Reviewing case reports and clinical series

[00:01:13] Prof. Bhatia:
Thank you very much Daniel for having me on this. It's a great honor and privilege and I'm happy to be here and answer any queries or questions what you have up your sleeve today.
 

[00:01:28] Dr. Di Luca:
To begin with, case reports and case series are quite popular in the field of Movement Disorders, probably more than any other subspecialty in neurology. And also as young trainees, it's more likely that we will be invited to review such studies in comparison to perhaps large original articles.

Would you be able to give us a quick background on what is a case report and clinical cases and why are they so important for us in neurology and specifically in movement disorders?
 

[00:02:02] Prof. Bhatia:
I think over time, a lot of us are sort of paying a lot of attention to the basic science and publishing or trying to have high-impact basic scientific type of papers. But I think it's very important to remember the humble case report and the humble case series still remains a very important source off research and clinical material, particularly in movement disorders, where all of us are still doing a sort of clinical phenomenology, which is our bread and butter, and day to day. So finding a new sort of a definition of phenomenology of a known condition or describing some new aspects is very important for us to recognize — particularly in this day and age where you have a lot of genes and some genes can cause different phenotypes or vice versa. These sort of case reports and case series are even more important than perhaps previously.

So I think that we should not forget that this is how we began. When we started in movement disorders, phenomenology was the key, and I still think it remains the key, even in this day and age where we have lots of genetic advances and basic science advances.
 

Dr. Di Luca:
You are obviously an editor of a very important journal in movement disorders. Can you comment on what are editors looking for when reviewing such case reports?
 

Prof. Bhatia:
Well we have two or three different type of publications in this regard. In fact, I can say at least four different. So we have case reports. We have case series, we have genotype phenotype letters and we have clinical vignettes Okay. So although this might sound like, you know, okay, what's the difference between each of them? There can be a bit of an overlap.

So you may have a case report for example, which is not a genetically based case report, but it is showing a important new sign or new feature, a side effect or reaction to some, a variety of different things.And even a single case report might be illuminating. And we would consider that on the case report.

Then you may have a series of similar cases which are providing a story or a new information and which is visualized in these multi cases. So that's why that becomes a case report series.

And then we have the genotype phenotype. These may be genetic disorders, which have a particular interesting phenotype, or, you know, expanding the phenotype or a new phenotype with a particular gene. So that goes under the GP letters. 

And then finally we have clinical vignettes. So here, this may be something which is known, but it is showing some interesting aspect of that known condition. Or it may be so nice as a typical disorder of some rare condition that we feel that even though this is known, this may be educative as being so classic that we feel that we want to show that for educational purposes.

It's meant for maybe some of the inexperience or younger people who are coming up and who have not seen this before, and they want to see that.

That's the reason why we have divided these into these particular categories.
 

Dr. Di Luca:
Thank you, professor Bhatia. I think it shows how important and broad case reports and case series can be in movement disorders.

I think now from a reviewer's perspective, what should reviewers look for in those submissions to make sure they are original, they're valid, and also to help the editors, making their decision on acceptance or rejection?
 

Prof. Bhatia:

Well, firstly, he or she has to look at whether the report does say, or show what it is supposed to be showing.

And this can be a problem. For example, they are talking about phenomenology. Let's say they think that this person has a tremor or chorea, but when you actually see the video, you may have some doubts. So it may start as simple as that — that the phenomenology is not what you agree with. In our field, that's so important.

And then, many of our reviewers have to be like detectives. So we had a example of one particular case report where they said this was pre- and post- treatment, but the reviewer was very astute and had noticed that all the things in the tooth were exactly the same.

And had some doubts about whether this was pre and post a particular treatment. So we expect that from them.

The other thing is whether this is really original, has it been published before? Quite often, you'll find that there may be a paper or report which has been sent to you, which has been published already in a part of a series or something in another journal. And unless there is a particular aspect, which is original, the reviewer has to be careful about that.

And then finally you have to ask yourself, the question, what is the value of this case report being published? Would it add to the literature? And that is the question which the reviewer really has to answer.

And then of course take up what the reviewers have said, and you'd be surprised how often it is that even two or three reviewers, separated from each other in different parts of the world in different forms of expertise or experience, still seem to come up more or less similar answers. People come to the same sort of conclusions, even though they are separated out.
 

[00:06:31] Dr. Di Luca:
Thank you so much professor Bhatia. That's a great overview of the process. Finally, as we have been asking all guests that are coming to our podcasts, can you share one peer review tip with young trainees?
 

[00:06:44] Prof. Bhatia:
Well, I think the best way is hands-on. You have to dirty your hands when you are sculpting something, you can't do it without that. We are quite open to people putting themselves forward to add to the pool of reviewers.

 I feel that, particularly in our field, which is relatively small, if you think about it, there does tend to be a sort of incestuous pool, if you may use the word, because we all know each other. And it's almost sort of automatic that you send it to the people you know. And they keep getting papers to review. Although it is inevitable because we have such a small number of people who are experts, at the same time, I think that is the reason why we need to expand our pool, have new faces, fresh voices.

 I actually get quite surprised at how nice sometimes you get an opinion from somebody unexpected. You know, we are all in a sense, slightly biased. Sometimes it's difficult for people to go beyond that bias. So therefore, is always a good idea to have a fresh voice, a different look.
 

[00:07:50] Dr. Di Luca:
Thank you very much. Professor Bhatia. Today we had the honor to discuss how to review and approach a case report and case series in movement disorders with professor Bhatia.

For our next episode, we will discuss how to review other types of articles, such as original papers and reviews.

Thank you all for listening.