bluuebunny/crossref_metadata_2025_split huggingface dataset:
099 A retrospective study of mortality rates in a video-EEG telemetry patient cohort
Authors: Mirza Farhat , Cahill Varduhi , Cooper Paul , Mohanraj Rajiv 
Published: March 2023

RationaleDespite emerging evidence of altered brain connectivity patterns in patients with non-epileptic attack disorder (NEAD), studies on the mortality rates in these patients remain scarce.MethodsMortality data was studied retrospectively in a cohort of patients admitted for video-telemetry evaluation at the Manchester Centre for Clinical Neurosciences from 2009 to 2019. The diagnosis of NEAD, epilepsy or both was confirmed by the consensus opinion of experienced epileptologists. Mortality and cause of death were identified from the death alert system linked to the Electronic Patient Record and from coroners’ reports, where available.ResultsOut of 693 patients 662 were included in the study analyses. Death was registered in 23 patients, 82.6% of whom suffered with epilepsy and 17.4% with NEAD. In epilepsy patients, sudden unexpected death was recorded in 42.1%, death from other medical conditions in 52.6% and death from external causes - in 5.3%. In the NEAD group, the causes of death included iatrogenic and other medical conditions.ConclusionsMortality rates in the NEAD group of patients are not negligible. With NEAD patients being at risk of unnecessary iatrogenic interventions, increased awareness of the heightened mortality rates in this patient cohort could avert preventable deaths.
101 PET-CT in patients with suspected paraneoplastic neurological conditions
Authors: Cheema Sanjay , Young John , Pencharz Deborah 
Published: March 2023

BackgroundPET-CT is often used to investigate for underlying malignancy in patients with suspected paraneoplastic neurological syndromes (PNS). However, evidence supporting its utility is limited, other than in patients with a ‘classical’ PNS, positive antibodies, and after conventional imaging has already been performed and is negative.ResultsWe collected data on 41 consecutive patients with suspected PNS who underwent whole-body PET-CT in our centre. 5/41 (12%) patients were antibody-positive. In 32/41 (78%) CT body imaging had been performed prior to PET-CT.In only one patient did PET-CT uncover a malignancy which was not already known about. In one patient PET-CT led to the diagnosis of neurosarcoidosis, which would not have been identified otherwise. No patients developed a malignancy in the follow up period (range: 10–33 months, median: 22 months) – a negative prediction value (NPV) of 100%.In 29% (12/41) PET-CT showed incidental findings which required further investigation or follow up.ConclusionWe found a low rate of detection of malignancy via PET-CT. This could be explained by low rates of antibody positivity and the small, heterogeneous cohort. The 100% NPV is reassuring. PET-CT identified a non-paraneoplastic condition (sarcoidosis) as a cause of one patient’s symptoms.
102 Episodic memory functional connectivity in temporal lobe epilepsy
Authors: Buck Sarah , Caciagli Lorenzo , Vos Sjoerd , Duncan John S , Sidhu Meneka Kaur 
Published: March 2023

PurposeFunctional magnetic resonance imaging (fMRI) has previously demonstrated functional reorganisation of memory representations in people with Temporal Lobe Epilepsy (TLE). Less is known about the changes in functional connectivity within the memory network.MethodsWe studied 77 patients with unilateral TLE (37 left) and 27 controls. All participants performed a memory encoding fMRI paradigm of faces and words. Psychophysiological Interaction (PPI) analysis was conducted to examine brain regions that were time-correlated with activations in the left and right hippocampi.ResultsDuring word encoding, left TLE patients showed reduced connectivity from the left hippocampus to the prefrontal cortex, compared to controls. During face encoding, right TLE patients showed reduced connectivity from the right hippocampus to the ipsilateral lateral temporal lobe and bilateral fusiform gyri. However, left and right TLE patients showed greater connectivity to posterior hippocampi bilaterally during word and face encoding.ConclusionTLE is increasingly recognised as a network disease and correspondingly we demonstrate widespread memory network reorganisation in people with epilepsy. The reorganisation of eloquent functions has important implications in the planning of epilepsy surgery and a network approach may be helpful in the prediction of memory outcome after epilepsy surgery.
105 Ring-enhancing lesions – diagnostic challenge in a DGH
Authors: Oo Aung 
Published: March 2023

A 79-year-old male was admitted to stroke ward following two episodes of mild headaches, slurred speech and left arm weakness over the past 3 days. On both occasions, the symptoms resolved within an hour. On admission to the ward he suffered 2 focal seizures. He denies any fever.He has the background of benign oesophageal stricture which was recently dilated, and melanoma on his neck which was resected 5 years ago.Neurological examination was unremarkable. WBC- normal, CRP- slightly high. LP was also normal.The MRI brain revealed 4 ring-enhancing lesions bilaterally. DWI showed restricted diffusion.After discussion with neuroradiologists and neurosurgeons, antibiotics started for brain abscesses. Despite this, he gradually developed progressive left arm weakness. After another discussion, it was thought that his lesions were metastases. Biopsy/aspiration could not be performed due to limited resources. We stopped antibiotics and started dexamethasone. His left arm weakness subsequently improved. However, MRI scan repeated after 2 weeks showed increase in size of lesions. Thus, antibiotics restarted, and the subsequent scans showed improvement.Discussion Brain abscess is a rare but serious complication following oesophageal dilation. A cystic lesion that markedly restricts centrally on DWI should be considered an abscess until proven otherwise.
110 Phenotype of new daily persistent headache
Authors: Lobo Rhannon , Lobo Sean , Jacobs Benjamin , Bahra Anish 
Published: March 2023

New daily persistent headache (NDPH) is characterized by new onset headache which remains daily from onset for at least three months. So far only a few studies have been reported in this field. The aim of this study is to report on the phenotype and patient characteristics of NDPH as well as considering the strengths and limitations of the current International Classification of Headache Disorders, 3rd edition, beta version (ICHD-3).In this retrospective study, we studied 216 patients who were seen at our headache clinic at the National Hospital for Neurology and Neurosurgery (from March 2005 to April 2015) and from Whipps Cross University Hospital (from April 2005 to December 2015). All patients fulfilled ICHD-3 criteria for NDPH. Each patients’ medical file was reviewed to record demographic and outcome parameters.Overall, median age at onset was 37 (IQR 23) and male: female ratio was 0.56. It was found that 83.8% of this patient population had chronic migraine. Other clinical syndromes included tension type headache (6.9%) and primary stabbing headaches (2.8%).This is one of the largest cohorts of NDPH to integrate ICHD-3, our findings amalgamate those previously reported and include phenotypes which had been previously been omitted.
14.45 Relationships between walking speed, cognition & brain pathologies: an imaging study of the 1946 birth cohort
Authors: Buchanan Sarah M , Parker Thomas D , Lane Christopher A , Keshavan Ashvini , Keuss Sarah E , Schrag Anette E , Fox Nick C , Richards Marcus , Schott Jonathan M 
Published: March 2023

IntroductionSlowing of gait is associated with risk of cognitive decline, but whether this is due to brain pathology or a consequence of normal neural ageing remains unclear. We investigate associations between gait speed, cognitive test scores, white matter hyperintensity (WMH) volume, whole brain volume (WBV) and β-amyloid load in a sample of healthy older adults born in the same week of March 1946 in mainland Britain.Methods502 participants underwent quantitative gait measurement, neuropsychological assessment, structural MRI and 18F-florbetapir amyloid PET. Excluding individuals with major neurological disease or missing data, 374 individuals (age 70.6 ±0.69 years) were analysed.ResultsMean self-paced walking speed was 1.44 ± 0.19 ms-1. Slower walking speed was associated with lower performance on the Digit-Symbol Substitution test (p=0.007) and MMSE (p<0.05), but not tests of memory or fluid intelligence. These associations were not significantly altered by adjusting for WBV, WMH volume or PET evidence of cerebral β-amyloid deposition.ConclusionIn healthy older adults, gait speed is associated with processing speed and global cognition, but not with tests of non-verbal reasoning or memory. These associations were not accounted for by the measured cerebral pathologies. Further analyses incorporating region-specific and microstructural brain imaging are required.
122 Apomorphine infusion-induced ulcers and skin necrosis
Authors: Keh Yann Shern , Kulkarni Omesh 
Published: March 2023

IntroductionSubcutaneous apomorphine infusion is a therapeutic modality for patients with Parkinson’s disease with suboptimal control of motor fluctuations on oral medication. Bruising is described but severe skin reactions are only rarely reported. We describe two cases of apomorphine-induced severe skin reactions necessitating therapy cessation.Case descriptionsWe describe the cases of two patients (48- and 66-year-old males) with a 5–7 year history of idiopathic Parkinson’s disease who were commenced on apomorphine infusion due to ongoing motor fluctuations despite high dose oral levodopa with dopamine agonist and MAO-I co-therapy. Despite tolerating apomorphine well initially, within 12–18 months the patients developed superficial necrotic ulcers around infusion sites, to the point where cessation of treatment was required.The patients were changed onto Duodopa (via jejunostomy) and Opicapone respectively, with good symptom control.DiscussionPrevious apomorphine infusion cohorts report a 2.8% incidence of skin necrosis. In some cases, surgical incision and wound lavage has been required. In most cases described to date, severe skin reactions do not manifest until later on in treatment. It is unclear what factors may increase the risk of developing this complication.ConclusionClinicians should be aware of the potential side effect of skin necrosis when prescribing apomorphine infusions and indications to stop apomorphine and escalate to Duodopa or deep brain stimulation.
123 T and B lymphocyte senescence in parkinson’s disease
Authors: Jensen Melanie , Scott Kirsten , Camacho Marta , Greenland Julia , Kouli Antonina , Wijeyekoon Ruwani , Solim Imtiaz , Barker Roger , Williams-Gray Caroline 
Published: March 2023

IntroductionEvidence suggests the immune system contributes to Parkinson’s disease (PD) aetiopathogenesis and this represents a tractable target for disease-modifying therapy. As ageing is a risk factor for PD, it is relevant to investigate age-related immune changes (immunosenescence) in PD.MethodsBlood samples were collected from 20 early PD patients and 20 controls. T- and B-cell senescence subsets were identified using flow cytometric immunophenotyping. CMV/EBV serostatus was ascertained given its well-documented effect on immunosenescence.ResultsCD4+ TEMRA cells, T-cell senescence markers, were reduced in PD cases versus controls (p=0.046). This was not driven by differences in age or CMV/EBV serostatus across groups. CMV positivity was associated with increased CD4+ TEMRA cells as expected in controls, but not in PD cases. Switched memory B-cells were lower in patients versus controls (p=0.040). No changes were observed in the CD8+ T-cell pool.ConclusionsThese findings suggest that the senescent ‘shift’ induced by viral infection and ageing is atypical in PD. Reductions in senescent lymphocytes may favour the passage of activated lymphocytes across the blood brain barrier, promoting central inflammation and neurodegeneration. Pragmatically, this study shows that immune abnormalities occur in early-stage disease, adding urgency to the search for immune-modulating therapies in PD.
124 Real world use of neurophysiology in differentiating hyperkinetic movement disorders
Authors: Gandhi Sacha E , Silverdale Monty A , Mercer Deborah , Marshall Andrew G , Kobylecki Christopher 
Published: March 2023

Neurophysiology constitutes a potentially useful aid in differentiating hyperkinetic movement disorders (HMD). Parameters including presence of a Bereitschaftspotential on back-averaged EEG have been demonstrated to help distinguish between these disorders. In 2008, a Movement Disorder neurophysiology service was established in Greater Manchester to aid in the diagnostic process.We retrospectively reviewed records of 39 patients with HMD who underwent EEG back-averaging through this service from January 2009 until January 2018. The aim was to determine how frequently neurophysiology altered the final diagnosis.We reviewed 39 patients (23 females, 16 males), with a mean age at onset of 42.6 years and mean disease duration of 2.0 years. The clinical diagnosis was altered in 23 cases (59%). Distractibility (P=0.001), variability (P=0.002), the presence of a Bereitschaftspotential (P<0.0001), and EMG burst duration > 300 ms (P=0.012) were more frequent in those with a final diagnosis of functional movement disorder than other HMD.Neurophysiology is an invaluable adjunct in complex HMD, altering the diagnosis and treatment options for a significant proportion of patients. We hope these results will be beneficial for other units considering establishing this type of service.
125 A case of multiple paraneoplastic syndromes associated with CRMP5 antibodies and lung cancer
Authors: Alareed Ahmad , Broad Rebecca , Cousins Oliver , Changaradil Deepthi , Redmond Ian , Caimanque Lorena Flores 
Published: March 2023

The collapsin response-mediator protein-5 (CRMP5) autoantibody is a recognised biomarker for small cell lung cancer associated neurological Paraneoplasia.We describe a 79-year-old lady, who presented with right hemi-chorea. This progressed over one month, becoming bilateral and rendering the patient bedbound.MRI revealed bilateral signal change within the caudate and lentiform nuclei. CT chest detected mediastinal lymphadenopathy, while PET identified pulmonary malignancy with radiological staging T1bN3M0. Serum CRMP5 antibodies were positive.Haloperidol and intravenous methylprednisolone lead to some improvement in Chorea and mobility. However, visual acuity deteriorated to finger counting. Fundoscopy revealed mild cataracts, while visual evoked potentials were very delayed on the right and absent on the left, suggesting optic neuropathy.She deteriorated with leg pain, weakness, and loss of tendon reflexes, as well as cognitive decline and visual hallucinations. Clinically this raised suspicion of radiculoneuropathy and encephalopathy respectively. Whilst retaining capacity the patient refused further investigations and treatment. She was discharged to a nursing home and died 6 months later.CRMP5 antibodies, targeting intracellular antigens, precipitate an onconeuronal autoimmune process through mechanisms not fully understood. We report a case of combined chorea, optic neuropathy, peripheral neuropathy, and encephalopathy, which highlights the potential for CRMP5 to cause multifocal neurological dysfunction.
126 Quality of life in idiopathic dystonia: a systematic review
Authors: Girach Ayesha , Aragon Ana Vinagre , Zis Panagiotis 
Published: March 2023

ObjectiveDystonia is characterised by sustained muscular contractions frequently producing repetitive and twisting movements. The primary aim of this systematic review was to establish how quality of life (QoL) is affected in idiopathic focal, multifocal and segmental dystonia. This review aimed to evaluate variations in QoL between different subtypes of dystonia, identify the determinants of QoL and assess the effects of different treatments on QoL.MethodologyA systematic computer-based literature search was conducted using the PubMed database to search for papers on QoL in idiopathic focal, segmental, multifocal and generalized dystonia. We identified 75 studies meeting our inclusion criteria. Information was extracted regarding prevalence, demographics and response to treatment where indicated.ResultsThis review revealed QoL to be a significant yet overlooked issue in idiopathic dystonia. Data consistently showed that dystonia has a negative effect on QoL in patients compared to healthy controls, when measured using disease specific and generic QoL measures. The majority of studies (n=25) involved patients with cervical dystonia, followed by benign-essential blepharospasm (n=10). Along with the beneficial effect to the dystonia symptoms, treatment using Botulinum Toxin and Deep Brain Stimulation is also effective in improving overall QoL across the majority of subtypes.ConclusionThe findings demonstrate that patients’ QoL should routinely be assessed and monitored, as this may affect subsequent management. Further research will allow for more robust management of non-physical impairments.
129 Validating a new dependency measurement for parkinson’s disease
Authors: Ramsay Neil , Macleod Angus , Counsell Carl 
Published: March 2023

IntroductionFunctional dependency is a key outcome in Parkinson’s disease (PD). We created an algorithm to dichotomously assess dependency in PD patients, based on the Unified Parkinson’s disease rating scale (UPDRS) part 2, routinely collected in PD studies.MethodsWe defined dependency from items of UPDRS Part 2 (i.e. hygiene, dressing, feeding, getting out of chair and walking). We validated this algorithm using dependency data from 1113 patients from 6 community-based incidence PD cohorts. We also validated against indirect measures relating to cognition, quality of life and motor impairment.ResultsOur algorithm showed high specificity and sensitivity (specificity 94% and sensitivity 70% at baseline; 90% and 84% respectively at 5 years). We found evidence for construct validity with poorer MMSE and quality of life scores in dependent patients.DiscussionWe have validated a algorithm to dichotomously assess dependency in PD patients, which can be widely used in research studies.
130 Trust the patient not the doctor: non-motor symptoms and quality of life in cervical dystonia
Authors: Ndukwe Ihedinachi , O’Riordan Sean , Hutchinson Michael 
Published: March 2023

IntroductionMood disorder is common amongst Cervical Dystonia (CD) patients and can impact on quality of life (QoL). It often precedes the onset of CD and doesn’t improve with botulinum toxin therapy. We hypothesize that mood disorder is part of the primary pathogenic process causing CD.AimTo assess the prevalence of mood disorder and measure QoL in relation to severity, disability and pain in CD patients receiving botulinium toxin therapy with good effect.MethodsWe prospectively collected data using questionnaires; TWSTRS for pain, severity and disability; CDIP-58 and Euro-QoL VAS for QoL and BAI, BDI-II & HADS for mood disorder assessment.ResultsIn 192 patients with mean age 62 years (SD: 12.67), using the BAI-II and BDI, 56% reported anxiety and/or depression. There was a significant correlation between mood disorder and quality of life using CDIP-58 {(Anxiety: R2=0.39; p<0.0001) and (Depression: R2=0.33; p<0.0001)}. There was weak correlation between disease severity and quality of life; R2=0.09; p<0.0002.ConclusionThere was a significant correlation between reported mood disorder and QoL in CD but a weak association with severity, pain and disability scales. This shows that patient-reported measures, particularly the CDIP-58, are a significant source of disability reporting which is not determinable by standard recommended measures of CD severity, administered by the neurologist. Therefore it is important to trust the patient.AcknowledgementFunding was by Merrion Neuroscience Foundation ProgrammeI have no financial relationships to disclose
133 Acute parkinsonism
Authors: Gandhi Sacha E , Marshall Vicky 
Published: March 2023

Idiopathic Parkinson’s disease (IPD) is typically insidious in onset and gradually progressive. Acute onset Parkinsonism is, conversely, a rare entity. It may be attributable to rapid onset dystonia parkinsonism; post-encephalitic sequelae; vascular lesions, such as stroke or subdural haematoma; acute metabolic disturbance; central and extra-pontine myelinolysis; drug side effects, including neuroleptic malignant syndrome; and toxins, ranging from cadmium to carbon monoxide and organophosphate poisoning.We report two cases of clinically confirmed IPD (followed up over 7 months and 2 years, respectively), which presented atypically with abrupt onset Parkinsonism in the context of significant psychosocial stress. A comprehensive blood panel (including ATP1A3 in Patient B) and brain magnetic resonance imaging (MRI) were unremarkable. (123)I-FP-CIT SPECT (single photon emission computed tomography) confirmed a marked presynaptic dopaminergic deficit in the basal ganglia for both patients, consistent with degenerative Parkinsonism. Both had asymmetrical parkinsonism (without dystonia or functional signs) and progressed as expected for IPD, with typical motor fluctuations in one patient. Patient B, who was commenced on drug therapy, exhibited a significant Levodopa response consistent with IPD. These cases highlight the potential for IPD to present atypically with rapid symptom evolution in the presence of significant psychological stress.
135 Hyperhidrosis as an identifier in parkinson’s disease subtyping
Authors: Wamelen Daniel van , Leta Valentina , Podlewska Aleksandra , Wan Yi-Min , Krbot Katarina , Jaakkola Elina , Rizos Alexandra , Parry Miriam , Metta Vinod , Ray Chaudhuri K 
Published: March 2023

ObjectiveTo identify associated (non-)motor profiles of Parkinson’s disease (PD) patients with hyperhidrosis.MethodsCross-sectional analysis of participants enrolled in the non-motor Longitudinal International Cohort Study (NILS; UKCRN No: 10084) at the Parkinson’s Centre at King’s College Hospital (London, UK). Hyperhidrosis responses (yes/no) on question 28 of the Non-Motor Symptom Questionnaire (NMSQ) were used to classify patients with normal sweat function (n=172) and chronic hyperhidrosis (n=56) (analysis 1; n=228). The grade rating NMS scale (NMSS) question 30 scores were then used for severity grading (analysis 2; n=352): absent score 0 (n=267), mild 1–4 (n=49), moderate 5–8 (n=17), and severe 9–12 (n=19).ResultsBaseline demographics were similar between groups. Patients with hyperhidrosis exhibited significantly higher NMSS burden (as graded from total score; p<0.001). Secondary analyses revealed significantly higher dyskinesia scores, worse quality of life and sleep, and higher anxiety levels in hyperhidrosis patients (p<0.001). Tertiary analyses showed higher scores for dysautonomia (orthostatic hypotension, sialorrhea, constipation, urinary urgency and frequency) as well as fatigue and somnolence, among other NMS (p<0.001).ConclusionsChronic hyperhidrosis is associated with a dysautonomia dominant clinical picture combined with fatigue and somnolence in PD patients. These patients also are likely to be dyskinetic. This is the first description of motor and nonmotor correlates of hyperhidrosis in PD.