bluuebunny/crossref_metadata_2025_split huggingface dataset:
Altered cerebral blood flow in the anterior cingulate cortex is associated with neuropathic pain
Authors: Watanabe Keisuke , Hirano Shigeki , Kojima Kazuho , Nagashima Kengo , Mukai Hiroki , Sato Takatoshi , Takemoto Minoru , Matsumoto Koji , Iimori Takashi , Isose Sagiri , Omori Shigeki , Shibuya Kazumoto , Sekiguchi Yukari , Beppu Minako , Amino Hiroshi , Suichi Tomoki , Yokote Koutaro , Uno Takashi , Kuwabara Satoshi , Misawa Sonoko 
Published: October 2018

ObjectiveTo assess the cerebral blood flow (CBF) in patients with diabetic neuropathic pain, and its changes after duloxetine therapy.MethodsUsing iodine-123-N-isopropyl-p-iodoamphetamine single-photon emission computed tomography (IMP-SPECT), we performed a cross-sectional study of 44 patients with diabetes, and compared CBF in those with (n = 24) and without neuropathic pain (n = 20). In patients with neuropathic pain, we also longitudinally assessed changes in CBF 3 months after treatment with duloxetine.ResultsIMP-SPECT with voxel-based analyses showed a significant increase in cerebral blood flow in the right anterior cingulate cortex and a decrease in the left ventral striatum in patients with neuropathic pain, compared with those without pain. After duloxetine treatment, volume of interest analyses revealed a decrease in cerebral blood flow in the anterior cingulate cortex in patients with significant pain relief but not in non-responders. Furthermore, voxel-based whole brain correlation analyses demonstrated that greater baseline CBF in the anterior cingulate cortex was associated with better pain relief on the numerical rating scale.ConclusionsOur results suggest that the development of neuropathic pain is associated with increased activity in the anterior cingulate cortex, and greater baseline activation of this region may predict treatment responsiveness to pharmacological intervention.Trial registration numberUMIN000017130;Results.
THUR 199 MS DMT monitoring according to abn guidelines & product specification
Authors: Carter E , Macleod MA , Visser E 
Published: October 2018

AimRetrospective audit monitoring Multiple Sclerosis (MS) patients on Disease Modifying Therapies (DMT’s) according to Association of British Neurologists (ABN) guidelines (2015) and product specifications. This requires blood tests prior and during treatment and reviews by MS professionals.MethodsMS nurse database identified patients, records were reviewed and data extracted including bloods, JC virus (JCV) testing, imaging, specialist tests and counselling. Analysis was presented to the MS team. Protocols and referral pathways were designed, and new patients were re-audited.ResultsThe first cycle comprised of 280 patients, representing 325 individual DMT regimens. Prior to commencing treatments 90.7% blood tests, 58% imaging, and 60% JCV testing was completed on average. At 12 months, this decreased to 88.7% bloods, 30% imaging, and 25% JCV testing. Electronic records revealed that counselling documentation was sometimes incomplete. The second cycle analysed 55 patients showing improvement in Progressive multifocal leukoencephalopathy counselling and annual imaging.ConclusionMonitoring of bloods is done at a high standard, imaging and JCV testing less frequently meet monitoring guidelines. Factors influencing this include rural locations, variation in practice, and changing guidelines. Further work will include yearly follow-up, documentation of stopping criteria and regular review of monitoring guidelines. Patient involvement should be considered.
THUR 220 To c or not to c
Authors: Pipis Menelaos , Jaunmuktane Zane , Brandner Sebastian , D’Sa Shirley , Marafioti Teresa , Shah Sachit , Fuller Geraint , Reilly Mary M 
Published: October 2018

Peripheral T-cell lymphomas (PTCLs) are rare and heterogeneous haematological malignancies that can rarely develop first in the peripheral nervous system, or more commonly, invade nerves from more usual primary locations. Patients with PTCLs usually respond poorly to treatment and have a poor clinical outcome.We report a patient with multiple skin lesions, multifocal mononeuropathies and constitutional symptoms all suggestive of a lymphoproliferative disorder, in whom repeat skin biopsies and clonality studies failed to achieve a diagnosis. Neurophysiological studies confirmed severe post-ganglionic lesions in the lower limbs including the sciatic, femoral, obturator, tibial and sural territories. Based on this neurotropic presentation we undertook a sural nerve biopsy, despite the clinical and neurophysiological presence of a nerve lesion more proximal to the biopsy site, and this allowed us to establish a final diagnosis of PTCL. The patient was treated successfully with chemotherapy and an autologous stem cell transplant.In our case PET imaging and MR neurography provided radiological evidence of widespread lesions in the subcutaneous and nerve tissues, and there is emerging evidence for the importance of PET imaging in the diagnostic work-up of PTCLs. Furthermore, a post-treatment PET scan confirmed the complete metabolic remission, highlighting its usefulness as a surveillance tool.
WED 223 Predicting disease activity in inflammatory neuropathies
Authors: Mahima Kapoor , Aisling Carr , Michael Lunn , Mary M Reilly 
Published: October 2018

BackgroundThere is currently no accurate way to determine who will need long-term immunoglobulin (IVIg) treatment in chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy (MMN).AimsRetrospectively compare clinical, investigational and treatment factors in patients who have successfully ceased IVIg with patients who have active disease.Methods15 patients who have successfully suspended IVIg infusions were compared with 15 in whom decreasing the IVIg dose was unsuccessful.Results30 patients (12 with CIDP and 3 with MMN in both groups) were diagnosed 39.5 months from onset of symptoms in the successful group vs 40.7 months in the unsuccessful group (p=0.953). There was a significant difference in the summed upper limb sensory amplitudes on electrophysiology prior to starting IVIg between the patients with CIDP (17.4 mV vs 9.8 mV p=0.007). There was no difference between the average doses between the groups. A successful cessation trial was attempted at a mean of 60.5 months post starting treatment, compared with 60 months in the unsuccessful patients.ConclusionOther than the differences in initial upper limb amplitudes, other factors did not help predict a successful cessation trial of IVIg. This reinforces the need for an objective biomarker to measure disease activity.
WED 224 Building causality networks for inherited neuropathies
Authors: Yung Tiet May , R Barnes Michael 
Published: October 2018

BackgroundInherited neuropathies are genetic conditions affecting the peripheral motor and sensory nerves. The number of causative genes are continuing to expand. As more genes are being discovered, more phenotypes are attributed. Despite our rapidly growing knowledge, inherited neuropathies remain incurable diseases.With the wealth of information now available, bioinformatic platforms are available to visualise functional enrichment of genes and gene-phenotype annotations to enhance our understanding of the mechanism of disease and support hypothesis-driven research.MethodsThe interactors of inherited neuropathy genes were explored using the Search Tool for Recurring Incidences of Neighbouring Genes (STRING) database. Drug-phenotype interactions were assessed using PhenogramViz, human phenotype ontology terms (HPO). We used the Drug Gene Interaction Database (DGIdb) to find drug-gene interactions then used DoGSiteScorer to view potential drug binding pockets.ResultsInherited neuropathy genes were associated with gene ontology terms related to axonal transport. A total of 380 HPO terms were annotated to the genes which shared a phenotypic spectrum with neurodegenerative disorders. We identified 221 drug-gene interactions.ConclusionBioinformatic platforms are available to rapidly visualise and explore large gene-sets. Platforms to annotate drug-gene interactions need to be developed to assist drug discovery and identify potential agents that can be repurposed.
THUR 229 Inertial sensors improve traditional gait monitoring in HSP patients
Authors: Mary McNamara , Ruta Segamogaite , Pamela Shaw , Christopher McDermott , Claudia Mazzá , Channa Hewamadduma 
Published: October 2018

BackgroundHSP is characterised by spasticity and progressive gait impairment. There’s no reliable way to monitor gait deterioration during clinics. Optoelectronic systems have demonstrated differing characteristics between gait of HSP patients and controls. They’re expensive and impractical for use in clinic settings. Inertial sensors haven’t been used to characterise HSP gaitObjectivesStudy use of inertial sensors to identify gait characteristics that differentiate mild HSP patients from controls. To identify a gait based biomarker which can be used to monitor disease progression in a longitudinal study.MethodsNeurological examination, SPRS, Modified Ashworth score, brief pain inventory were undertaken. Instrumented timed up and go (iTUG) and instrumented 10 metre walk tests (i10) wearing an inertial sensor during clinic appointments at 6 month intervals.ResultsGait variables differentiating between patients and controls, including those with mild disease, were identified. Parameters differentiating between patients with SPG4 and SPG7 mutations were found. 8 patients were re-assessed after 6 months. Analysis did not show gait deterioration.ConclusionInertial sensors can detect differences between HSP patients and controls, including those mildly affected. They can also differentiate between patients with different mutations. Further follow up data is needed to assess whether inertial sensors can predict future gait deterioration.
THUR 018 Advice and guidance: not so quick and easy
Authors: Christopher Kipps , Sarah Delves , Georgina Burke , Christopher Halfpenny , Joanna Kitley , Jonathan Frankel , Sean Slaght , William Gibb 
Published: October 2018

BackgroundWaiting times for outpatient consultations are consistently under pressure, and delivery of the mandatory 18 week target from referral to completed review remains challenging. An Advice and Guidance scheme offers an opportunity to access neurological advice while reducing face-to-face consultation needs. We designed this project to develop the requirements, methods, audit and costing of sustainable neurological advice.MethodsA DGH Neurology service worked with a local CCG comprising 18 GP practices. All 176 referrals and advice requests received during a 6 month pilot were considered for A and G instead of a clinic appointment.ResultsAdvice was offered in 37% of cases overall (48 patients), but a net increase of 12% in face-to-face consultations was observed, as 28 (16%) of advice requests required clinic review. Headache and alteration of consciousness were common, and cases with an established diagnosis the most tractable for the ‘Advice Only’ option. GP referral quality was judged good, neurology satisfaction was reasonable, and a cost of at least £68 per episode was indicated.DiscussionThis pilot showed an increase in the number of face-to-face clinic reviews required. We suggest that other reported schemes may have not included advice requests that resulted in referrals in their metrics.
WED 243 Enhancing our knowledge of leptomeningeal disease – a case of DL-GNT
Authors: Marc Edwards , Alistair Lammie , Chirag Patel , Stefan Schwarz , Mark Wardle 
Published: October 2018

A 57-year-old woman presented with several weeks of headache associated with neck stiffness, drowsiness and nausea. She developed diplopia with right-sided 6th nerve palsy and subsequently developed a complex ophthalmoplegia and right-sided ptosis.Repeated lumbar punctures showed high opening pressures of up to 60 cm H2O and high protein levels up to 2.48 g/L. She developed episodes of marked loss of responsiveness but EEGs showed only generalised slowing. Brain imaging was essentially normal. An MRI Spine showed an enhancing intramedullary hyperintensity T8-T10 with overlying meningeal enhancement. A CT-PET scan revealed uptake along the cord consistent with diffuse infiltration or a meningitis – biopsy was inconclusive but macroscopically the dura was thickened with calcification observed on the spinal cord surface. A brain biopsy did not aid diagnosis and unfortunately the patient deteriorated with increasing severity of headaches and drowsiness. She died after a number of cardiorespiratory arrests.At post-mortem, thickened meninges showed a glioneuronal cell infiltrate and a diagnosis of diffuse leptomeningeal glioneuronal tumour (DL-GNT). WHO recently described DL-GNT in the 2016 update of CNS tumour classification. Previous case reports of this rare disease have concerned adults and children. DL-GNT should be considered in cases of radiological leptomeningeal enhancement and high CSF protein levels.
WED 244 CSF cytology alone is unable to predict CNS neoplastic process
Authors: Alex Osborne , Channa Hewamadduma 
Published: October 2018

Incidence of both primary and secondary central nervous system (CNS) malignancies are increasing, yet detection and diagnosis of which remains challenging. Neurological examination, CSF cytology and neuroimaging each offer diagnostic value, however, individually, each method has relatively low sensitivity. CSF cytology is often routinely requested as part of the diagnostic work-up. Therefore, we reviewed the value of CSF cytology in predicting CNS neoplastic process.We systematically analysed 296 patients who had had CSF cytology. All consecutive patients over the last 2 years were included. The 12 patients positive for CSF cytology were also found to have concurrent; clinical findings (92%), radiological findings (92%), or both (83%). In no patient CNS malignancy was identified by CSF cytology alone. Additionally, only 7 of the 12 CSF positive cases were collected by means of lumbar puncture, the rest were carried out during neurosurgical procedures.We conclude that if there is neither clinical findings nor abnormal neuroimaging, assessing CSF cytology does not contribute towards diagnosis of CNS malignancy. Yield of CSF cytology is high when both clinical and radiological evidence are present. Where neuroimaging is normal but suspicion remains, the low sensitivity of the CSF-cytology would make it a weak corroborator to exclude malignancy.
WED 261 Stroke scan agnosia – what radiologists do not see
Authors: Mark McCarron , Jacqueline McKee , Carrie Wade , Ferghal McVerry 
Published: October 2018

BackgroundNeuroimaging helps clinicians make accurate diagnoses. Most stroke patients have their imaging reported by general radiologists.MethodsAs part of a quality assurance program a database for neurological patients with second opinion reporting from neuroradiologists was searched from 2008 to 2016 to identify patients in whom stroke lesions were missed at initial reporting by general radiologists. Patient demographics, scanning modality, stroke type, location and laterality were recorded.Results36 patients, 18 men, 18 women, mean age 59.0 (SD 13.8) years were identified in whom a stroke lesion was not detected on initial reporting. The lesions included cerebellar infarcts in 14 patients (bilateral in 3), pontine ischaemia/infarction (n=6), supratentorial infarction (n=9), vessel abnormality (n=6 – dense middle cerebral and basilar arteries, dissection and cerebral venous sinus thrombosis), and spinal infarction (n=1). In 9 (24%) patients the missed lesions occurred solely on CT brain scanning. The missed lesions were acute presentations in 8 (22%) patients.ConclusionStroke lesions can be missed with both CT and MRI. The posterior fossa and dense artery signals (middle cerebral artery and basilar artery) are prone to detection errors.
THUR 265 Complaints from patients with functional disorders
Authors: Clare Bolton , Paul Goldsmith 
Published: October 2018

ObjectiveTo evaluate the nature of complaints from patients with functional neurological disorders and understand the reaction of UK neurology consultants to receiving complaints from this patient group.MethodsA voluntary anonymised online retrospective survey was advertised to UK consultant neurologists. Questions asked about the nature of the complaint, how it was dealt with, how it affected their emotional wellbeing, attitude to work, and whether it influenced their clinical practice. The frequency of total responses was analysed. Respondents were given opportunities to add comments.ResultsResponses from 58 clinicians were included. The majority of complaints stemmed from patients not agreeing with their diagnosis. Respondents felt that complaints from patients with functional disorders tended to be more involved and personal than other complaints. Lack of awareness about functional conditions among non-specialists was also a common theme. For many respondents, the complaint adversely affected their emotional wellbeing. Following the complaint, defensive practice was more common, and working patterns were altered.ConclusionsComplaints from patients with functional neurological disorders appear more difficult to resolve than other complaints, and clinicians who deal with them often become the ‘second victim’ in the process leading to potentially adverse effects on patient care. Strategies to tackle these issues are discussed.
WED 268 Improving junior doctors induction: queen square junior doctors handbook
Authors: Talal Al-Mayhani , Aytakin Khalil 
Published: October 2018

IntroductionAll junior doctors joining Queen Square undergo an induction package delivered along with the Queen Square Junior Doctors’ Handbook (QS-H). QS-H is supposed to provide general guidance to daily medical jobs in addition to useful clinical information, contact details and hints.AimThe aim of this quality improvement project (QIP) was to update, and improve, the quality of QS-H. The idea was that better and more informative induction can make carrying out daily jobs easier, increase the efficacy/effectiveness of medical staff and, ultimately, impact positively on patients care.MethodsIn this QIP a participatory assessment approach was employed where the opinions of the beneficiaries (junior doctors) were sought to screen for the strengths/weaknesses of the old version of QS-H, and to assess, later on, the new version.Results and conclusionMost junior doctors highlight the length of QS-H and the outdated information of its contents. Based on their suggestions a new, brief and practical version was drafted and was well received with some comments that led to additional round of improvement. Distributing hardcopies of QS-H around the wards further improved the junior doctors’ accessibility, efficiency, effectiveness and satisfaction.
WED 273 Wessex healthlines: neuroline
Authors: Pauline Lillistone , Rachel Chappell , Charlie Dukes , David Higenbottam , Christopher Kipps 
Published: October 2018

BackgroundThe ability to provide timely signposting to patient with neurological conditions seen in clinic is crucial, but information resources are not always available or updated. Individuals wishing to participate in clinical trials may find it difficult to locate research opportunities, and busy clinicians may not be aware of local clinical research studies. We sought to develop a means of collating, organizing and displaying information on neurological conditions and research trials in an easily accessible form online.MethodsOver 350 local support groups, information resources and websites dealing with neurological conditions relevant to neurological patients in Wessex were identified. These were then displayed via a website that maps these resources, and offers a summary with a link to the primary source.ResultsOver the past year, the Wessex HealthLines site has been visited by over 2300 users, with the NeuroLine pages (wessexhealthlines.nhs.uk/neuroline) accessed by over 750 users. The site has now been expanded to include neurological research trials running in the region (ResearchLine).DiscussionThe Wessex HealthLines website (NeuroLine, ResearchLine) makes use of multiple resources to support information signposting in neurological conditions, and to clinical trials, across Wessex. Other regions interested in quality improvement projects may find this approach useful.
275 Poster: acute neurology care model – ‘the neuro network’
Authors: Fletcher Nick 
Published: October 2018

The neuro network is a well-developed model in North West England and North Wales, hosted by the Walton Centre Liverpool. It is based on the principle of an equitable, locally accessible service taking responsibility for a regional population, rather than one based on a single unit or small area.Centralised tertiary activity is based in Liverpool – for patients requiring specialised diagnostic or therapeutic intervention and care; particularly neurosurgery, thrombectomy, neurological ITU or frequent review of complex acute neurological disorders.Acute neurological support is delivered to 12 acute sites across the region using a combination of consultant visits and ward liaison sessions (typically 3–4 days each week), telemedicine video consultations (presently being developed at pilot sites), 24/7 telephone advice and a weekday consultant advice line for GP’s. Patients are then treated, whenever possible, by a local medical team (or HASU) supported by a neurology management plan (and subsequent on-site or remote review if necessary) or by transfer to the centre if clinically appropriate.The model offers acute neurology provision to a wide area, by the most effective, resilient and equitable deployment of limited resources.
278 Inspector norse
Authors: Amy Ross Russell , Luke Massey , Imogen Williams , Mark Fabian , James Nicoll , Efrem Eren , Emmanuela Pelosi , Martin Prevett , James Hell , Haider Katifi 
Published: October 2018

A 26 year old, Caucasian, female student nurse presented with facial pains and vesicular rash, and over the following three days developed focal faciobrachial twitches. She was febrile, with an erythematous rash. Neurological examination was normal. MRI showed a non-enhancing lesion in the right medulla. CSF was normal with negative viral PCR. EEG demonstrated no seizure activity.A month earlier she was treated with steroids and antibiotics for acute liver injury and maculopapular rash, of presumed allergic aetiology. On that admission, deficiency of Immunoglobulins A and G was noted prompting diagnosis of Common Variable Immune Deficiency, treated with IVIg.Her conscious level deteriorated rapidly, requiring ventilation 10 days after admission. Repeat MRI showed a new subcortical inflammatory lesion. EEG showed new background slowing, and progressed to electrographic status, which continued despite six anticonvulsants, IV Propofol and Midazolam. Sequential imaging showed progressive deterioration with widespread inflammation and oedema, and consequent herniation. Life-support was withdrawn one month after presentation.Post-mortem demonstrated T-lymphocytic inflammation with inclusion bodies suggesting viral encephalitis. Electron microscopy demonstrated filamentous viral particles. Measles PCR was positive in brain tissue and CSF, diagnosing Measles Inclusion Body Encephalitis. Serum measles IgM, previously reported as negative, was re-evaluated and tested positive.