bluuebunny/crossref_metadata_2025_split huggingface dataset:
WED 131 Evaluating the clinical utility of the parkinson’s kinetigraph (PKG)
Authors: Hutchinson Lewis , Dominey Thea , Pearson Emma , Murphy Fiona , Bell Lucy , Carroll Camille 
Published: October 2018

ObjectiveTo evaluate the utility of the Parkinson’s Kinetigraph (PKG™) in the remote management of Parkinson’s disease (PD).BackgroundThere is a movement in Parkinson’s care from a clinic-based model1 to P4 medicine, meaning medicine that is predictive, preventive, personalised and participatory.2 The development of wearable technology provides an opportunity to monitor patients remotely, and deliver targeted care. The PKG™ is a wrist-worn device that objectively measures Parkinson’s symptoms.AimTo evaluate the utility of the PKG™ in managing PD patients remotely, and the perception of service users.MethodPKG™ data were collated in real time. Patient acceptability data were collated via a patient questionnaire (n=61).ResultsBetween July 2015 and January 2018, 216 PKGs were performed. A variety of symptoms were identified, including different types of ‘OFF’ times (wearing off (25%), delayed on (6%) no drug response (8%)) and non-motor complications (fragmented sleep (33%) and daytime somnolence (21%)), with subsequent treatment recommendations being made. Patient acceptability of the PKG™ was high, 81% of patients being satisfied not having to travel for clinic appointments.ConclusionsThe PKG™ facilitated remote treatment recommendations. Remote management was acceptable to patients. Future evaluations will evaluate patient outcome.References. van der Eijk M, Nijhuis FAP, Faber MJ, Bloem BR. Moving from physician-centered care towards patient-centered care for Parkinson’s disease patients. Parkinsonism Relat Disord [Internet]. Elsevier; 1 November 2013;19(11):923–7. Available from: https://www.sciencedirect.com/science/article/pii/S1353802013001697?_rdoc=1&_fmt=high&_origin=gateway&_docanchor=&md5=b8429449ccfc9c30159a5f9aeaa92ffb [cited 2018 February 6]. P4 medicine: how systems medicine will transform the healthcare sector and society. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4204402/pdf/nihms532619.pdf [cited 2018 April 6]
WED 145 Human T-lymphotropic virus (HTLV)-associated encephalitis
Authors: Ania Crawshaw , Divya Dhasmana , Carolyn Gabriel , Brynmor Jones , Steve Sturman , Nick Davies , Graham Taylor 
Published: October 2018

Clinical features of human T-lymphotropic virus type 1 (HTLV-1)-associated myelopathy (HAM) are predominantly consistent with cord pathology. Imaging and autopsy studies have also demonstrated brain inflammation in HAM though this is generally subclinical. Six cases (of whom four had HAM) have previously been reported with encephalopathy in HTLV-1 infected patients, without alternative identified aetiology. Histopathology was reported in three of these, with perivascular CD8 +lymphocytic infiltrates in the brain, similar to that seen in the spinal cord in HAM.We describe three further cases of encephalitis in the UK HAM cohort (n=142). Clinical features included: reduced consciousness; fever/hypothermia; headache; seizures; focal neurology. Investigation showed: raised CSF protein; pleocytosis; raised CSF:peripheral blood mononuclear cell HTLV-1 proviral load ratio; MRI either normal or showing diffuse, partially reversible leucoencephalopathy. No alternative aetiology was found. Two died following 1–5 recurrent episodes over a period of 1–5 years, despite responses to immunosuppression.We reviewed the existing literature together with our new cases. 7/9 had concurrent HAM. All seven deteriorated sub-acutely preceding encephalopathy. 7/9 were treated with IV steroids, six improved. Six died, five despite steroids.We propose that HTLV-associated encephalopathy may be part of the spectrum of disease seen in HAM itself.
THUR 150 Treatment and outcomes in primary angiitis of the CNS (PACNS)
Authors: Xin Chua Wei , Dan Whittam , Saif Huda , Anu Jacob 
Published: October 2018

BackgroundPACNS is a rare and heterogeneous disorder with many uncertainties regarding management and outcomes. Published adult UK series total just 20 patients.MethodHospital record search of an adult tertiary neurosciences centre identified 14 cases of PACNS from 1033 potential cases over 20 years.ResultsAll 14 cases were ‘definite’ by Calabrese Criteria (1988), confirmed by brain biopsy in 8/14 and by angiography in 6/14.The median age of onset was 52 years and most presented with focal deficits (86%), headache (36%) and cognitive change (29%). MRI showed multifocal deep white matter change in 86% and infarcts in 50%. Gadolinium enhancement was seen in 43%. Two patients had solitary ring-enhancing lesions and one patient had signs of cord ischaemia. CSF was abnormal in 90%.All patients received corticosteroids, 11/14 cyclophosphamide, 3/14 Mycophenolate Mofetil, 3/14 Methotrexate and 2/14 Azathioprine. At 13.3 months median follow-up, all but the two patients with solitary lesions remained on immunosuppression. Clinical relapses occurred in 30% and radiological relapse in one case despite immunosuppression.Only 62% had a favorable outcome (mRS 0–2). One patient died as a direct consequence of PACNS and one patient died due to co-morbidities.ConclusionPACNS remains a treatable neuroinflammatory disease with poor outcomes.
THUR 154 NMDAR-AB encephalitis: frequency of diagnosis and outcomes
Authors: H Lim , D Whittam , E Jackson , N Williams , D O’Connell , C Chadwick , G Keir , S Huda , A Jacob 
Published: October 2018

BackgroundThe association of N-methyl d-aspartate receptor-antibodies (NMDAR-Abs) and encephalitis is now well recognised. MethodsRetrospective review of frequency of diagnosis and outcomes in encephalitis with NMDAR-Abs identified at the Walton Centre between 2012–2017.ResultsNMDAR-Abs were detected in 29/1131 (3%) of sera and/or CSF samples. Of 20 (69%) patients with encephalitis, 50% were identified in the last two years. Median onset age was 34(17–75) years and 60% (12/20) were female. Median symptom duration before diagnosis was 24(2–720) weeks between 2012–2015, improving to 14(1–96) weeks between 2015–2016. Five patients (25%) had an infectious prodrome (one prior HSV-1 encephalitis). Psychiatric/cognitive symptoms, seizures, and movement disorders were present in 80% (16/20), 70% (14/20), and 55% (11/20) of patients respectively. Three patients had ovarian teratomas.Electroencephalograms were abnormal in 65% (15/23) and MRI brain in 37% (7/19) patients. Unmatched intrathecal oligoclonal bands and CSF pleocytosis were present in 31% (5/16) and 60% (15/25) of samples respectively. Immunotherapy was beneficial in 73% (11/15) of patients. Two patients died (sepsis and multi-organ failure) and two improved spontaneously. At a median follow-up of 9 (5–180) months, 69% (11/16) of patients had an mRS ≤2. ConclusionAlthough the recognition of NMDAR-Ab encephalitis has improved, there is still a significant delay to diagnosis. The majority of patients have good outcomes.
THUR 156 Safe prescribing of immunosuppression: quality improvement project
Authors: Kathryn Bush , Vivien Smith , Gemma Maxwell , Neil Archibald 
Published: October 2018

BackgroundThe use of immunosuppression therapies in Neurology has extended exponentially since they were first used in the 1970s for myasthenia gravis. However there are no NICE or neurology specific guidelines in this area for Neurologists to refer to in their clinical practice.Method and resultsThis 2014 retrospective case notes audit compared medical documentation to ‘10 key statements’ pertaining to the safe use and monitoring of immunosuppression therapies. This is a framework for clinical practice that was first published by The British Association of Rheumatology and The British Association of Dermatology in 2008.A number of key areas of poor documentation around drug safety, pregnancy and vaccinations were identified and in response generic and drug specific safety ‘check-lists’ and guidelines were produced, to be filled out with all patients, prior to starting therapies.In 2016 following the implementation of the quality improvement project, a repeat audit of patient’s medical notes showed a clear improvement in documentation.ConclusionsDrug specific guidelines led to an improvement in documentation and we believe that this also reflects safer prescribing and improved clinical practice. We are now in the process of developing guidelines to be used throughout the entire Northern Deanery.
THUR 158 Susac’s syndrome: treatment and outcomes in three cases
Authors: Xin Chua Wei , Dan Whittam , Saif Huda , David Rog , Martin Wilson , David Smith , Peter Enevoldson , Anu Jacob 
Published: October 2018

BackgroundSusac’s syndrome (SS) is a rare, autoimmune microangiopathy causing a triad of branch retinal artery occlusions, sensorineural hearing loss and brain lesions. Published data on immunotherapy and outcomes is very limited.MethodSingle centre case note review. Electronic hospital records between 1996 and 2017 were searched. 277 possible cases were reviewed.Results3 cases (2 female, 1 male) with the full SS triad were identified. Median age of disease onset was 35.2 years with headache (n=3), confusion (n=1), hearing loss (n=3), vertigo (n=2) and visual field loss (n=2). Time from onset to diagnosis with the full triad was 3–23 months. MRIs showed characteristic corpus callosum involvement. All patients received high-dose corticosteroids as acute therapy. Case 1 was treated with Mycophenolate Mofetil (MMF) and Prednisolone for 27 months, and followed up for a further 8 months. She remained relapse-free. Case 2 relapsed on steroid-reduction, so received Rituximab followed by MMF and Prednisolone. She has now been stable for 14 months. Case 3 was intolerant to high-dose corticosteroids, Cyclophoshamide and MMF. He relapsed off treatment then commenced Azathioprine. Duration on Azathioprine is 14 months with one further relapse.ConclusionSS is rare but causes significant morbidity. Recognition of characteristic findings and early immunotherapy improves outcomes.
WED 162 Cognitive impairment in a greek ms patient cohort using bicams
Authors: T Kalatha , E Koutsouraki , M Arnaoutoglou 
Published: October 2018

IntroductionCognitive impairment (CI) can present in 40%–70% of MS patients and in the early stages of the disease. The Brief International Cognitive assessment for MS (BICAMS) is a brief, practical and potentially universal battery for cognitive assessment in MS.AimTo correlate cognitive function with clinical parameters as disease type, EDSS, and disease durationMethodsThe cognitive function was measured with the validated to the Greek population BICAMS tool, which consists of the Symbol Digit Modalities Test (SDMT), the Greek Verbal Learning Test (GVLT) and the Brief Visuospatial Memory Test-Revised (BVMT-R). Results36% patients classified as impaired according to the BICAMS battery. Progressive types of disease had worst scores than the relapsing in the SDMT (MD=1.73; 95% CI: 0.46, 3.0; p=0.009), GVLT (MD=1.77; 95% CI: 0.82, 2.72; p=0.001) and BICAMS z-score (MD=1.39; 95% CI: 0.54, 2.24; p=0.002). The two groups were also different in EDSS (p<0.001). EDSS showed correlation with BICAMS test. Disease duration did not correlate with CI. Age was identified as a risk factor of CI.DiscussionEarly management of CI can lead to improvement in the patient’s quality of life. Progressing types of the disease might benefit from early cognitive assessment in the disease course.
WED 170 The utility of brain FDG-PET in a patient with natalizumab associated PML-IRIS
Authors: Aravindhan Baheerathan , Sabrina Kalam , Helen Grote , Cillian Mcnamara , Neil Rane , Richard Nicholas 
Published: October 2018

Natalizumab, a highly effective disease modifying drug used in relapsing remitting multiple sclerosis (RRMS), is associated with progressive multifocal leukoencephalopathy (PML), a fatal intracerebral demyelinating disease caused by the JC virus that can be worsened with concurrent use of steorids. Stopping natalizumab in the context of PML can cause immune reconstitution inflammatory syndrome (IRIS) that can be treated with steroids. IRIS can be indistinguishable from PML on MRI - thus causing a clinical conundrum.We describe a woman with RRMS on Natalizumab who developed dysarthria and right-sided hemiparesis. MRI demonstrated non-enhancing peridentate white matter signal abnormality in the right middle cerebellar peduncle (RMCP). Cerebrospinal fluid JC virus DNA was >1 million copies/ml. PML was diagnosed and Natalizumab withdrawn. Four weeks later she developed bulbar weakness and left-sided hemiparesis despite falling JC virus DNA. Repeat MRI demonstrated new extensive pontine changes consistent with PML-IRIS.FDG-PET imaging confirmed focal areas of hypometabolism at the original site of PML and multiple areas of hypermetabolism in the left pons and middle cerebellar peduncle, suggestive of IRIS. Her clinical deterioration was attributed to IRIS and Prednisolone was commenced.In this case FDG-PET scanning helped distinguish between PML and IRIS, guiding patient management.
THUR 172 Phase iv study of cladribine tablets and quality of life: clarify-ms
Authors: Schippling S , Langdon D , Solari A , Brochet B , Hupperts R , Piehl F , Lechner-Scott J , Montalban X , Keller B , Alexandri N 
Published: October 2018

Authors Disclaimer: http://medpub-poster.merckgroup.com/ABN2018DISC_CLARIFY.pdfBackgroundRelapsing multiple sclerosis (RMS) negatively affects health-related quality of life (HRQoL).ObjectiveAn open-label, single-arm, exploratory Phase IV study in centres in Europe and Australia will assess HRQoL in RMS patients receiving CT 3.5 mg/kg (CT3.5).MethodsEligible patients will receive CT 3.5 (cumulative) over 2 years. HRQoL (Multiple Sclerosis Quality of Life-54 [MSQoL-54]) and other patient-reported outcomes (Fatigue Severity Scale; Hospital Anxiety and Depression Scale; Treatment Satisfaction Questionnaire for Medication v1.4) will be assessed at baseline, and at 6, 12, 24 months.Other outcomes include AEs, MRI measures (T1 Gd+ lesions, T2 lesions, brain atrophy), number of relapses, and disability/functioning measures (EDSS; 9-Hole Peg Test; Timed 25-Foot Walk and Brief International Cognitive Assessment for Multiple Sclerosis). The sample size estimation is based on the power to detect a mean difference of 5 points in MSQoL-54 composite score at 24 months vs baseline.ResultsThe study aims to recruit 356 adults with RMS by 2019. Final data are anticipated in 2022.ConclusionsThis study will explore the effects of CT on HRQoL outcomes, and describe the effects of CT on treatment satisfaction and disability/functioning.Disclosure statementThe trial is sponsored by Merck KGaA, Darmstadt, Germany.
WED 012 Reversible optic neuritis secondary to metronidazole
Authors: Natalie Anwyll , Paul Gerry , Kevin Gormley 
Published: October 2018

Metronidazole is a nitroimidazole antibiotic used to treated anaerobic bacteria and protozoal infections. Neurological side-effects are documented mainly relating to peripheral neuropathy. There are only isolated case reports of optic neuropathy secondary to Metronidazole.We describe a 36 year old man who presented with reduced central visual loss on a background of a two year history of Metronidazole use for a perianal fistula. Electrophysiology confirmed bilateral optic neuropathy. On cessation of Metronidazole visual acuity and electrophysiological studies returned to normal. This is the reported longest duration of metronidazole at maximal dosing causing an optic neuropathy with complete resolution on cessation.
WED 185 Clarity: mri outcomes in high disease activity relapsing ms
Authors: Giovannoni Gavin , Rammohan Kottil , Cook Stuart , Comi Giancarlo , Rieckmann Peter , Soelberg-Sorensen Per , Vermersch Patrick , Dangond Fernando , Hicking Christine 
Published: October 2018

BackgroundThe CLARITY study demonstrated the benefit of cladribine tablets 3.5 mg/kg (CT3.5) for patients with relapsing MS (RMS). Patients with high disease activity (HDA) RMS are at risk of clinical activity and disability progression.ObjectivePost-hoc analysis of MRI outcomes in CLARITY for CT3.5 vs placebo.MethodsRetrospective analysis using HDA definitions based on relapse history, prior treatment, and MRI characteristics: high relapse activity (HRA) and HRA plus disease activity on treatment (HRA+DAT).ResultsFor cumulative new T1 Gd+ lesions, relative risk ratios (RRR) for both subgroups (HRA: 0.087; 95% CI: 0.052 to 0.144; p<0.0001) (HRA+DAT: 0.077; 95% CI: 0.046 to 0.128; p<0.0001) were lower for CT3.5 vs placebo. Risk reductions (RR) (91% and 92%, respectively) were similar to the 90% reduction in the overall CLARITY population (0.097; 95% CI: 0.070 to 0.134; p<0.0001). Cumulative active T2 lesions RRR favoured CT3.5 vs placebo for both subgroups (HRA: 0.263; 95% CI: 0.180 to 0.383, p<0.0001) (HRA+DAT: 0.254; 95% CI: 0.178 to 0.363; p<0.0001): RRs of 74% and 75%, reflecting the 73% overall population reduction (0.272; 95% CI: 0.221 to 0.335; p<0.0001). Cumulative combined unique lesions RRR favoured CT3.5 vs placebo for HRA (0.212; 95% CI: 0.145 to 0.311; p<0.0001) and HRA+DAT (0.203; 95% CI: 0.141 to 0.291; p<0.0001): RRs were 79% and 80%, reflecting the 77% overall population reduction (0.234; 95% CI: 0.190 to 0.290; p<0.0001). There were no significant interactions between HDA and non-HDA subgroups.ConclusionsThe treatment benefit of CT3.5 on MRI outcomes was similar in HDA RMS subgroups and the overall CLARITY study population.Disclaimerhttp://medpub-poster.merckgroup.com/ABN2018DISC_HDAMRI.pdf
WED 187 Infections in ocrelizumab recipients from phase III studies
Authors: Gavin Giovannoni , Hans-Peter Hartung , Giancarlo Comi , Jérôme de Seze , Bernhard Hemmer , Ludwig Kappos , Xavier Montalban , Krzysztof Selmaj , Nicole Mairon , Jerry Wolinsky 
Published: October 2018

BackgroundOcrelizumab Phase III study safety findings in relapsing (OPERA I/II [NCT01247324/NCT01412333]) and primary progressive multiple sclerosis (ORATORIO [NCT01194570]) were reported; infections and serious infections are reported here. Methods: Ocrelizumab patients received 600 mg intravenously every 24 weeks for 96 weeks (OPERA I/II) or ≥120 weeks (ORATORIO; 2 × 300 mg infusions 14 days apart every 24 weeks). Controls received interferon beta-1a 44 µg thrice weekly (IFNβ−1a; OPERA I/II) or placebo (ORATORIO). Infections were classified by MedDRA system organ class/preferred term.ResultsNon-serious infection rates in ocrelizumab-treated patients in OPERA were 58.4% (pooled analysis) and ORATORIO 69.8%; comparators were IFNβ−1a 52.4% and placebo 67.8%. Most infections were mild-to-moderate. Common infections (≥10% in either group) reported more in ocrelizumab treated patients were upper respiratory tract infections and either nasopharyngitis (OPERA) or influenza (ORATORIO);<1% of ocrelizumab-treated patients withdrew due to non-serious infections. Serious infections occurred in 1.3% (OPERA) and 6.2% (ORATORIO) of ocrelizumab-treated patients; comparators were IFNβ−1a 2.9% and placebo 5.9%. No infection-related deaths occurred in ocrelizumabtreated patients in OPERA; two deaths occurred in ORATORIO (aspiration pneumonia and pneumonia [unrelated per investigator, related per sponsor]). No opportunistic infections were reported.ConclusionSerious infection rates with ocrelizumab were numerically lower than with IFNβ−1a and similar compared with placebo.
THUR 194 Autologous haematopoietic stem cell transplant in ms
Authors: Joyutpal Das , John Snowden , Sona Mistry , Simon Bell , Helen Jessop , Basil Sharrack 
Published: October 2018

IntroductionAutologous haematopoietic stem cell transplantation (AHSCT) is a very effective treatment in patients with highly active relapsing remitting multiple sclerosis (RRMS) who failed standard disease modifying therapies (DMTs).MethodsWe retrospectively reviewed the medical records of all patients with RRMS who received AHSCT in Sheffield.Results25 patents with RRMS received AHSCT between July 2013 and July 2017. Their median age at diagnosis was 40 (22–56) years. All had highly active disease with gadolinium enhancing lesions on their pre-transplant MRIs. Eighteen patients had previously been treated with various DMTs and seven were treatment naïve. Median pre-AHSCT EDSS was 5.5 (2.5–7.5). Median follow up was 12 (3–42) months. Median post-AHSCT EDSS at the last follow up was 3 (1–6.5), p<0.001. No patient experienced further relapses following transplantation. Three patients had new lesions on their first follow up MRI at 6 months, but none had any new or enhancing lesions on subsequent MRI scans. Only routine transplant related toxicities were observed. One female and the wife of a male patient successfully conceived following AHSCT.ConclusionAHSCT is safe and effective in inducing remission in patients with highly active RRMS. Further studies are required to compare its efficacy with standard DMTs.
Drug-coated balloons for the treatment of symptomatic intracranial atherosclerosis: initial experience and follow-up outcome
Authors: Han Ju , Zhang Jun , Zhang Xiao , Zhang Jinping , Song Yun , Zhao Wei , Zheng Meimei , Sun Lili , Wang Wei 
Published: October 2018

BackgroundThe optimal treatment for patients with symptomatic severe intracranial atherosclerotic disease is not well established. Angioplasty and stenting have been attempted, with controversial results, mainly attributed to perioperative complications and a high incidence of restenosis or in-stent restenosis. Drug-coated balloons (DCBs) have shown encouraging results for coronary and peripheral artery disease, without convincing data for intracranial vasculature.ObjectivesTo assess the feasibility, clinical and angiographic outcomes of DCBs for patients with intracranial de novo atherosclerotic disease.MethodsBetween September 2016 and September 2017, details of 30 patients with 31 arteries treated with DCBs for symptomatic severe intracranial atherosclerotic disease (≥70% stenosis or chronic total occlusion) were retrospectively collected in our centre. All lesions were predilated with conventional balloons. Periprocedural complications and clinical and vascular imaging follow-up outcomes were analysed.ResultsAll arteries were successfully dilated with DCBs and 29 (93.5%) arteries achieved good antegrade perfusion, with remedial stenting for two arteries. Two patients presented with new ischemic stroke after the procedure. Over a mean follow-up of 9.8±2.6 months, no patient had recurrent ischemic symptoms. Repeat vascular imaging was performed at 7.0±1.1 months, with cerebral angiography in 24 patients (25 arteries) and MR angiography in six patients (six arteries). Only one (3.2%) artery presented with angiographic asymptomatic restenosis.ConclusionsThis study suggests that DCB dilatation may be a safe and effective alternative for intracranial de novo atherosclerotic disease.