, and Global. We identify and align education objectives with the needs of future digital neurologists. The authors also discuss real-world advances that are aligned to serve the next generation of patients and providers.

Migraine is the second most common primary headache disorder after tension-type headache and is the leading cause of disability worldwide. Cortical spreading depression involves neuronal excitation and inhibition and is involved in pathophysiology of migraine. Many anti-epileptic drugs act by inhibiting Cortical Spreading Depression and block desensitization. Anti-convulsants are commonly used in Migraine prophylaxis and the ones being more effective than placebo include Sodium Valproate and Topiramate. Levetiracetam has unique mechanism as it targets hyper-excitable neurons by binding to synaptic vesicle protein. This results in inhibition of neurotransmitter release thus decreases hyperexcitability. Levetiracetam has minimal side effect profile (dizziness, somnolence and mood changes) and it can be well tolerated by patients. In this review, a total of seven studies were included (four open-label trials and three randomized-control trials) which evaluated the role of Levetiracetam in the prophylaxis of migraine in adult patients. On review of this evidence, Levetiracetam appears to be effective in treating migraine with and without aura and is considered safe because of its limited side effects. There was a significant reduction in the frequency, severity, and duration of migraine with a high responder rate. Levetiracetam was well tolerated with minimal side effects and no reported interactions. However, larger randomized controlled trials are needed and these studies should be done on special population to see the outcomes. In addition, studies for extended-release formulations should also be done.

Myasthenia gravis (MG) is an autoimmune neuromuscular junction disorder that is more common among women than men. It has two major subtypes, namely, ocular and generalized MG, and while facial weakness is common in generalized MG, facial weakness without the involvement of ocular muscle is exceedingly rare. Here, we describe the case of a middle-aged man who presented with bilateral facial palsy but without diplopia or proximal muscle weakness. The patient tested positive for acetylcholine receptor antibodies and exhibited amplitude decrement on repetitive nerve stimulation, which are diagnostic for MG. This report emphasizes the importance of neurodiagnostic and physiological testing in patients presenting with bilateral facial weakness alone.

Aim: To evaluate the level of awareness regarding childhood autism among medical professionals of Pakistan. Methodology: A cross-sectional descriptive survey was conducted among 105 medical students and health-care professionals to estimate their knowledge regarding Autism in Pakistan. By random sampling method, questionnaires were distributed during the month of April 2020. IRB approval was obtained. Results: The results have highlighted that medical students have significant knowledge of Autism Spectrum Disorder while Post Graduate trainees and House Officers have moderate knowledge. However, it is alarming to see that there is lack of knowledge among Medical Officers and Consultants. Due to this deficient knowledge gap, medical practitioners are unaware of the severity of this disorder in the region. The results emphasize that there is either initial lack of medical school curriculum or over time knowledge of medical professionals decreases due to which they are unable to identify the prevalent disorders. Conclusion: ASD is a pertinent regional health concern. Lack of clinical knowledge of this disorder amongst healthcare professionals, needs to be addressed by application of awareness systems. This will improve diagnosis and redesign treatment modalities alongside strategize preventive measures. Keywords: Autism Spectrum Disorder, Medical, Student, Child Development Disorders