“Characterizing Vocal Tremor in Progressive Neurological Diseases via Automated Acoustic Analyses” is the CLIPNH Editor’s Choice for May 2020. This article focuses on the often-overlooked voice tremor. A quasi-rhythmic fluctuation in pitch and loudness of the voice secondary to involuntary oscillatory movements in speech-related muscles, voice tremor is frequently not thoroughly investigated. Professor Ziemann and I encourage the reading of what Professor Hlavnicka and colleagues found when they examined voice tremor in a large cohort of 240 patients with different neurological diseases, using automated amplitude and frequency analysis of speech recordings of the vowels /a/ and /i/.

This message contains links to resources of relevance to the CN community regarding the COVID-19 pandemic. Providing a forum to exchange knowledge in relation to Clinical Neurophysiology is what the IFCN is here to do; please continue to share your experiences via this Open Blog.

In order to provide the best possible knowledge exchange in Clinical Neurophysiology we ask you to answer five new questions in this IFCN survey focused on the human toll that the COVID-19 virus has eventually taken within your workplace. You are welcome to provide “yes” or “no” answers, or you can share additional comments.

Non COVID-19 activities go on. Worth mentioning is an update of “Terminology in Neuromuscular Electrodiagnostic Medicine and Ultrasound.” This endeavor is a joint effort between the IFCN and the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM).

The CN community mourns the passing of Jasper Daube, MD, a neurology pioneer (hot link to obt.). Dr. Daube and François Mauguière were editors for the IFCN Handbook Series. The success of the first series has created a demand to a second Handbook Series. Mark Hallett, Marc Nuwer, Margitta Seeck, and Ulf Ziemann are organizing this endeavor.

During these challenging time, nefarious activities tend to increase making use of Covid-19 concerns. Please be aware that the IFCN has not and does not solicit funding from individuals. Should you receive such requests apparently coming from IFCN, please do not respond to the sender, and instead notify the IFCN HQ office.

Resources:

Website resources:

• AAN Tools and Resources
• ACNS COVID-19 Resources
• AANEM COVID-19 Guidance

I wish all of us good health and thank you for sharing your experiences via the survey and blog.

Sincerely,
Walter Paulus
IFCN President

Thank you for finding the time to complete the IFCN COVID-19 survey. Your responses have yielded some interesting results. It is not surprising to learn that most formal training programs have been suspended, curtailed, or, in one case, trainees have been sent to the neurological departments to help with stroke care.

Additionally, educational activities such as congresses and other face-to-face meetings have been cancelled, postponed, or moved to virtual events. Please visit the IFCN Meetings and Events page for the latest information regarding convention dates and format. The financial impact to these host organizations may not be known for a while. 

The financial impact of COVID-19 varies widely within the CN community, with some reporting no impact at all; while others, such as private practice clinicians have seen a reduction in elective OPD services. Moreover, neurophysiologists at hospitals who are paid for services-provided are seeing a sharp reduction in their workload.

Due to differing country regulations, hospitals and laboratories are instituting various precautionary measures when allowing standard CN studies to be conducted. Many IFCN member societies have and are posting recommendations for how best to meet patients’ needs. I encourage you to continue to visit your local society website, as well as review the resources provided below. The IFCN website will continue to link to resources and COVID-19 relevant articles. 

Diverse facilities have different protocols for CN testing while dealing with the COVID-19 crisis. Some have added taking a patient’s temperature before proceeding with normal practices. If tests are conducted on non-COVID patients, almost all survey respondents reported that they and their staff have the necessary personal protective equipment (PPE) needed to be safe while working. Results show that although some neurophysiology technologists are being called to the front lines to help manage medical issues with COVID-19, most are not. 

The “yes” and “no” survey responses were almost evenly split for the following questions:

• Are neurophysiologic studies (EEGs, EMGs, other) being requested on COVID-19 patients more or less often than you would have suspected?
• Do you approach all patients as if they are COVID-19 patients? 
• In your outpatient practice, are you finding that many of your epilepsy/neuromuscular/sleep or other patients are being affected by COVID-19 more than the general population?

From this short survey, it is challenging to make any global assessment of the impact that COVID-19 is having on the CN community.

In addition to sharing the results from the IFCN COVID-19 survey, this message contains links to resources and journal articles of relevance to the CN community regarding the COVID-19 pandemic. The New England Journal of Medicine, “Death from Covid-19 of 23 Health Care Workers in China”, provides evidence that with sufficient precautions, infectious risks can be very low in healthcare workers. One person who died was an electrocardiography technician, closely associated to those we rely on in our profession, reflecting the need for continuous awareness and protective measures in both infected and non-infected COVID areas.

Providing a forum to exchange knowledge is what the IFCN is here to do; please continue to share your experiences via this Open Blog.

Resources:
Journal articles:

• Death from Covid-19 of 23 Health Care Workers in China
• COVID-19: Neurologists in Italy to Colleagues in US: Look for Poorly-Defined Neurologic Conditions in Patients with Coronavirus

Website resources:

• AAN Tools and Resources
• ACNS COVID-19 Resources
• AANEM COVID-19 Guidance

I wish all of us good health and thank you for sharing your experiences via the survey and blog.

Sincerely,
Walter Paulus
IFCN President

 In addition to sharing knowledge, we wish to learn more about how COVID-19 is impacting the CN community. Your willingness to spend five minutes to complete this survey is appreciated. The analysis of the results will be shared via the IFCN website. I want to recognize Professor Aatif Husain for initiating this assessment effort. After completing the survey, continue to share your experiences via this open blog.

Resources:

Additional resources will be shared on the IFCN Facebook page.

I wish all of us good health and thank you for sharing your experiences via the survey and blog.

Sincerely,
Walter Paulus
IFCN President

An IFCN sponsored committee has prepared the 3rd edition of, “Safety and recommendations for TMS use in healthy subjects and patient populations, with updates on training, ethical and regulatory issues.” The documents Safety and recommendations for TMS and Supplemental materials are now in draft form and we welcome public comment that will help in finalizing the document. Please send your comments to crussell@ifcn.info by April 13. Feel free to share this opportunity with your colleagues. The final manuscript will be published in Clinical Neurophysiology.