Background High definition transcranial direct current stimulation (HD-tDCS) has been administered over single brain regions for small numbers of sessions. Safety, feasibility and tolerability of HD-tDCS over multiple brain regions, multiple daily stimulations and long periods are not established. Objective We studied safety, feasibility and tolerability of daily HD-tDCS over 2–4 brain regions for 20 sessions in healthy adults. Methods Five healthy adults underwent physical and neurological examination, electrocardiogram (EKG), electroencephalogram (EEG) and cognitive screening (ImpACT) before, during and after HD-tDCS. Four networks (left/right temporoparietal and frontal) were stimulated in sequence (20 min each) using HD-tDCS in 20 daily sessions. Sessions 1–10 included sequential stimulation of both temporoparietal networks, sessions 11–15 stimulations of 4 networks and sessions 16–20 two daily stimulation cycles of 4 networks/cycle (1.5 mA/network). Side effects, ImpACT scores and EEG power spectrum were compared before and after HD-tDCS. Results All subjects completed the trial. Adverse events were tingling, transient redness at the stimulation site, perception of continuing stimulation after end of session and one self-resolving headache. EEG power spectrum showed decreased delta power in frontal areas several days after HD-tDCS. While at the group level ImpACT scores did not differ before and after stimulations, we found a trend for correlation between decreased EEG delta power and individual improvements in ImpACT scores after HD-tDCS. Conclusion Prolonged, repeat daily stimulation of multiple brain regions using HD-tDCS is feasible and safe in healthy adults. Preliminary EEG results suggest that HD-tDCS may induce long lasting changes in excitability in the brain.

Background: Thrombotic thrombocytopenic purpura (TTP) is a rare clinical disorder which was associated with poor prognosis for a long time. The outcome has been improved by the consistent introduction of thera-peutic plasma exchange (TPE) as standard treatment of TTP. Patients and Methods: We describe our experience in the use of solvent/detergent-treated plasma (SDP) for TPE in TTP. We retrospectively analyzed acute TTP epi-sodes in 8 patients (mean age = 27 years, range 18–44 years) treated with TPE using SDP with regard to tolerability and efficacy. Results: All 8 patients were positive for anti-ADAMTS-13 antibody. Seven out of 8 had a se-vere ADAMTS-13 deficiency. All patients responded rapidly to SDP TPE with an increase in platelet count to above 150 × 10⁹/l. Hemolytic anemia disappeared over the treatment period. Approximately 2,000 l SDP were used for more than 500 treatments. Treatment with SDP was well tolerated; none of the patients experienced an adverse drug reaction after exposure to SDP. No major complications occurred even after multiple TPE. Conclusion: Our investigations suggest that TPE using SDP as replacement fluid is an effective treatment for TTP. The data described also indicate that SDP might offer the benefit of reducing adverse drug reactions.

Patients in a headache clinic in an academic tertiary care setting require a high intensity of remote outpatient care, more so than patients in other neurology subspecialty clinics and general neurology clinic, with the exception of the neuroimmunology/MS clinic. This is to a large extent secondary to the very frequent use of secure email linked to the electronic medical record by headache patients.

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Background: Stroke is emerging as a public health threat to sub-Saharan African countries. Even though cognitive impairment is increasingly being recognized as a major cause of disability in stroke survivors there is no data on the burden of stroke related cognitive dysfunction from Ethiopia. In this study, we aimed to assess the frequency and predictors of post-stroke cognitive impairment in Ethiopian stroke survivors.Methods: Participants were adult stroke survivors who came for follow-up at least 3 months after the last stoke. Demographic and clinical data were collected using a structured questionnaire. We employed the Montreal Cognitive Assessment Scale-Basic (MOCA-B), modified Rankin Scale (mRS) and Patient Health Questionnaire-9 (PHQ-9) to assess post-stroke cognition, functional recovery, and depression, respectively.Results: Among 67 stroke survivors (mean age: 52.1 ± 12.7 years, females: 40.3%, low or no education: 41.8%, median stroke duration: 3 years), 28 (41.8%) had post-stroke cognitive impairment. Of these, 20 (30%) had mild cognitive impairment and 8 (12%) had post-stroke dementia. On multivariate analysis, increased age [AOR=0.24, 95% CI (0.07,0.83)], lower education [AOR=4.02, 95% CI (1.13,14.32)] and poor function recovery (mRS ³3) [AOR=0.27, 95% CI (0.08-0.81)] were independently associated with post-stroke cognitive impairment.Conclusion:Cognitive impairment is frequent among Ethiopian stroke survivors. We found that increased age, low educational attainment, and poor recovery on physical function were independently associated with cognitive decline. Although causality cannot be inferred, physical rehabilitation and better education might play a significant role in building cognitive resilience among stroke survivors.