bluuebunny/crossref_metadata_2025_split huggingface dataset:
TP1-11 MS-STAT2: a phase 3 trial of high dose simvastatin in secondary progressive multiple sclerosis
Authors: Williams E , John NA , Blackstone J , Brownlee W , Frost C , Greenwood J , Chataway J ,   T.p.h.l.s.t.8.a.A.f.l.o.a.c.c.b.p.o. request
Published: February 2019

ObjectivesDisease modifying treatment for secondary progressive multiple sclerosis (SPMS) represents a major unmet need. We outline here the rationale for the MS-STAT2 trial – a phase 3 study of simvastatin in decreasing clinical progression in SPMS. MS-STAT2 will be a landmark study not only for patients with SPMS, but also for the area of drug repurposing and academically led clinical trials as a whole.DesignMulticentre, double blind, parallel group randomised placebo-controlled trial. It follows the positive outcome from the phase 2 MS-STAT1 trial, which demonstrated a 43% reduction in the annualised rate of brain atrophy compared to placebo.1Subjects1180 patients with SPMS with an expanded disability status scale (EDSS) score of 4.0–6.5. Patients need to show evidence of disease progression over the preceding 2 years.MethodsSubject will be recruited at 28 sites across the UK, and randomised to simvastatin 80 mg or matched placebo and assessed every 6 months over the 3 year trial.ResultsThe primary outcome measure is time to 6 month confirmed disability progression, based on change in Expanded Disability Status Scale (EDSS) scores compared to baseline. Secondary outcomes include assessments of cognition, walking, upper limb function and vision. Sub-studies will include advanced imaging outcomes, ocular coherence tomography and fluid biomarkers.ConclusionsMS-STAT2 is set to be a pivotal trial for SPMS. Recruitment has now commenced and further sites are welcome.ReferenceChataway J, et al. MS-STAT. Lancet2014;383:2213–21.
TP2-4 The impact of social deprivation upon global traumatic brain injury outcome
Authors: Humphries TJ , Singh R , Ingram S , Sinha S 
Published: February 2019

ObjectivesThe aim of this study was to assess the impact of social deprivation upon global TBI outcome.DesignThe study was a prospective observational study.Subjects1332 consecutive adult TBI patients were recruited into the study. 131 study participants were lost within the study.MethodsAll patients were assessed by the acute TBI team at the point of their injuries. Both injury and demographic data was collated at this point including: age, gender, medical comorbidities and GCS. The measure of social deprivation used, was the Indices of Multiple Deprivation (IMD) Score. The outcome measure, conducted at 12 months post-injury, was the GOSE. Univariate analyses were conducted prior to the final Multinomial Regression, between the GOSE score and injury factors.ResultsWith regard to the representation of IMD deciles, the study population and the general population are two independent groups, but the standard deviation is sufficiently similar for them to be considered pooled (equal variance)(t-test p=0.139). Within the univariate analyses statistically significant relationships were noted between IMD and GOSE (p≤0.00). There was no relationship noted between IMD and GCS at the time of injury (p=0.409), or medical co-morbidity (p=0.682). The multinominal regression revealed a significant relationship between between worsening GOSE and IMD, Age, Medical Comorbidity and GCS (p≤0.00).ConclusionsThere is a statically significant relationship between increasing social deprivation and worsening global TBI outcomes.
TM3-1 Idiopathic intracranial hypertension: consensus guidelines on investigation and management
Authors: Mollan SP , Davis B , Silver NC , Shaw S , Malucci C , Wakerley BR , Krishnan A , Chavda SV , Ramalingam S , Edwards J , Hemmings K , Williamson M , Burdon MA , Hassan-Smith G , Digre K , Liu GT , Jensen RH , Sinclair AJ 
Published: February 2019

ObjectivesThe aim was to capture interdisciplinary expertise from a large group of clinicians, reflecting practice from across the UK and further, to inform subsequent development of a national consensus guidance for optimal management of Idiopathic Intracranial Hypertension.DesignConsensus guideline critically reviewed by the Association of British Neurologists, British Association for the Study of Headache, the Society of British Neurological Surgeons and the Royal College of Ophthalmologists.SubjectsAn initial UK survey of attitudes and practice in IIH was sent to a wide group of physicians and surgeons.MethodsBetween September 2015 and October 2017 a specialist interest group including neurology, neurosurgery, neuro-radiology, ophthalmology, nursing, primary care doctors, and patient representatives met. A comprehensive systematic literature review was performed to assemble the foundations of the statements.ResultsOver twenty questions were constructed: One based on the diagnostic principles for optimal investigation of papilloedema and twenty-one for the management of IIH. 3 main principles were identified:to treat the underlying disease;to protect the vision andto minimise the headache morbidity.Statements presented provide insight to uncertainties in IIH where research opportunities exist.ConclusionsIn collaboration with many different specialists, professions and patient representatives we have developed guidance statements for the investigation and management of adult IIH.
TM3-2 The expanding burden of idiopathic intracranial hypertension
Authors: Mollan SP , Aguiar M , Evision F , Frew E , Sinclair A 
Published: February 2019

ObjectivesTo quantify the hospital burden and health economic impact of Idiopathic Intracranial Hypertension.DesignObservational cohort study.SubjectsAll those within England with a diagnosis of Idiopathic Intracranial Hypertension were included.MethodsHospital Episode Statistics (HES) national data was extracted between 1 st January 2002 and 31 st December 2016. Those with secondary causes of raised intracranial pressure such as tumours, hydrocephalus and cerebral venous sinus thrombosis were excluded.Results23 182 new IIH cases were diagnosed. 52% resided in the most socially deprived areas. Incidence rose between 2002 to 2016 from 2.3 to 4.7 per 1 00 000 in the general population. Peak incidence occurred in females aged 25 (15.2 per 100,000). 91.6% were treated medically, 7.6% had a cerebrospinal fluid diversion procedure. Elective caesarean sections rates were significantly higher in IIH (16%) compared to the general population (9%), p<0.005. Admission rates rose by 442% between 2002 and 2014, with 38% having repeated admissions in the year following diagnosis. Costs rose from £9.2 to £50 million per annum over the study period with costs forecasts of £462 million per annum by 2030.ConclusionsIIH incidence is rising (by greater than 100% over the study), highest in areas of social deprivation and mirroring obesity trends. Re-admissions rates are high and growing yearly. The escalating population and financial burden of IIH has wide reaching implications for the health care system.
TP3-3 Why do some patients fail to respond to VNS? – a retrospective analysis of cardiac based seizure detection (CBSD) therapy
Authors: Wysota B , Samarasekera S , Hamilton P , Soryal I 
Published: February 2019

ObjectivesTo identify predictors of poor response to cardiac based seizure detection (CBSD) VNS therapy.DesignData was collected retrospectively for patients with epilepsy who had VNS Aspire SR implanted between June 2014 and June 2017. 51 patients who reached a therapeutic level of stimulation were included. We compared those who achieved significant seizure reduction (at least 50%) with the remainder to identify potential factors predicting response.Subjects51 patients achieving therapeutic stimulation (1.5mA) with the VNS Aspire SR.MethodsWe reviewed patients’ electronic records over the period between June 2014 and June 2018.Results32 (63%) patients achieved significant seizure reduction. The following factors applied equally to both responders and non-responders: patient age, duration of epilepsy prior to VNS insertion, seizure type, the presence of a causative structural abnormality and the presence of a carer. Co-existing learning disability and/or non-epileptic attacks were commoner among poor responders. Polytherapy (3 or more AEDs) and non-compliance with medical treatment were also commoner among the poor responders; none of these factors was statistically significant.ConclusionsFactors potentially predicting response to resective surgery (including patients’ age and duration of epilepsy) do not necessarily predict response to VNS therapy. The presence of a learning disability and the extent of seizure refractoriness may influence response to VNS therapy; a larger study is needed to assess their significance.
TP3-4 Changes in whole brain connectomes with simulated laser interstitial thermal therapy (LITT) using seizure free and non-seizure free ablation cavities in mesial temporal sclerosis: a graph theory approach
Authors: Vakharia N , Manchini M , Vos B , Li K , McEvoy A , Sparks R , Ourselin S , Duncan S 
Published: February 2019

ObjectivesLITT is a novel means of focal lesioning. Improved seizure free outcome has been associated with the extent to which the mesial hippocampal head is ablated, but not overall ablation volume. We question whether specific changes in structural network connectivity exist in patients that achieve seizure freedom.DesignRetrospectiveSubjects25 MTS patients after LITT with 2 year outcome.MethodsAblation cavities from 11 seizure free and 14 non-seizure free patients were combined to generate group masks. In 12 separate pre-operative patients with MTS (6 right), weighted normalized connectomes were generated with 1 × 10^7 streamlines. To simulate ablations the group cavity masks were excluded from the connectomes prior to normalization. Differences in connectomes were assessed by graph theory metrics.ResultsGreater node strength (str) in non-seizure free patients were present in the ipsilateral basal temporo-occipital cortices in both right and left MTS. Str and local efficiency were relatively maintained in the ipsilateral thalamus of seizure free cavities. Betweenness centrality in non-seizure free cavities were greater in ipsilateral temporal poles in right and left MTS.ConclusionsDifferences in network connectivity are present following simulated LITT for MTS between seizure free and non-seizure free ablation cavities. LiTT ablation cavities may be pre-operatively modelled to ensure the ablation cavity includes important structures and non-essential or inhibitory connectivity is spared. Prospective validation is required.
TP3-6 Preliminary evaluation of diagnostic home video telemetry (HVT)
Authors: Stern W , Leschziner G , Howard R , Koutroumanidis M 
Published: February 2019

ObjectivesTo assess the clinical usefulness of HVT over the first 2 years.DesignCohort observational.Subjects60 patients (49 F) with epilepsies or non-epileptic paroxysmal clinical events.Methods48–72 hour continuous video EEG at patients’ own environment.ResultsHVT answered the primary clinical question in 45/60 patients (75%), and provided additional clinical information in 5 patients [2 with unsuspected coexistent psychogenic non-epileptic seizures (PNES) and 3 with unsuspected sleep disorders (SD)]. Of the 12 patients with Idiopathic Generalized Epilepsy, absences had been overestimated in 6 and underestimated in 4, while absence status was recorded in 1 of the 2 patients in whom it had been suspected. Valproate was possible to drastically reduce or stop in 3/6 women. Focal seizures were recorded in 19 of 28 patients with focal epilepsies, PNES were the habitual seizures in further 2 patients, while syndrome classification changed in one. In all 4 patients referred for differentiation between SD and epilepsy, HVT confirmed parasomnias in 2, daytime naps in 1 and idiopathic hypersomnia in 1. The diagnosis of PNES was confirmed in 8 of 13 suspected patients. HVT was unhelpful in the 3 patients referred for not witnessed, poorly understood episodes of loss of consciousness. Three patients switched off the video and 2 failed to change battery on day 2.ConclusionsHVT is a useful diagnostic test provided that diagnostic hypothesis and clinical question are appropriate.
FM1-2 A prospective study on surgical management of foot deformities in charcot marie tooth disease
Authors: Laura M , Ramdharry G , Singh D , Kozyra D , Skorupinska M , Reilly M 
Published: February 2019

ObjectivesCharcot-Marie-Tooth (CMT) Disease is the most common inherited peripheral neuropathy. Foot deformities are frequently observed in CMT patients and orthopaedic surgery is often required. Currently the evidence base on surgical management is limited. We prospectively studied surgical management of CMT patients attending our centre.SubjectsPatients were assessed at baseline and yearly after surgery.MethodsAssessment and data included: history of ankle instability, pain, skin condition, lower limb strength assessment, Charcot-Marie-Tooth Examination Score, Foot Posture Index, ankle dorsiflexion range of movement, questionnaires, details of surgical procedures.Results29 feet in 24 CMT patients (17 males, 7 females, mean age: 38.6±13) were evaluated prior to surgery. All patients but one had genetically confirmed CMT (18 CMT1A; 4 CMTX; 1 CMT4A). 17 feet in 12 pts were evaluated after 1 year; 10 feet in 9 pts were evaluated after 2 years; 8 feet in 7 pts were evaluated after 3 years. A wide range of surgical procedures were performed by one dedicated orthopaedic surgeon. There was significant improvement of foot alignment (p<0.001), callosities (p=0.002) and pain (p=0.022) after surgery. Surgery had no significant effect on strength, ankle range of movement, falls and fatigue.ConclusionsThe findings showed significant improvement of foot alignment, callosities and pain after surgery. Data acquired from this study will help developing orthopaedic intervention guidelines and identify areas for further research.
FM1-4 Intraneural perineuriomas: radiologically classic, clinically varied
Authors: Kapoor Mahima , Pierce Kirsten , Quaegebeur Annelies , Lunn Michael P , Carr Aisling S , Shah Sachit , Reilly Mary M 
Published: February 2019

ObjectivesIntraneural perineurioma is a rare, benign neoplasm of peripheral nerve. The histopathological features are well defined.DesignWe describe 5 cases of histologically confirmed perineuriomas and 14 cases diagnosed on clinical and radiological characteristics to highlight the features of this rare entity.MethodsWe identified cases from the imaging and histopathology database and conducted a retrospective case note review.ResultsThe subjects include 7 men and 12 women, with mean (standard deviation) age of 17.64 (13) years at onset of symptoms. 14 of the 15 lower limb cases were located in the sciatic nerve or its divisions. 1 each was identified in ulnar, median and radial nerves and 1 case was in a facial nerve. The MRI features were homogenous between the groups. The nerves biopsied included 1 tibial, 1 ulnar, 1 radial, 1 facial and 1 sciatic all showing classic pathology findings. 2 patients, interestingly, had coincidental intracranial meningioma, given the recent discovery of a potential shared pathogenesis (mutations in TRAF7) with intracranial meningiomas. 2 patients had ‘skip lesions’ within the same nerve and 3 patients had foraminal and extraforaminal involvement of lumbosacral nerve roots.ConclusionsOur unit now favours the clinicoradiological features for diagnosing perineuriomas rather than performing a biopsy on all patients. Also, the potential shared pathogenesis with meningiomas raises the clinical issue of screening in patients with perineuriomas but more clinical evidence is required.
FM1-5 The impact of neurosurgical technique on outcome of adult patients with chiari I malformation
Authors: McAllister SM , Gallo P 
Published: February 2019

ObjectivesThis study aimed to compare and evaluate any differences in clinical and radiological outcomes between three surgical techniques of cranio-cervical decompression (CCD) in adults with symptomatic Chiari malformation type I (CM1).DesignRetrospective review using the theatre management system (ORSOS) and records of the patients who underwent CCD for CM1 from January 2011 to January 2018.SubjectsPatients over 16 years of age who underwent CCD secondary to CM1 diagnosed by clinical and radiological criteria.MethodsPatients were divided in three cohorts according the operative technique used: an extradural osteo-ligamentous decompression (BD), BD plus dural opening either without duroplasty (DOWD) or with watertight augmentative duroplasty (DOPD). The primary clinical outcome was measured by utilizing the Chicago Chiari Outcome Scale (CCOS). Syrinx outcome was measured on post-op MRI. Statistical analysis was performed using IBM SPSS 24 with α=0.05.ResultsFifty-two adults underwent fifty-three CCD: 7 BD, 29 DOWD, 17 DOPD. Median follow-up was 12 months (IQR 6–23). Patients who underwent BD or DOPD had a shorter median hospital stay (6 days) than DOWD (11 days). Median CCOS was lower following DOWD (13) compared to BD (14) and DOPD (15). Post-operative complications were higher in DOWD (51.7%) compared to DOPD (17.5%).ConclusionsBetter clinical outcomes, lower complication risk and shorter duration of hospital stay were associated with DOPD. Prospective randomized studies could confirm these findings.
FM1-7 Cranio-cervical instability in ehlers-danlos syndrome employing upright, dynamic MR imaging; a comparative study
Authors: Prezerakos GK , Khan F , Davagnanam I , Smith F , Casey AT 
Published: February 2019

ObjectivesEhlers-Danlos syndrome (EDS) is a hereditary connective tissue disorder leading to hypemobile joints including the craniocervical junction. Neck pain is a prominent feature. Structural abnormalities may have a dynamic element and thus may not be captured in a recumbent MRI. There is currently a lack of evidence1assessing the use and diagnostic impact of positional MRI in Ehlers-Danlos syndrome. We aim to evaluate structural features and dynamic instability in an EDS cohort employing dynamic MR imaging against a non EDS symptomatic cohort.DesignComparative Study.SubjectsPatients diagnosed with Ehlers-Danlos syndrome and control subjects (non EDS with cervical spondylosis) were included in this study.MethodsCranio – cervical spine global and segmental movement parameters in the neutral, extension and flexion positions were measured from T2-weighted images in the midline sagittal plane. These parameters included the clivo axial angle, grabb oakes line, C2 sagittal vertical axis, C0-C1 angle, C1-2 angle, cervical lordosis and T1 slope.ResultsThe clivo- axial angle measured in neutral was 139.7±10.4 degrees in the EDS group vs 148.9±8.4 in the control group (p<0.01) The cervical range of movement between flexion and extension was 74.6±24.4 in the EDS group vs 39.4±11.3 in the controls (p<0.0001).ConclusionsEDS patients with neck symptoms exhibit different static as well as dynamic craniocervical structural features compared to a general population control.ReferenceOnt Health Technol Assess Ser[Internet]2015July;15(13):1–24.
FP1-2 Implementation of duty of candor regulation within neurosurgery: a national cross-sectional survey
Authors: Marcus HJ , Sayal P , Kitchen N , Surajit B , Thorne L 
Published: February 2019

ObjectivesStatutory Duty of Candor was introduced in 2014 for NHS bodies in England. Contained within the regulation were definitions regarding the threshold for what constitutes a notifiable patient safety incident. The aim of this survey was to evaluate the interpretation of these definitions by British neurosurgeons.MethodsFull members of the SBNS were electronically invited to participate in an online survey. Surgeons were presented with 15 cases and asked to decide in each one whether they would trigger the process of Duty of Candor. Cases were stratified according to their likelihood and severity.ResultsIn all, 106/357 (29.7%) members participated in the survey. Responses varied widely with almost no members triggering the process of Duty of Candor in cases where adverse events were likely (>10% likelihood) and required only outpatient follow up (7/106; 6.6%), and almost all members doing so in cases where adverse events were rare (<0.1% likelihood) and resulted in death (102/106; 96.2%). However, there was clear equipoise in triggering the process of Duty of Candor in cases where adverse events were unlikely (0.1%–10% likelihood) and resulted in moderate harm (38/106; 35.8%), severe harm (57/106; 53.8%), or death (49/106; 46.2%).ConclusionsThere is considerable nationwide variation in the interpretation of definitions regarding the threshold for Duty of Candor; this has important implications with some providers at risk of penalties, and others unduly burdened by the associated administrative processes.
FP1-4 Factors affecting patient flow in a neurosurgery department
Authors: Irvine S , Chharawala F , Lawrance N , Peterson D , Banerjee S , Camp S 
Published: February 2019

ObjectivesThe objectives of this study were to audit the NHS Improvement SAFER patient flow bundle, evaluate the impact of the Red2Green initiative, and assess the impact of frailty on patient flow.DesignA prospective review over a 3 month period.SubjectsAll patients admitted to a Neurosurgery Unit from 01/09/2017 to 30/11/2017 were included.MethodsData were prospectively collected from daily ward lists and patient notes, including demographics, admission/discharge details, length of stay (LOS), expected discharge date, red days with reasons, and frailty (Rockwood Clinical Frailty Scale). NHS Improvement Reference Costs were used for cost analyses.Results420 patients (55% elective) were included, total 3909 bed days. All patients received a daily senior review before midday, and EDDs were set at daily MDT meetings. 10% patients were discharged before midday. There were 21% (837) red days, significantly more (76%) for emergency patients (639 vs 198 elective; p<0.001). 63% red days were attributed to awaiting a bed in a local hospital. 25% (106) patients were classed as frail (50 elective), which was associated with a significantly longer LOS (17.3 vs 6; p<0.01), and more red days (615 vs 222; p<0.01). Considering bed costs and lost revenue (with penalties), red days cost is estimated at over £1M per year.ConclusionsSAFER has identified areas for improvement in patient flow, with obvious cost implications. It has created a platform for discussion within the referral network, and identified a role for a geriatric liaison service.