Background and Objectives: The COVID-19 pandemic triggered significant delays in the treatment of people with movement disorders who depend on face-to-face clinic encounters for receipt of their regular botulinum toxin injections. Against this background, it was the aim of this study to look into pandemic-related characteristics of patients with dystonia and hemifacial spasm treated with botulinum toxin at a tertiary centre in Romania and identify potential correlations between delays in treatment and health perceptions.
Materials and Methods: A cross-sectional, questionnaire-based, study was conducted between May-September 2021 on the 175 patients in the centre’s botulinum toxin database.
Results: Of the 90 patients who qualified for inclusion most were late middle-aged females with long-standing dystonia, of which torticollis and blepharospasm were the most common phenotypes. Treatment was delayed by an average of 8.5 months, whereas the overall quality-of-life health score was 61.1, with 60% of respondents rating themselves above 50. No statistically significant correlation was identified between delays in treatment and overall healthscores. Instead, statistically significant differences were uncovered based on type of disorder (dystonia vs. hemifacial spasm).
Conclusion: The results of this study may go on to show that, in the event of similar pandemic surges, patient micromanagement by type of disorder may be part of a well-balanced restriction-cum-access health policy.

The importance of burnout amongst medical staff was highlighted by various papers, showing that this issue implies job demands and job resources. The current challenge of SARS-CoV-2 pandemic also raised many concerns about its impact on healthcare sector. A new survey after 4 years from the previous study of the Bucharest College of Physicians is coming with new data, containing the effect of COVID-19 on the psychological wellbeing of its members.
The increasing of burnout was found in all categories, and the most frequently solutions claimed by the respondents were related to decreasing of workload and bureaucracy, and an important number of physicians identify the need for specialized psychological assistance.
The COVID-19 pandemic period exacerbated the system related factors that contribute to the phenomenon of burnout.

Introduction: Tuberous sclerosis complex (TSC) is a genetic disorder with a heterogenous clinical phenotype, with possible involvement of virtually any organ. Although recent advancement in genetics has allowed a better understanding of the pathophysiology of TSC, enabling a genetic diagnosis, TSC is primarily diagnosed on clinical grounds. Neurological manifestations amount to over 90% of people with TSC. Ensuing surveillance and treatment of TSC imply a multidisciplinary team of specialists. Case reports: We report 2 cases of TSC, both admitted to our Neurology Department on account of poor seizure control. One was diagnosed early in his infancy having a typical onset with infantile spasms and subsequent generalised seizures whereas the other was diagnosed with TSC in our department, at 56 years of age. They both also have skin and renal involvement as major clinical features. Conclusion: Recognition of the clinical hallmarks of TSC, albeit variable, is important for early diagnosis and subsequent multidisciplinary management. Neurological involvement, as illustrated in our case reports, is frequent and is largely responsible for morbidity and mortality in TSC.

Introduction: Myotonic dystrophy (DM) type 1 is a genetic disorder, caused by a trinucleotide CTG repeat expansion in the DMPK gene on chromosome 19. The skeletal muscle is the most severely affected organ, patients clinically presenting weakness and myotonia. Additionally, it may affect other organs, transforming it into a multisystemic disease. The pathophysiological mechanism involves RNA toxicity resulting from the expanded repeat in the mutant DM alleles. Phenotypes of DM1 may be classified as congenital, juvenile, classical or late onset. Case Report: We present the case of a 36-year-old male diagnosed with chronic hepatitis B virus infection 4 years ago, admitted to the Neurology Department for progressive weakness of the distal lower limbs and multiple falls without loss of consciousness due to muscle weakness. Considering the clinical evolution, neurological examination and paraclinical investigations, the patient was diagnosed with myotonic dystrophy type 1 and mild sensitive axonal polyneuropathy of the lower limbs. Conclusion: The diagnosis of DM can be established clinically if the patient has typical manifestations and positive family history. Genetic testing for CTG repeat expansion in the DMPK gene is the gold standard in diagnosing DM1. There is no disease-modifying therapy available for DM yet and management is only symptomatic.

Since its fi rst description in 1980 by Freudenberger, the phenomenon of burnout has been studied intensively by many scholars in the past decades and stakeholders are getting more and more aware of the problematic burnout poses in the professional fi eld, as well as the healthcare threat it poses. It is well known today that when it comes to the fi eld of healthcare workers, burnout plays a signifi cant role in regards to physicians’ well-being. The Bucharest College of Physicians wanted to evaluate this phenomenon amongst doctors working in Romania’s capital city and launched a survey addressing its’ members. The study revealed a rather high number of physicians suffering from at least one kind of burnout. The numbers were highest in the fi eld of personal and professional burnout – 55% and 52% of respondents respectively. In regards to burnout caused by the nature of their work (working with patients), a still high number of 36% of respondents showed signs of burnout. Participants in the study named the increasing number of bureaucratic tasks as one of the major stressors at the job and suggested that by eliminating some bureaucracy, one could improve their level of stress on the job. The results of the study conducted by the Bucharest College of Physicians fall in line with other studies regarding healthcare workers around the globe. The alarmingly high numbers of burnout cases and increased levels of stress should signal stakeholders in the healthcare system to take action in order to improve physicians’ well-being.

Malignant melanoma is a cancer of melanocytic origin, typically cutaneous. Despite recent advances, the prognosis is poor. Brain metastases occur in approximately 7-16% of cases and leptomeningeal metastases in 5-7%. Primary central nervous system (CNS) melanoma is rare, accounting for 1% of all melanoma cases and 0.07% of brain tumors. Methods: A 65-year old man presented with haemorrhagic venous infarction of the left temporal lobe, leading to reversible motor aphasia and right-sided hemiparesis. Brain magnetic resonance imaging also revealed peculiar supratentorial cerebral and meningeal lesions suggesting neoplasia or vasculitis. Ancillary tests were unremarkable, a brain biopsy was proposed, but the patient declined. After 1.5 years symptoms recurred and imaging studies found progression of lesions, with necrosis and surrounding vasogenic oedema. The patient finally agreed to a brain biopsy for conclusive diagnosis. Results: Histopathological and immunohistochemical assessment was consistent with malignant pigmented melanoma. There were no suspicious primary lesions, but the patient recounted having had a thoracic skin lump excised some years prior, allegedly benign, yet unavailable for second opinion. Conclusion: In suspicious CNS presentations, histopathological reevaluation of previously excised skin lesions is advised, especially if brain biopsy cannot be performed. Albeit rare, primary CNS melanoma should also be considered.

Repetitive transcranial magnetic stimulation (rTMS) is a relatively new therapeutic and diagnostic technique that uses non-invasive neuromodulation and has an excellent safety profile[1]. According to recent EAN guidelines on central neurostimulation in chronic pain conditions there is only week evidence for primary motor cortex rTMS in neuropathic pain[2], while other guidelines on rTMS state a defi nite analgesic effect of high frequency rTMS of the primary motor cortex contra-lateral to pain site in neuropathic pain[3]