bluuebunny/crossref_metadata_2025_split huggingface dataset:
14 Saving Adam from the apple: using transcranial magnetic stimulation as a transdiagnostically relevant tool to decrease cue-reactivity
Authors: Hanlon Colleen A 
Published: December 2022

Professor Hanlon’s scientific research has been to map neural circuit irregularities in substance dependent populations and then modulate these circuits using brain stimulation techniques or neurofeedback. She is leading NIH-funded research directed at longitudinal investigations of neural connectivity in cocaine & alcohol dependent individuals undergoing substance abuse treatment, & developing patient-tailored brain stimulation protocols which may either enhance cognitive control or attenuate craving in treatment seeking individuals. Her trainees & collaborators are pioneering non-invasive neuromodulatory strategies for treating addiction including continuous Theta Burst Stimulation to the medial prefrontal cortex, & real-time fMRI biofeedback. She has also received independent funding to pursue research in PTSD, Tourette Syndrome, & Stroke rehabilitation.AbstractThe struggle between internal self-control and external temptation from environmental cues is a tale as old as written history, yet as relevant today as any time in the past. For most individuals, the occasional surrender to a tempting cue will not impair their ability to fulfill daily and longer term responsibilities. For other individuals, including those with substance use disorders, elevated reactivity to positive or negative cues causes a disabling cascade of events ultimately impeding long-term goals. In these populations, salient cues evoke elevated activity in a consistent network of neural regions. This network contains the ventral medial prefrontal cortex (MPFC), anterior cingulate cortex (ACC), and insula.Our laboratory has spent the last 7 years systematically and empirically developing a non-invasive, neural circuit based intervention to dampen cue-reactivity in various drug and alcohol dependent populations. This talk will briefly review the data that motivated our selection of a candidate neural circuit, and will then summarize the results of 7 studies, culminating in the first 2 double-blinded, sham controlled clinical trials of MPFC TMS as a behavioral treatment adjuvant among treatment-engaged cocaine users and alcohol users.The intent of this talk is to highlight one example of a systematic path for TMS treatment development in patients. This path is not necessarily optimal, exclusive, or appropriate for every neurologic or psychiatric disease. Rather, it is one example of a reasoned, empirically-derived pathway which we hope will serve as scaffolding for future investigators seeking to develop TMS treatment protocols.
18 What can human lesion studies tell us about the function of the claustrum?
Authors: Atilgan Huriye , Doody Max , Oliver David K , McGrath Thomas M , Shelton Andrew M , Echeverria-Altuna Irene , Tracey Irene , Vyazovskiy Vladyslav V , Manohar Sanjay G , Packer Adam M 
Published: December 2022

Objectives/AimsThe claustrum is a sheet-like bilateral brain region whose function remains unknown. We comprehensively examined cases of human claustrum lesions to assess their support for various hypotheses of function. To do so we searched the following terms on PubMed and Scopus: ‘claustrum AND (lesion OR contusion OR in- jury OR trauma)’.ResultsIn total our search uncovered 103 cases, which were then screened for confirmed damage to the claustrum by neuroimaging. Thirty-eight individual cases and 14 cohort studies were included. Our results suggest human claustral lesions do not selectively impair a singular domain. Instead, they argue that human claustrum may have a more general function. The high incidence of seizures following claustral lesions suggests this may involve maintenance of excitation-inhibition balance.ConclusionsThe wide range of symptoms observed following claustral lesions do not provide compelling evidence to support prominent current theories of claustrum function such as spatial navigation, attentional allocation, cognition, multisensory integration, and salience computation. Conversely, the lesions studies support the hypothesis that the claustrum regulates cortical excitability.
22 Pharmacological treatment of agitation in acute traumatic brain injury: a service evaluation of prescribing at the walton centre
Authors: Black Lori , Costa Antonio Da , Smith Jon , Cleary Lindsay , Sahitya Vijay 
Published: December 2022

ObjectivesA diverse range of medications are used to treat agitation in patients presenting with acute Traumatic Brain Injury (TBI). A service evaluation was conducted at The Walton Centre, a regional neuroscience centre to establish which psychopharmacological agents were being used most frequently in patients admitted with acute TBI.Methods187 patients were admitted with an acute TBI between April 2020 and July 2021. The notes of these patients were audited to find out their demographic details, the nature of their injuries, the surgical interventions they received and pre-morbid medical and mental health diagnoses. We then collated information on medications they were prescribed during their acute admission with a focus on analgesia, antiepileptics, benzodiazepines, antidepressants, antipsychotics, mood-stabilisers and melatonin. The data was then analysed.Results187 patients were admitted to the Walton Centre with an acute traumatic brain injury between April 2020 and June 2021. 127 (68%) of these patients were male and 60 (32%) female. 17 patients died as a result of their injuries, 99 were discharged home and the remainder were transferred to other hospitals for ongoing rehabilitation following their acute admission.24.6% (n=46) of patients had a premorbid diagnosis of a mental disorder. Of these, 25 (54%) had a diagnosis of major depressive disorder and 23 (50%) an anxiety disorder. 11 patients had premorbid psychotic disorders, including 5 patients with schizophrenia, 2 with Bipolar Affective Disorder and 4 with other psychotic disorders with an unspecified diagnosis. 39 (20.9%) patients had a history of substance misuse. 87.1% (n=34) of these patients consumed alcohol to excess.29.9% (n=56) of patients were prescribed an antidepressant. Of these, trazadone was used most frequently accounting for 35.7% (n=20) of antidepressant prescriptions. Mirtazapine was used in 10 patients and sertraline in 13. 30 patients (16%) were treated with an antipsychotic. Of these, 80% (n=24) of patients were given atypical antipsychotics whilst 26.7% (n=8) were prescribed typical antipsychotics. Olanzapine accounted for 56.6% (n=17) of antipsychotic prescriptions. 13.9% (n=26) of patients were prescribed melatonin, which was the most frequently used medication for sleep regulation.ConclusionsPatients admitted with TBI commonly had premorbid mental health diagnoses. Around 30% required pharmacological treatment for neuropsychiatric symptoms, with antidepressants, antipsychotics and mood-stabilising anti-epileptics being commonly used.
23 An evidence based screening protocol for chronic traumatic encephalopathy
Authors: Sharma Kanch 
Published: December 2022

IntroductionRepeated head injury is unequivocally associated with brain damage, and an increased risk of Chronic Traumatic Encephalopathy (CTE) dementia. From 1928 until 2005 CTE was a diagnosis exclusively associated with pugilism but is now postulated to be associated with other sports such as rugby and football. For over twenty years the British Boxing Board of Control (BBBoC) has run a neurological screening programme. There are approximately 1000 licenced boxers who undergo a MRI cerebral angiogram on initially licencing with a MRI brain which is repeated annually. This was devised to screen for abnormalities, such as arterio-venous malformations which might predispose to catastrophic bleeding following occupational trauma. A ‘neuro panel’ consisting of one neurologist and three neurosurgeons, was setup to manage abnormal scan findings.RationaleThe BBBoC puts boxer safety as the top priority. Using the latest, best available evidence we have modified the neurological screening programme to proactively assess for CTE in evolution. The clinical presentations of CTE are not well understood and may include a broad range of cognitive, neurobehavioural and motor abnormalities. It is therefore rational to align a CTE screening programme to evaluate for neurodegenerative diseases broadly rather than narrow the focus to features highlighted in retrospective studies.ProtocolAbstract 23 Figure 1ConclusionProfessional boxers are a self-selecting group of individuals and many of these athletes will fall outside of normative data e.g. in neuropsychology but be normal within themselves. The screening programme is designed to look for serial change within an individual rather than compare their results to the general population, which replicates best clinical practice.Our recommendations are based on our cumulative experience both in professional boxing and clinical practice. The screening protocol is devised to balance the cost of an effective test battery against management of incidental findings and false positive errors. If this protocol is proven effective it can be adapted and extended to amateur and professional athletes of any sport where there is the potential for CTE.
25 ‘In a mist?’ – What is ‘brain fog’?
Authors: Smyth Heather , Hoeritzauer Ingrid , Couturier Anna , Stone Jon , Carson Alan , McWhirter Laura 
Published: December 2022

ObjectivesThe term ‘brain fog’ is increasingly used in social and other media. But what is brain fog? What sort of experiences do people talk about when they talk about brain fog? And, in turn, what might this tell us about potential underlying pathophysiological mechanisms? In this study we examined first-person descriptions of brain fog in order to better understand a) the phenomenology of brain fog, and b) the causal attributions of those describing brain fog. We use this information to consider implications for clinical research.MethodsData were scraped from the social media platform Reddit using Python. Posts containing ‘brain fog’ were identified between 27thOctober 2021 and 3rd November 2021. Those not describing or discussing brain fog as a symptom or experience were excluded. Potentially identifying information was removed prior to analysis. We undertook thematic analysis of containing subreddits (topic-specific discussion forums), causal attributions, and discrete brain fog experiences.Results1663 posts including the term ‘brain fog’ were identified, of which 717 met inclusion criteria.44% (315/717) posts originated from subreddits concerned with illness and disease: including COVID-19 (87 posts), autoimmune, functional, neurodevelopmental, major psychiatric, and endocrine disorders. Brain fog was also discussed in subreddits about prescribed and non-prescribed drug use, and subreddits concerned with intentional restriction of masturbation (‘nofap’).141 first person descriptions of brain fog described overlapping concepts including: forgetfulness (51), difficulty concentrating (43), dissociative phenomena (34), perceived cognitive ‘slowness’ and excessive effort (26), communication difficulties (22), a feeling of ‘fuzziness’ or pressure in the head (10), and fatigue (9).570 posts described a perceived cause of brain fog, of which half attributed brain fog to illness or disease (282/570) (the most common single attribution being ‘long COVID’ in 59/570 (10%)), followed by psychiatric conditions in 38/570 (7%). The second most common single attribution of brain fog, in 24/570 (24%), was restriction or excessive masturbation.ConclusionsBrain fog is discussed on the Reddit social media platform in association with a wide range of illnesses, diseases, drugs, and activities. The term is used to describe heterogeneous experiences, which do not map in a straightforward way to the domains enquired about during a ‘cognitive’ clinical examination, but include experiences of dissociation, fatigue, and excessive cognitive effort. Encouraging detailed description of subjective experiences – moving away from a psychometric testing approach and towards a phenomenological approach – might open new routes into understanding cognitive difficulties in health and disease.
28 Functional neurological disorder in the chronic pain clinic; a retrospective study of comorbidity
Authors: Mason Isabel , McWhirter Laura , Carson Alan , Stone Jon , Hoeritzauer Ingrid 
Published: December 2022

Objectives/AimsChronic pain is commonly reported as a comorbidity in patients with functional neurological disorder (FND) however the prevalence of FND in those presenting with chronic pain is unknown. We aimed to estimate 1) the prevalence of FND in patients seen at a chronic pain clinic and 2) how patients with chronic pain and comorbid FND differ from those without FND in terms of pain characteristics, psychiatric comorbidity, pain management and pain outcome.MethodsRetrospective electronic records review of consecutive new patients attending chronic pain clinics of 8 pain specialists in Lothian from the 1st of August 2019 to the 19thSeptember of 2019. Mean duration of follow up was 25 months. We recorded the clinical features, medication, management and outcome of chronic pain, any lifetime (up to November 2021) diagnoses of functional, FND and psychiatric disorders and undiagnosed neurological symptoms (where it was unclear if symptoms related to FND or another condition).ResultsOf 190 patients attending a chronic pain clinic, 32 (17%) had at least one lifetime diagnosis of FND and an additional 8 (4%) had undiagnosed neurological symptoms. FND diagnoses were functional limb weakness (8%), functional sensory disorder (8%), dissociative seizures (6%), functional cognitive disorder (5%), functional movement disorder (4%) and others (2%). Chronic primary pain (p<0.001), widespread chronic primary pain (p<0.00001) and pain with no precipitating trigger (p<0.01) were more common in pain patients with comorbid FND. A history of depression (p<0.001), anxiety (p<0.05) and suicide attempt (p<0.05) were also more common in these patients. However, patients with chronic pain and comorbid FND did not differ significantly from patients without FND in age, gender, prescribed analgesia (opiates and benzodiazepines) or pain outcome (25% vs 34% pain improved).ConclusionsFND was found in a surprisingly high 17% of new patients at a chronic pain clinic. This may be an underestimate based on an additional 4% of patients with undiagnosed neurological symptoms. Patients with chronic pain and FND are significantly more likely to have chronic primary pain compared to other pain patients but do not experience different pain management or outcome. These results provide further evidence of the important overlap between FND and chronic pain conditions.
29 Mental health patient-reported outcome measures (PROMs) for children and young people with epilepsy: a systematic review
Authors: Pick Susannah , Aveiro Bianca De , Winsor Alice , Simpson Anna , Nicholson Timothy , Pal Deb , Richardson Mark 
Published: December 2022

Objectives/AimsChildren with epilepsy (cwE) are at a higher risk of mental health disorders such as depression, anxiety, and attention deficit hyperactivity disorder (ADHD) compared to the general population. Psychiatric comorbidities can negatively impact cwE as they can be associated with reduced response to treatment, reduced quality of life, as well as increased mortality. Despite the high prevalence and negative impact on cwE, psychiatric comorbidities often go undetected and as a result are not treated. Therefore, it is essential to detect psychiatric comorbidities early in cwE, to facilitate provision of appropriate interventions and improve long-term neuropsychological outcomes. We sought to identify and evaluate child mental health Patient-Reported Outcome Measures (PROMs) that have been validated specifically in children and/or young people with epilepsy, to inform selection of high quality mental health PROMs in paediatric epilepsy settings.MethodsWe systematically searched MEDLINE, EMBASE and Psych Info for studies that validated mental health PROMs in paediatric epilepsy samples and assessed methodological quality using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidance. Data on PROM development, structural validity, internal consistency, test-retest reliability, convergent validity and responsiveness were extracted and used to assess the measurement properties with reference to standardised criteria.ResultsA total of nine papers were identified that validated 10 mental health PROMs (two epilepsy-specific, eight generic). The overall appraisal of each questionnaire was limited by the availability of only one or two published articles for each PROM. Internal consistency and convergent validity were the more commonly assessed properties across studies, whereas there were very few evaluations of PROM development, structural validity, test-retest reliability, and criterion validity. The strongest performing tool demonstrating the most evidence was The Neurological Disorders Depression Inventory-Epilepsy for Youth (NDDI-Y-E). The ADHD Rating Scale-IV (ADHD-RS-IV) and The Paediatric Symptom Checklist -17 (PSC-17) demonstrated good evidence in favour of at least two measurement properties.ConclusionsThis systematic review identified only a small number of validated mental health PROMs for paediatric epilepsy, highlighting the need for further development, validation and evaluation of mental health PROMs in this population.
4 Medicolegal considerations in functional neurological disorders
Authors: Carson Alan 
Published: December 2022

Dr Carson graduated in Medicine from Edinburgh University in 1991 and completed basic Psychiatry training at the Royal Edinburgh Hospital. Following six months as a Wellcome Research Fellow examining the cognitive effects of HIV infection in a Kenyan population, he was Lecturer and Honorary Senior Registrar in Psychiatry at University of Edinburgh.During this time he developed his interest in neuropsychiatry and was trained by Professor Michael Sharpe, Professor David Owens and Professor Charles Warlow. He was subsequently appointed Consultant Neuropsychiatrist to Rehabilitation Medicine at the Astley Ainslie Hospital and to the Department of Clinical Neurosciences at the Western General Hospital.He was an original grant holder for the development of the Scottish Mental Health Research Network.AbstractFunctional neurologic disorder often occur in association with physical trauma or psychologically stressful events. This means they are commonly a complication of accidents and as recognition improves they are more commonly encountered ing the setting of personal injury. It is important to recognise that there is nothing new here, similar patients and presentations have been recognised in the Court over the past century.In this talk I will describe my approach to assessment of such cases and how one might attempt to integrate current scientific understanding in a way that helps the Court decide what has happened and who was to blame.We will cover diagnosis, exaggeration, onset, risk and triggers and treatment.
42 Inhibition of personal memory retrieval in dissociative amnesia: a study of two cases
Authors: Marsh Laura C , Apšvalka Dace , Abe Nobuhito , Kawaguchi Jun , Anderson Michael C 
Published: December 2022

Objectives/AimsDissociative amnesia refers to loss of autobiographical memory with a presumed psychological, rather than neurological cause. The neurocognitive mechanisms underlying the memory loss are not fully understood. One theory suggests that prefrontal control mechanisms ‘block’ access to autobiographical memories. A parallel body of experimental work has defined a prefrontally-mediated memory control network which can be engaged voluntarily to inhibit memory retrieval. We aimed to examine the possible role of this retrieval control system in dissociative amnesia.MethodsWe re-analysed fMRI data from two previously reported cases of dissociative amnesia (Kikuchi et al. 2009). Both patients had extensive focal retrograde amnesia covering several years, with preserved anterograde memory. In the scanner, they were presented with reminders of people from the forgotten period (current colleagues), as well as a period they could still remember (high school friends). Contrasting the forgotten with the remembered condition, we examined the extent to which the activated regions overlapped with regions involved in retrieval control, derived from a meta-analysis of retrieval inhibition tasks (the ‘think/no-think task’). We used dynamic causal modelling to examine the effective connectivity between the right dorsolateral prefrontal cortex (DLPFC) and hippocampus when patients were reminded of people they could not recognise. One patient later recovered their memories, whilst the other remained amnesic. Both were scanned a second time, and we repeated the same analyses on these data to examine changes associated with recovery.ResultsWe observed increased DLPFC activation and decreased hippocampal activation in response to reminders of forgotten colleagues, relative to remembered high school friends. There was a high degree of overlap with the regions engaged during typical laboratory-based tasks of memory inhibition. Using dynamic causal modelling, we found clear evidence that the right DLPFC downregulated the right hippocampus when the patients were reminded of forgotten colleagues. This pattern persisted in the patient who remained amnesic at follow-up, but was no longer evident in the patient who recovered their memories.ConclusionsThese findings provide preliminary evidence that retrieval control systems may be maladaptively recruited to inhibit memory retrieval in dissociative amnesia. This is often temporary, and may occur on a semi- or sub-conscious level. These findings may provide a mechanistic target for current and future treatment approaches.
5 Medicolegal considerations in head injury – challenging dogma in TBI
Authors: Newcombe Virginia 
Published: December 2022

Dr Virginia Newcombe is a consultant in Neurosciences and Trauma Critical Care Medicine, and Emergency Medicine at Addenbrooke’s Hospital, Cambridge. Originally from Australia she came to Cambridge to complete a MPhil in Epidemiology and stayed to undertake a PhD and clinical training. She is a Royal College of Emergency Medicine Associate Professor and holds an Academy of Medical Sciences and Health Foundation Clinician Scientist Fellowship.Her main research interests focus on prognostication, neuroimaging and the use of biomarkers after traumatic brain injury as well as long-term outcomes after critical illness. Her work has been recognised with awards from European Society of Intensive Care Medicine, the International Society for Cerebral Blood Flow and Metabolism, the International Society for Magnetic Resonance Medicine, National Neurotrauma Society (USA) and a Churchill Fellowship.AbstractThis talk will discuss how our understanding of some of common perceptions and beliefs about TBI are changing and/or can be challenged with new evidence. Discussion will range through controversies in TBI as well as specific examples in sports concussion and mild TBI.