bluuebunny/crossref_metadata_2025 huggingface dataset:
032  Improving access to inpatient ambulatory cardiac monitoring for acute stroke patients during the Covid-19 pandemic
Authors: Jeffery Harriet , Sanz Elena Rivero , Turner David
Published: May 2022

Introduction

Ambulatory cardiac monitoring (ACM) identifies atrial fibrillation (AF) in 10.7% of patients with ischaemic stroke and no prior history of the condition.

Prior to the Covid-19 pandemic, there was limited access to inpatient ACM. During the pandemic the stroke unit was provided with rapid access to inpatient ACM.

Aims

1. To examine the number of inpatient and outpatient ACM performed during the pandemic and the number of these which positively identified AF. 2. to measure the mean waiting time for the ACM.

Methods

The records of patients in the six months prior to (n=118) and the five months during the pandemic (n=354) were analysed.

Results

The proportion of ACM performed as an inpatient increased from 21% to 59% during the pandemic. Inpatient rapid access ACM identified AF in 6% of patients (vs. 0% previously) and all were anticoagu- lated within 14 days of their stroke. Waiting times for inpatient ACM decreased from a mean of 17 to 4 days during the pandemic.

Discussion

There was a significant shift in clinical practice and diagnostic access to inpatient ACM during the pandemic, resulting in a greater proportion of tests, increased identification of AF and early anticoagulation, leading to improved patient care and potentially preventing further ischaemic events.

harriet

jeffery@nhs.net|ABN Bursary

41
034  Early lowering of blood pressure after acute intracerebral haemorrhage: systematic review and meta-analysis of patient-level data
Authors: Moullaali Tom , Wang Xia , Sandset Else , Woodhouse Lisa , Law Zhe Kang , Salman Rustam Al-Shahi , Anderson Craig , Bath Philip
Published: May 2022

Objective

To summarise evidence of the effects of blood pressure (BP)-lowering interventions after acute spontaneous intracerebral haemorrhage (ICH).

Methods

Pre-specified systematic review of the Cochrane Central Register of Controlled Trials, EMBASE and MEDLINE databases from inception to 23 June 2020 to identify randomised controlled trials that compared active BP-lowering agents vs. placebo or intensive vs. guideline BP-lowering targets for adults <7 days after ICH. Primary outcome was function (distribution of scores on the modified Rankin scale) 90 days after ran- domisation. Radiological outcomes were absolute (>6mL) and proportional (>33%) haematoma growth at 24 hours. Meta-analysis used a one-stage approach, adjusted for pre-specified covariables and trial.

Results

Of 7094 studies identified, 50 trials involving 11,494 patients were eligible and 16 (32.0%) shared patient-level data from 6,221 (54.1%) patients (mean age 64.2 [SD 12.9], 2,266 [36.4%] females) with a median time from symptom onset to randomisation of 3.8 hours (IQR 2.6−5.3). Active/intensive BP-lowering had no effect on the primary outcome compared to placebo/guideline treatment (adjusted OR for unfavourable shift in modified Rankin scale scores: 0.97, 95%CI 0.88−1.06; p=0.50), but there was signifi- cant heterogeneity by strategy (pinteraction=0.031) and agent (pinteraction<0.0001). Active/intensive BP-lowering reduced absolute and relative haematoma growth.

Interpretation: Overall, a broad range of interventions to lower BP within 7 days of ICH had no benefit on functional recovery, despite reducing bleeding. The treatment effect appeared to vary according to strategy and agent.

tom.moullaali@ed.ac.uk
038  Investigatory imaging in autoimmune-paraneoplastic encephalitis
Authors: Seddigh Arshia , Arun Tarunya
Published: May 2022

Introduction

About 60% of patients with Autoimmune-Paraneoplastic Encephalitis (AIE-PNE) develop a clinical syndrome before malignancy is diagnosed. Tumour screening, early recognition and prompt treatment is likely to improve outcomes. Imaging guidelines for the management of these patients have not yet been defined. This study aimed to characterise the current use of imaging in the monitoring and management of people with AIE-PNE.

Methods

We enrolled 23 patients with a diagnosis of suspected or confirmed AES-PNE (Dalmau, 2016). MRI head, whole body CT and PET scans patterns were analysed.

Results

Patients had a diagnosis of suspected or confirmed AIE-PNE. A third had MRI abnormalities at presentation. 81% underwent a body CT at presentation with 20% having abnormalities. 66% had PET scans at presentation with 22% showing an abnormality. Most prevalent antibodies were NMDA (35%), LGI1 (17%) and GABA-B (9%). 14% had lung malignancy.

Conclusion

Body CT was the commonest imaging investigation performed at presentation and only a little over half had further investigations if initial CT was negative. No patient that responded to initial treatment had further investigations to look for an underlying malignancy. There is an urgent need for follow up studies that will inform future imaging criteria for AIE-PNE.

arshia

seddigh@nhs.net|ABN Bursary

44
040  Service evaluation of acute neurology referrals in the regional neuroscience centre
Authors: Grundmann Alexander , Duddy Martin , Anderson Kirstie , Ng Yi Shiau
Published: May 2022

Background

Neurological disorders account for 20% of acute medical admissions and 7% of GP consulta- tions. We evaluated our acute neurology service with the catchment area of 3 million people. Moreover, we investigated the impact on the service during the COVID19 pandemic.

Methods

We identified 6618 urgent phone calls logged between March 2017 and June 2020. We performed a detailed analysis of 800 referrals: 400 in 10 weeks before and 400 in 11 weeks during the first national lockdown.

Results

Referrals were made by teaching hospitals (43%), district general hospitals (35%) and GPs (22%). The reasons for referrals were similar between hospitals and GPs: epilepsy (33% vs 30%), headache (15% vs 20%), sensory symptoms (10% vs 7%) and weakness (10% vs 8%). The outcomes of these referrals were telephone advice only (64%), neurology ward admission (9%), rapid assessment and other outpatient clinics (8% and 25% respectively). There was a threefold decrease in the number of phone calls during the initial four weeks of national lockdown. However, the patient demographics and the range of diagnoses remained overall unchanged.

Conclusions

This provides important descriptive data on demographics and outcomes for acute neurology referrals, which can be used to guide service provision and training.

alexander

grundmann@nhs.net

45
042  Opportunities and challenges of remote neurological outpatient consultations
Authors: Hogan Joseph , MacDonald Bridget , Mastrolilli Francesca , Nitkunan Arani
Published: May 2022

Croydon University Hospital

Remote consultations were rapidly introduced in the spring of 2020 in the neurology outpatient setting across the UK and worldwide due to the Covid-19 pandemic. Consulting remotely provides new chal- lenges to previously familiar practices. Here we present four different but commonly seen cases in a south London outpatient neurology service. With each case we address a key domain: history taking, examina- tion, the digital divide and changing the consulting environment. History taking is largely unchanged and indeed may improve the patient experience when performed in a familiar environment. The examina- tion is different and a greater understanding of which aspects of the neurological exam are and are not possible remotely continues to be discussed. The adoption of remote consultations requires patients to have a confident ability to activate and interact with technologies. The future development of technolo- gies and guidelines should proactively engage with patients of all ages and abilities to avoid biases in their development. Remote consultations are likely to continue to play a part in the future of outpatient neurology; understanding their most effective allocation and proactively developing technologies with patients will be essential for their success.

joseph

hogan1@nhs.net|ABN Bursary

46
044  Analysis of urgent acute medicine and ward referrals to neurology at the district hospital
Authors: Melikyan Elina , Nandoskar Ashwini
Published: May 2022

Purpose

The aim of the study was to analyse the referrals for patients presenting with neurological emergency to the district hospital, as this aspect of the neurologist’s workload is often under-recognised, in comparison to attention dedicated to out-patient clinics.

Methods

We retrospectively reviewed acute medicine and ward referrals to Neurology service at the Hillingdon Hospital (July 2019-June 2020).

Results

Total 1480 referrals were identified, with 50% of them from the Acute Medicine, 42% from the General Medicine, 8% from the other units. A 73.2% of referrals constitute delirium, falls, and other multi- factorial syndromes, presented as ill-defined and clinically challenging cases, 14.5% - acute headaches and neuroinflammatory disorders, 12.3% seizures/fits/syncopes. Regarding ward referrals, there was an average 5.4 days’ time lag between time of admission and neurological input, at the average 11.8 days of hospitalization. An early neurological consultation was likely to lead to more tailored diagnostic workup, improving outcome for the patient.

Conclusion

The amount of referrals reaffirms the importance of the neurologist’s role in the Emergency Care and the unmet need for acute neurology service, which is likely to increase with pressure on the district general hospitals to manage complex neurological cases locally given that the pandemic affects the safe transfer of patients to tertiary neurosciences centre for onward management.

ehmelikyan@yandex.ru

47
045  Post discharge telephone calls from neurology specialist nurses can reduce re-admission rates: a re-audit
Authors: Ravindran Pahalavi , Shanmuganathan Sarah , Boodhoo Ajay , Schon Fred , Nitkunan Arani
Published: May 2022

We carried out audits of all in-patients referred for consultant neurology opinions in a single district general hospital over 2-month periods in 2018 and after relevant adjustments in 2020.

In 2018, of 235 patients seen, the overall 30-day re-admission rate was 18.7% (44 patients). Of the 235 patients, the consultant requested post discharge follow-up on 76 (32.3%) but only 42 were contacted (55%) of which 24 (57%) were phoned within 30 days. The re-admission rate was reduced by only 0.5% in those successfully contacted.

In 2020, of 252 patients seen, the 30-day re-admission rate was 18.7% (47 patients). Follow up was requested for 52.8% (133 patients). We improved our successful telephone rate to 77% of which 49 (47.6%) were contacted in under 30 days. Re-admission rate for those contacted was reduced to 16.5% compared to 21% amongst those not contacted. The majority of re-admissions (55%) were for non-neurological diagnoses. Patients with multiple co-morbidities were 46% more likely to be re-admitted.

NICE guidelines recommend a post discharge telephone follow-up. Our results suggest trying to achieve maximum early contact is likely to reduce re-admission rates.

pahalavi@hotmail.co.uk
046  Preparing new registrars for practice in the age of Zoom
Authors: Rees Richard , Russell Amy Ross , Patel Faheemah , Lawrence Joanne , Jones Matthew , Warner Tom
Published: May 2022

Introduction

In 2019 the ABN delivered the first Acute Neurology Boot Camp. This addressed an unmet need in post-graduate training. We designed a one-day series of seminars covering common or critical presentations for neurology registrars on-call.

In 2020, face-to-face events weren’t feasible, and while having to adapt to a new model of working including tele-neurology, virtual radiology meetings, we adapted the boot camp to this model.

Methods

We designed an online version of the boot camp over two weeks. Videos were recorded for repeat viewing. All delegates were encouraged to complete surveys on confidence levels, before and after each session, and with reference to the course as a whole.

Results

77 participants provided feedback. 289 logged-in live and YYY have viewed the videos on-demand. This compares to XYZ in the 2019 iteration. 30% of respondents were confident or very confident at being the neurology registrar on-call prior to the course, compared to 88% at the end of the course (p< 0.00001).

Participants were very happy with the delivery, content and format of the talks, with “very good” ratings for 60%, 56% and 57% respectively.

Conclusion

The Covid-19 pandemic brought tumultuous shifts in practice that were uncharted waters for the entire neurological community. As we all tried to stay afloat, we also provided a necessary life-raft to trainees who were negotiating the challenge of the transition to being a neurology registrar.

rnrees@gmail.com|ABN Bursary

48
047  The cord, the COVID and the cancer
Authors: Torabi Parisa , Corkill Robin , Johnston Ann
Published: May 2022

Introduction

Throughout the COVID-19 pandemic, our understanding of the relationship between COVID-19 infection and acute neurological disorders has been evolving. We present two cases of trans- verse myelitis, both with positive COVID-19 PCRs.

Case 1: A 62-year old man presented with an ascending paraparesis 3 weeks after COVID-19 infection. Initial neuroimaging showed cord compression with signal change at C5/6. Repeat imaging 7 days later showed a longitudinal myelitis. CSF examination was unremarkable. He was treated with intravenous steroids and an oral taper. No other cause was identified.

Case 2: A 55-year old woman presented with sub-acute back pain and worsening leg weakness over 2 weeks. She had a positive COVID-19 test on admission but was asymptomatic. Neuroimaging showed a longitudinal myelitis, but also noted a multicystic lesion within the pelvis. A CSF examination was unremark- able with negative cytology. A raised CA-125 coupled with an adnexal mass on CT-TAP was felt in keeping with ovarian malignancy which we hypothesise caused the myelitis through an immune phenomena, rather than by a para-infectious route or by COVID-19 itself.

Conclusions

These cases highlight the broad aetiology of transverse myelitis and illustrate the need for a careful search for underlying causes, which may include post-COVID syndromes.

parisa.torabi@wales.nhs.uk
049  Is the out of hours acute neurology service provision in South West London equitable?
Authors: Yiu Daniel , Harral Josie , Fisk Monica , Nitkunan Arani
Published: May 2022

Providing equitable access to neurologists out of hours regardless of whether a hospital is a neurosciences centre or a district general hospital (DGH) is key to ensuring excellent patient care for all. The aim of this audit was to determine whether there was variability in the out of hours referrals across South West London (SWL). Data were collected from June to August 2020. We found a large disparity - 78% of referrals were from the hospital aligned with the neurosciences centre although it accounted for 31% of the SWL population and 46% of acute admissions. 46% of the calls received by trainees at the neurosciences centre were discussed with the consultant, with 5% of cases requiring transfer. 84% of referrals from DGHs were advised to contact local teams for continued input. Conditions with established pathways such as seizures (23% of referrals) and headaches (11%) were less likely to require escalation to the consultant on-call. The awareness of a regional out of hours service is being addressed at the DGHs. Increasing trainee time at DGHs with the Shape of Training changes will hopefully increase trainees’ awareness of DGH neurology teams. We aim to repeat this analysis next year.

Acknowledgements – SWL consultants, trainees in SWL daniel.yiu93@gmail.com
057  Para-herpetic SUNCT syndrome
Authors: Sim Nicholas Keyi ,   Goh, Ying Li , Mowafi Walied
Published: May 2022

Pre and post-herpetic SUNCT syndrome is a rare but previously reported complication of herpes zoster reactivation. We report a case of a zoster associated SUNCT syndrome developing at the same time as reactivation.

A 79-year-old gentleman was referred to Neurology for refractory right sided facial pain. 7 months prior to presentation he had developed shingles in the right upper face around his forehead area, which was managed by his GP. At the same time, he developed daily attacks of sharp stabbing pain behind his eye, up to 5 a day, lasting up to 5 minutes each. This was associated with injection and lacrimation of the affected eye. The attacks can be triggered by touch, such as a shower. Neurological examination was unremarkable except for allodynia in the right V1 distribution. Plain MRI scan showed cortical atrophy only.

He had a good response to lamotrigine. nchlasim@doctors.org.uk
A wolf in sheep’s clothing
Authors: Gibbons Emily , Whittam Daniel , Karthikeayan Venkatraman , Campagna Giovanna , Wong Sui , Yu-Wai-Man Patrick , Huda Saif , Jacob Anu
Published: May 2022

A 28 year-old Caucasian woman was found to have reduced visual acuity during routine optician checks and was referred to ophthalmology and then neurology. Examination revealed acuities of 6/12 in both eyes, pale optic discs and reduced colour perception. MRI brain did not show any lesions. Routine bloods were normal as were serum ACE, B1, B12, folate, HIV, syphilis, Lyme serology, AQP4-IgG and MOG-IgG. Leber’s and AD optic atrophy screens were negative. CSF protein was 0.41, WBC 7 (100% lymphocytes), elevated IgG Index 1.4 (normal<0.8),OCBs in serum and CSF with a single additional band raising the possibility of inflammatory optic neuritis. There was apparent stabilisation on empiric steroids which was then converted to steroid sparing immunosuppressants. However, as vision declined, whole mitochondrial genome sequencing and the clinical Exome Optic Atrophy Panel revealed compound heterozygous WFS1 mutations (c.605A>G p. (Glu2020Gly); c.874C>T p.(Pro292Ser) leading to diagnosis of‘Wolfram’Syndrome or DIDMOAD (diabetes insipidus, diabetes mellitus, optic atrophy, deafness) with an isolated optic atrophy phenotype. This case is unusual given the late age of presentation, lack of classical associ- ated features, suggestion of CSF inflammation and apparent steroid responsiveness. It also highlights the importance of expanded genetic testing in atypical optic atrophy cases.

emily.gibbons@doctors.org.uk
068  The effective management of idiopathic intracranial hypertension delivered by in-person and virtual group consultations
Authors: Wong Sui , Barrow Natasha , Hall Kimberley , Gandesha Prianka , Manson Alison
Published: May 2022

Background

In response to the rising incidence of IIH and service pressures, we set out to develop a group consultation(GC) service for IIH.

Method

Iterative, co-designing(with patients) a bespoke GC, i.e. clinical reviews in a group setting. Outcomes measured: patient satisfaction, self-perceived health literacy, successful implementation of GC.

Results

Eight in-person GCs delivered: once-monthly(Oct-Dec 2019), then twice-monthly(Jan-Feb 2020). Feedback from 49/53: 100% felt more satisfied and heard; 100% felt more involved in decision making; 98% had a better understanding of their condition; 96% felt more able to cope with their condition and keep themselves healthy; 94% rated this as a positive experience; 90% reported improved access and more time with their clinician compared to existing 1:1 appointments.

Since Sept 2020 (in response to COVID-19 pandemic) we have delivered once-weekly virtual GC (18 to date). Feedback median scores: patient satisfaction 9.5/10; being listened to by clinician 10/10; involved by clinician in treatment decisions 10/10; clinician explanation of treatment 10/10; opportunity to discuss condition or treatment 10/10).

Conclusions

GC is safe and effective for IIH and preferred in our cohort. This allowed ongoing high-quality, person-centred care despite the COVID19 pandemic. We will also share the potential for GC for other neurological conditions.

drsuiwong@gmail.com

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069  Post COVID neuropathic pain: a case report
Authors: Campos Hernandez Ana Karen , Win Myat , McWilliam Matthew , Ismail Shoaib , Fox Robin , Alkufri Fadi
Published: May 2022

COVID-19 has been reported to be associated with various neurological manifestations involving both the central and peripheral nervous system. Somatic and visceral pain, as well as headache, are all widely recognised in association with COVID-19, however, there is a comparative paucity of reports of neuropathic pain.

We present a case of COVID-19 associated neuropathic pain in a 61-year-old male. He developed acute severe burning pain affecting all four limbs distally, one week following confirmed COVID-19 infection. There was no ataxia or autonomic failure. Neurological examination was unremarkable. Electrophysiologi- cal tests revealed delayed SSEP in the lower limbs, however, skin biopsy and MRI of the neuroaxis was unremarkable. His pain was inadequately controlled with gabapentin but improved significantly after a short course of steroids. This case adds to the various neurological manifestations of COVID-19 infection, highlighting the possible variability of symptoms in patients with nervous system involvement of SARS-CoV-2 infection. This report provides additional evidence that COVID-19 disease can trigger autoimmunity which is consistent with previous reports of several autoimmune neurological diseases.

a.camposhernandez@nhs.net
071  Motor network remodelling in ALS and PLS
Authors: Edmond Evan , Proudfoot Malcolm , Menke Ricarda , Thompson Alexander , Talbot Kevin , Stagg Charlotte , Turner Martin
Published: May 2022

Background

Primary motor cortex hyperexcitability demonstrated in amyotrophic lateral sclerosis (ALS) is associated with wider network dysfunction. The precise topology and nature of these functional altera- tions remains unclear, including the extent of overlap between ALS and the pure upper-motor-neurone phenotype - primary lateral sclerosis (PLS).

Methods

Study participants comprised 41 ALS, 7 PLS, and 18 age matched healthy individuals. Partici- pantsunderwent motor task functional MRI (fMRI) of the brain at 3T (Siemens Magnetom). The task involved unilateral finger response (Go) to a directional visual cue with intermittent response inhibition (NoGo). Image preprocessing, voxelwise statistics with general linear modelling, and exploratory network analysis were performed using FSL (FMRIB software library).

Results

A bilateral pattern of activation was observed with finger movement in the ALS group, compared to the more restricted contralateral hemispheric activity in healthy controls (n.s. after stringent voxelwise multiple-comparison correction). Significantly increased activation was noted in the posterior insula in PLS patients during successful response inhibition compared to both ALS patients and healthy control. Network analysis demonstrated a significant positive association of increasing disability with pre-motor and supplementary motor nodes.

Discussion

Regional brain motor network remodelling in ALS may signify degeneration of inhibitory local circuit functional partitioning, or reflect adaptation and mobilisation of reserves to support motor execution. Replication and validation through standardised imaging protocols and task design offers the potential to refine targets for therapeutic neuromodulation.

eedmond@gmail.com|NIHR Bursary
073  Magnetic resonance spectroscopy to detect markers of brain injury in tuberculous meningitis (TBM)
Authors: Davis Angharad , Robertson Frances , Maxebengula Mpumi , Meintjes Ernesta , Wilkinson Robert
Published: May 2022

Centre for Infectious Diseases Research in Africa;4UCT Medical Imaging Research Unit, Division of Bio- medical Engineering, UCT, RSA;5Cape Universities Body Imaging Centre, UCT and Neuroscience Institute, University of Cape Town, RSA;6Department of Medicine, Imperial College London

1H-Magnetic Resonance Spectroscopy (MRS) allows non-invasive quantification of the biochemical com- position of imaged tissue in a single voxel within the brain; including concentrations of the neuroinhibitory and neuroexcitatory metabolites, GABA and glutamate. Excessive glutamate and neuro-excitotoxicity contribute to pathogenesis in tuberculous meningitis (TBM)[1], and like in other neurological conditions[2] may lead to cell death and brain injury. We hypothesised that glutamate would be raised and GABA decreased, in TBM vs healthy controls (HC). 11 patients with TBM, and 8 HC underwent 3-T MRI imaging at the University of Cape Town, South Africa, at two timepoints (baseline, day-56). We used MEGA-PRESS spectroscopy and GANNET software[3] to estimate metabolite concentrations in a voxel placed within the ‘tubercular zone’. Glutamate at baseline was significantly higher in TBM vs HC (15.9 vs 12.2 IU, p=0.042). This decreased by day-56, although did not return to levels seen in HC, suggesting ongoing neuro-excitation in the post-acute phase. By contrast, at baseline GABA was non-significantly decreased in TBM vs HC (3.79 vs4.02 IU, p=0.5). These findings provide further rationale for the investigation of glutamate/GABA as brain injury pathways and potential drug targets in TBM.

1. Rohlwink, U.K., et al., Nat Commun, 2019. 10(1): p. 3767 2. Meldrum, B.S., J Nutr, 2000. 130(4S Suppl): p. 1007S-15S. 3. Edden, R.A., et al., J Magn Reson Imaging, 2014. 40(6): p. 1445–52.

angharadgracedavis@gmail.com
Effects of immunotherapies and clinical outcomes in neurosarcoidosis : a retro- spective cohort study
Authors: Arun Tarunya , Freeman Sarah , Mistry Kieran
Published: May 2022

Introduction

Neurosarcoidosis is associated with a high degree of morbidity and mortality and its treat- ments are varied and complex. There is a paucity of information in current literature on patterns of treatment and long term outcomes. This study aimed to evaluate the clinical outcomes and responses to immunosuppressive therapy in a large cohort of biopsy proven neurosarcoidosis patients.

Methods

We enrolled 85 patients with a diagnosis of neurosarcoidosis. Prescription patterns and clinical outcomes before and after treatment and differences between the treatment groups were compared using Kruskal Wallis and Mann-Witney U tests.

Results

Patients with cranial mononeuropathy were more likely to be treated with steroids alone than patients with brain parenchymal involvement, hydrocephalus and spinal cord presentations who were likely to require second and third line treatments. Commonly used immunosuppressive agents were azathioprine (26%), methotrexate (17.5%) and corticosteroids alone (11%). Just over 85% of patients on corticosteroids went onto second or third line treatments. Patients on steroid monotherapy had the worst outcomes and those on a combination of corticosteroids, azathioprine and infliximab showed superior clinical improvements (p=0.008).

Conclusions

Our results provides evidence that early immunosuppressive treatments, with azathioprine, methotrexate and infliximab could effectively improve clinical outcomes in neurosarcoidosis.

tarunya1@gmail.com
077  ‘NeuroPodcases: a clinical neuroscience podcast’ – a remote learning resource
Authors: Bharambe Viraj , Healy Sarah , Mayer Josie , Williamson John
Published: May 2022

Background

Remote learning resources, such as podcasts, have grown in popularity and are of increas- ing importance during the 2020 pandemic. Podcast benefits include; convenience, accessibility to global expertise; and can be a useful adjunct to in-person teaching or a ‘flipped classroom’ approach.

Methods

We developed a case-based podcast covering topics across clinical neuroscience for medical students and doctors. ‘NeuroPodcases’ are freely available via a dedicated website (neuropodcases. co.uk), Spotify, Apple Podcasts and Soundcloud. To maintain quality, all podcasts are created with a Neurology trainee and Consultant.

Results

Over 35 neuroscience podcasts have been recorded for undergraduates (Essentials) and graduates (Advanced). Many are enhanced with additional illustrations and videos. There have been over 2,700 plays across 36 countries, from all habitable continents.

Feedback from local undergraduates suggests the podcasts are a useful adjunct at a time of limited bedside teaching. During a 4 week placement, the majority of students listened to >5 podcasts with 100% of respondents saying it increased their confidence in neurology.

Conclusions

Podcasts offer a global learning resource which is freely available and can support clinical learning outside traditional clinical education environments. NeuroPodcases is an example of their utility for clinical neuroscience education.

virajbh@hotmail.com
078  The future of outpatient appointments: do patients with epilepsy prefer remote consultations?
Authors: Bose Smriti , Samarasekera Shanika , Tittensor Sarah , Greenhill Lynn
Published: May 2022

In light of the COVID 19 pandemic, outpatient services have been restructured to facilitate remote con- sultations. As the pandemic has entered second and third ‘phases’, patients’ perspectives regarding remote consultation are essential.

Methods

Questionnaires were sent to PWE and carers attending tertiary epilepsy services at University Hospitals Birmingham. 25% of the population is from an ethnic minority.

Results

378 questionnaires were analysed- 278 in phase A, 100 in phase B. 57.0% respondents were female, 42.9% over 50 years. 8.2% had comorbid non epileptic attacks.

55.8% respondents preferred telephone consultation in phase A, 66% in phase B. 34.9% preferred face to face in phase A, dropping to 32% by phase B, the majority being non-white.

6.83% selected video consultation in phase A, none in phase B.

The proportion citing ‘safety’ as a reason for remote consultation in phase A (23%) was greater than in B (5%) P<0.001

The proportion citing ‘ease of access’ as key increased by phase B, though non significantly p=0.03.

Conclusion

Ease of access continues to drive preferences for telephone consultations with infection risk in outpatients becoming less of a concern. Translating services are essential if remote consultation is to be accessible to all.

smritibose55@gmail.com

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079  The impact of the COVID-19 pandemic on the mental health of MND patients
Authors: Gilchrist Abigail , Chaouch Amina , Ealing John , Hamdalla Hisham , Coen Sharon
Published: May 2022

Background

Motor neurone disease (MND) is an isolating condition that has many implications on patients mental health. Throughout the COVID-19 pandemic, patients with chronic health conditions, including those with MND, have been further removed from the support of their specialist teams.

Objectives

1) To determine the impact of the COVID-19 pandemic on the mental health of the Salford Royal MND patients. 2) To improve the mental health support offered by the service by addressing patient concerns and feedback.

Methods

A survey was sent to patients who had been receiving care by the Salford Royal MND Team since the 1st of January, 2020. The answers were reviewed and measures were put in place to address concerns. Patients were resurveyed two months later and answers were compared.

Results

Patients reported a higher proportion of issues with their mental health during the pandemic compared to prior. The service was seen as doing adequately but areas were identified to address. Our interventions were largely successful with many patients reporting an increase in the support they receive from the Salford Royal MND Team.

Conclusions

Areas of improvement were identified to accommodate the change in the way the Salford Royal MND Team deliver their care.

abigail.gilchrist@student.manchester.ac.uk
083  The impact of the Covid-19 pandemic on neurology outpatients services at Watford General Hospital
Authors: Teranaka Mayu , Mitchell Harry , Farrell Krista
Published: May 2022

Objectives

The Covid-19 pandemic has significantly impacted the delivery of outpatient services, and spe- cialists have adjusted to maximise safety for both patients and clinicians. This study examined the impact of remote consultations on the management of neurology outpatients during the Covid-19 pandemic.

Method

New neurology referrals to Watford General Hospital from August to September 2020 were reviewed. The type of appointment, telephone or face-to-face (F2F); investigations requested; and outcomes, discharge or follow-up, were analysed.

Results

Out of 288 total patients, 59% were triaged to telephone and 41% to face-to-face appoint- ments. Patients with headache (77%; n=78) or suspected seizures (77%; n=61) were more often triaged to telephone appointments. Only 13% and 6% respectively required subsequent review in F2F appoint- ments. Patients were more often triaged to F2F appointments if referred with visual disturbance (80%; n=5), movement disorders (73%; n=30) or weakness (71%; n=17). The discharge rate for telephone (54%) and F2F (53%) groups were similar.

Conclusion

This was a retrospective study of referrals to neurology outpatients during the Covid-19 pandemic. Results showed effective triaging with similar outcomes for telephone and F2F appointments. This data suggests that remote consultations are effective and could be helpful in managing patients after the Covid-19 pandemic.

mayu.teranaka@nhs.net
088  Brainstem progressive multifocal leukoencephalopathy
Authors: Hawken Jonathan , Pearson Owen , Smith Rachel , Sadiq Shaheena , Ingram Gillian
Published: May 2022

Progressive multifocal leukoencephalopathy (PML) is a rare but potentially fatal viral brain infection seen in immunocompromised patients and in patients with multiple sclerosis (MS) on disease-modifying treatments such as natalizumab. The most frequent reported pattern of PML is that of large subcortical T2 and diffusion hyperintense lesions. Brainstem PML, although previously reported, is rare and therefore easily missed.

A 46-year-old lady with a diagnosis of MS on treatment with natalizumab for 5 years, serum JC virus high positive; presented with worsening of long-standing unsteadiness. Prior imaging showed multiple supra and infra-tentorial T2 hyperintensities; however, repeat imaging at presentation demonstrated an increase in size and number of lesions in the medulla, more confluent lesions in the pons with restricted diffusion, but no change in the supra-tentorial lesion load. Natalizumab therapy was suspended and a lumbar puncture revealed a high JC virus titre (1,090,000 m/L), confirming a diagnosis of PML. Serial MRI’s showed lesion progression with contrast enhancement at 10–12 weeks with associated CSF pleocytosis indicating immune reconstitution inflammatory syndrome. The patient was managed conservatively and her disability remained stable.

PML affecting the brainstem is under-reported in the literature. Awareness and prompt recognition of the condition is needed to minimise complications.

Jonathan

hawken@wales.nhs.uk

69
090  UK multiple sclerosis register: understanding the gaps between patient outpatient experiences and preferences
Authors: Kee Rachael , Ramsay Stephen , McKee Jon , Middleton Rod , Rodgers Jeff , Nicholas Richard , Kennedy Fiona , Hughes Stella , McDonnell Gavin
Published: May 2022

Background

Provision of care to patients with Multiple Sclerosis (MS) is complex and an effective multi- disciplinary team (MDT) approach is needed. We surveyed patients’ experiences of ideal care and care actually provided.

Methods

We designed a questionnaire to evaluate service provision and expectation in a nationwide cohort of patients from the UK MS Register with subsequent qualitative and quantitative data analysis.

Results

2512 patients responded. 58% attend a specialist MS Clinic. Mean age 56 years, median EDSS

6.0. Of patients with established diagnoses, 48% had RRMS, 35% SPMS, 12% PPMS, 5% undetermined. The biggest reported gaps at clinic were; physiotherapy (reality vs preference) 13% vs 45%, occupational therapy 6% vs 31% and continence advice 6% vs 29%. Clinical course did not influence expectation in these services. Substantial gaps also existed for counselling and dietetics provision. 18% of patients did not report new symptoms/relapses to any healthcare professional. RRMS patients were less likely to be part of this group and PPMS patients more likely, with no difference between genders.

Conclusions

This study illustrates a gap between MDT service provision and patient preference at MS/neurology clinics throughout the UK, and across all patient subgroups. A concerning number of patients do not report new symptoms to MS services, particularly PPMS patients. Further resources should be directed towards bridging these care gaps for MS patients.

rachael

kee@doctors.org.uk|ABN Bursary

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091  Evaluation of remote assessments for multiple sclerosis in a real-world setting
Authors: Kuri Ashvin , Jacobs Benjamin Meir , Leddy Sara , Schmierer Klaus , Turner Benjamin , Allen-Philbey Kimberley , Stennett Andrea , Giovannoni Gavin , Thomson Alison , Dobson Ruth
Published: May 2022

Background

There is an urgent need for reliable methods to remotely monitor Multiple Sclerosis (MS). Existing assessments, such as Timed 25-Foot Walk (T25FW) and 9-Hole Peg Test (9HPT), are traditionally carried out in person by physicians. The use of self-administered, remote versions of these assessments could improve monitoring and hence care for people with MS (pwMS). This study evaluated the use of remote T25FW (rT25FW) and 9HPT (r9HPT) assessments.

Methods pwMS were given comprehensive instructions and equipment for completing rT25FW/r9HPT. We assessed relationships between EDSS scores (through a previously-validated webEDSS) and contem- poraneous rT25FW/r9HPT using Spearman’s rank-order correlation, to evaluate consistency with previous in-person studies.

Results

Seventy-one pwMS completed the webEDSS and r9HPT, and 108 completed the webEDSS and rT25FW. There was a mild-moderate positive correlation between webEDSS and rT25FW (rho=0.40, p<0.0001, 95%CI=0.23–0.55), a finding consistent with previous in-person studies. There was a non-significant weak correlation between webEDSS and r9HPT. Distributions of rT25FW/r9HPT times were positively skewed. 100% of r9HPT times and 93.5% of rT25FW times were within specified limits used in clinical trials.

Conclusion

These findings provide pilot evidence to indicate remote monitoring of MS is feasible. These assessments should be further developed to aid remote follow-up of pwMS.

ashvin.kuri99@gmail.com
097  Disability and quality of life changes in people with MS (pwMS) throughout the COVID-19 pandemic
Authors: Rodgers William , Middleton Rod , Witts James , Lumicisi Brooke , Nicholas Richard
Published: May 2022

Introduction

The UK MS Register (UKMSR) has collected longitudinal patient reported outcomes (PROs) on pwMS regularly since 2011.

Aim to assess changes in disability and quality in life (QOL) in the UKMSR before and during the pandemic

Methods pwMS who answered the PROs: webEDSS to assess disability in MS and EQ5D-3L visual analogue scale for QOL, six months prior to the pandemic (t-6), at the start (t0), and six months after (t+6).

Results

1553 pwMS completed QOL assessment. Of the 458 who started with a lower QOL (<50) there was improvement at t0 which stabilised at t6 (t-6=34, t0=40, t6+=39, x2=89.91, p<0.001). In those starting with a QOL ³50 their QOL worsened at the start of the pandemic (t-6=75, t0/t+6=71, x2=58.28, p<0.001).

webEDSS scores were completed by 902 pwMS. There was no change in 501 pwMS with an initial webEDSS ³6.0. In 401 pwMS with a webEDSS score <6 there was a worsening in median score at t0 but not then at t6 (t-6=3.0, t0/t+6=3.5, x2=21.57, p<0.001), QOL also worsened in a similar pattern in this group.

Conclusion

Disability and QOL worsened in those doing better at the start of the pandemic. Whereas in those more significantly affected, disability remained stable and QOL improved.

r.m.middleton@swansea.ac.uk
098  Treatment escalation in secondary progressive MS identified clinically and algorithmically in relapsing remitting (RR)MS
Authors: Nicholas Richard , Middleton Rod , Witts James , Rodgers William , Hillert Jan , Stahmann Alexander , Horáková Dana , Magyari Melinda , Lines Carol ,   RCN SPMS Research Group
Published: May 2022

Introduction

Objective algorithms (OA; Ramanujam, 2020) identify SPMS in those with clinically assigned (CA) RRMS, suggesting SPMS is under-diagnosed in practice. It’s unclear if clinicians are aware of this evolution and escalate therapy in response to clinical worsening with highly active (HA) disease modifying treatments (DMT).

Objective

Assess whether treatment intensity escalates as the disease advances from RRMS to OA-SPMS and from RRMS to CA-SPMS.

Methods

MS registries in Czech Republic, Denmark, Germany, Sweden and UK were used. Active DMTs at the date of last visit were classified as highly active (HA) or not, and DMT usage prior to CA-SPMS or OA-SPMS classification.

Results

3740 SPMS and 9542 OA-SPMS patients were on DMTs. HADMT use was 21.3% prior to OA-SPMS clas- sification in RRMS and 27.9% (p<0.0001) once classified. HADMT use was 23.5% prior to CA-SPMS diagnosis and 36.9% (p<0.0001) once diagnosed. HADMT use in the UK was lower than in other registries for all groups.

Conclusion

Across Europe the evolution to clinical SPMS via OA-SPMS is eliciting a response from clini- cians that is not initially reflected in a change of diagnosis. Country variations in HADMT use in transitioning patients should be explored further.

r.m.middleton@swansea.ac.uk

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100  Making decisions and sharing information, the patient experience: the UK Multiple Sclerosis Register (UKMSR)
Authors: Ramsay Stephen , Magill Fiona , Goldsmith Grainne , Kee Rachael , McKee Jon , Middleton Rod , Nicholas Richard , Kennedy Fiona , Hughes Stella , McDonnell Gavin
Published: May 2022

Objective

To evaluate the exchange of information and communication between MS patients and the clinical team regarding decisions around disease modifying therapy (DMT) and MRI results utilising the UKMSR, an established, validated cohort of people with MS.

Methods

An online questionnaire was designed and then disseminated to patients in February 2020.

Results

From 2512 responses, 44% were on DMT (86% had RRMS). Of 1089 responses, 60% indicated that the decision to start DMT was made with the clinical team, whilst 13% responded it was “largely my teams’ decision”. Only 117 (~10%) felt they received “too little information”. Overall, 2459 patients had undergone ≥1 MRI, with 70% seeing the images at least once. Almost 90% of patients would be interested in viewing scans at clinic, appearing independent of DMT exposure, although 2/3 of those who were “not interested” were not on DMT.

Conclusions

A majority of study participants reported adequate involvement and sharing of information in the decision-making process when starting DMT although a concerning minority appear disengaged. Patients are very interested in viewing MRI scans with a majority having had this opportunity. Not all expressed such an interest however. Patient preference should therefore be duly considered in clinical management.

sramsay03@qub.ac.uk|ABN Bursary
104  A case of natalizumab-related progressive multifocal leukoencephalopathy treated with pembrolizumab
Authors: Robinson Rebecca , Ramsay Stephen , Burns Paul , Flynn Peter , Herron Brian , Poots Jonathan , Kennedy Fiona , Hughes Stella
Published: May 2022

Introduction

Progressive multifocal leukoencephalopathy (PML) is a rare, but potentially devastating viral infection of the brain and can occur as a complication of natalizumab, a treatment for highly-active relapsing remitting multiple sclerosis (RRMS).

Case: Patient A is 52-years-old, diagnosed with RRMS in 2015. She commenced disease-modifying therapy with natalizumab following four clinical relapses in one year and had a stable clinical course for the subsequent 4 years. She was JCV antibody positive (titre 3.64) but had opted to continue natalizumab therapy, despite the risk of PML.

Early 2020, an MRI abnormality raised suspicion for PML. In May, she developed left hand weakness, pro- gressing to left hemiparesis. Serial MRIs showed increasing signal change however, it was difficult to differ- entiate PML from new inflammatory activity. CSF JCV PCR was negative on two occasions. She proceeded to brain biopsy, confirming PML. She was treated with pembrolizumab and has remained stable.

Discussion

This case highlights the difficulty in distinguishing PML from an MS relapse, despite the use of MRI and CSF. We highlight the role of brain biopsy in making a definitive diagnosis. There is also lack of consensus on effective treatment for PML, but emerging evidence for use of pembrolizumab, a PD-1 inhibitor.

rrobinson17@qub.ac.uk

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004  Physical activity monitoring to assess disability progression in multiple sclerosis
Authors: Stuart Charlotte M , Philip Sheaba , Galea Ian , Group SIMSStudy
Published: May 2022

To monitor multiple sclerosis (MS) disability, scales like the Expanded Disability Status Scale (EDSS) and Multiple Sclerosis Functional Composite (MSFC) are commonly used. Both rely on a single clinical assess- ment in time which may not reflect the patient’s performance in their living environment. They also require training and are time consuming. The SenseWear armband incorporates a triaxial accelerometer sensitive to upper and lower limb motion. A proprietary algorithm computes several physical activity variables, such as total energy expenditure, physical activity duration, metabolic equivalents (METs) and average daily steps. Here we assess the SenseWear armband for its ability to monitor disease progression, alongside the EDSS and MSFC. Progressive MS patients (n=50) wore the device for one week, every 6 months for

2.5 years. MSFC and EDSS were performed at the end of each week. The armband was agreeable and easy to use. Patients showed progression across all three disability measures (p<0.01). Baseline physical activity, EDSS and MSFC values correlated well between each other. The change in the three measures with time correlated poorly, suggesting that they measure functional aspects which have different pro- gression trajectories. In summary, physical activity monitoring is a user-friendly and ecological method to measure MS disability progression.

c.stuart@soton.ac.uk
116  Serum immunoglobulin levels and infection risk in Phase 3 ofatumumab trials in relapsing multiple sclerosis
Authors: Wiendl Heinz , Seze Jérôme de , Bar-Or Amit , Correale Jorge , Cross Anne , Kappos Ludwig , Selmaj Krzysztof , Häring Dieter , Su Wendy ,   et al
Published: May 2022

Objective

To assess the effect of ofatumumab vs teriflunomide on serum immunoglobulin (Ig) levels and evaluate potential association between decrease in IgM/IgG levels and infection risk.

Methods

Serum IgM/IgG levels were monitored at baseline (BL), W4, W12, and every 12 weeks thereafter. Proportion of patients with IgM/IgG levels below the lower limit of normal (

Results

Mean IgM/IgG levels were within reference ranges over time. Over all post-BL visits, higher propor- tion of ofatumumab patients had IgM

Conclusion

Reduction in serum IgM levels was observed over time, Ig levels predominantly remained above LLN. No decrease in IgG levels was reported within the observation period. There was no apparent association between decreased Ig levels and infections in ofatumumab-treated patients.

Funding statement

This study was funded by Novartis Pharma AG, Basel, Switzerland. teresa.sawtell@novartis.com

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