bluuebunny/crossref_metadata_2025_split huggingface dataset:
060 LFT monitoring for patients prescribed Cannabidiol -an audit of current practice at QEH -Birmingham
Authors: Elkider Mohammed , Samarasekera Shanika 
Published: August 2022

Queen Elizabeth HospitalIntroductionCannabidiol (CBD) is approved for the treatment of refractory epilepsy associated with Dravet and Lennox-Gastaut syndromes. Affected individuals have co-morbid intellectual disability, making serum monitoring challenging. Those prescribed CBD at the Queen Elizabeth Hospital underwent at least one face to face appointment in the twelve months preceding treatment. Many were initiated on CBD remotely, in keeping with trust guidance to reduce the burden of face-to-face consultations during the Pandemic.NICE recommends liver function test (LFT) monitoring in those prescribed CBD at baseline, 1, 3 and 6 months, then periodically thereafter 2. All patients initiating CBD were offered LFT on site, with a recom- mendation to GPs to continue LFT monitoring in the community.Aim To assesses whether CBD patients undergo LFT monitoring in keeping with NICE guidance.ResultsOf thirty patients prescribed Cannabidiol for a minimum of six months, sixteen (53%) had LFTs undertaken at least once. Twelve (75%) were conducted by their GP. Three patients had abnormal LFT at some stage which normalised within six months of initiation of treatment.RecommendationsRegular liaison with community healthcare providers about LFT protocols and access to finger prick testing (both on site and community) would potentially facilitate regular serum monitoring.
063 The role of Monoclonal antibodies in contrasting cases of NORSE
Authors: Samarasekera Shanika , Lightning Tom 
Published: August 2022

1. A 42-year-old female developed status ten days following admission for alcohol-related liver disease. MRI brain showed symmetrical medial temporal high signal. No cause was identified.Though the convulsive seizures settled, focal seizures persisted. A second MRI showed extensive multi- lobar signal change, presumed inflammatory in nature. Pulsed methylprednisolone and plasma exchange were ineffective.Tocilizumab was administered ten weeks following onset of seizures.Sequential MRIs showed resolution of inflammatory changes. The patient was discharged to rehabilitation- Modified Rankin Score 3.2. A 79-year-old female presented with convulsive NORSE, 24hours after first dose of Pfizer COVID vaccine. She had a background of vascular dementia.The patient never recovered her GCS. Convulsive seizures were replaced by epilepsy partialis continua. Sequential MRIs showed diffuse left parietal cortical high signal. An inflammatory aetiology was presumed, pulsed methylprednisolone and the ketogenic diet (3 months) were ineffective.Anakinra was administered on week twelve. Subsequent MRIs showed progression of confluent white matter disease, now bi-hemispheric. She remains symptomatic, a year post presentation.We hypothesise that both patients had NORSE arising from an unidentified inflammatory aetiology. Age and premorbid function are known to influence recovery. Early use of monoclonal antibodies may be beneficial, including in those with systemic disease.
065 Septal DNETs rarely cause seizures – consider other causes
Authors: Tanti Matthew , Mullatti Nandini , Sivakumar Gnanamurthy , Warren Daniel , Maguire Melissa 
Published: August 2022

Dysembryoplastic neuroepithelial tumors (DNET) result in focal seizures. Septal DNET-like tumours however are only associated with seizures in 30% of cases. We report a patient with drug resistant epilepsy and another with functional seizures both with presumably incidental septal DNET-like tumours.A patient with semiology of temporal lobe epilepsy had a right sided 7.5 mm cystic lesion in keeping with DNET. His epilepsy was refractory so he underwent surgery workup. Video telemetry captured eight right temporal lobe seizures. To rule out ictal spreading starting from the septal lesion he had stereotactic EEG. This revealed seizure onset from the right lateral temporal lobe, and the septal lesion was electrically silent. He is waiting for a temporal lobectomy.A young patient presented with headaches and seizure like episodes. She was diagnosed with functional seizure. An initial MRI revealed high signal at the right temporal pole. Five years later she developed new sensory symptoms in the limbs and a repeat MRI revealed a new right DNET. Updated video telemetry captured numerous habitual events without evidence of electrical seizures.These cases support the notion that seizures due to septal DNETs are rare and that alternative seizure foci or diagnoses should be entertained.
Risk factors and Parkinson’s disease presentations in primary care in a diverse UK population
Authors: Simonet Cristina , Bestwick Jonathan , Jitlal Mark , Waters Sheena , Ben-Joseph Aaron , Mar-Shall Charles R , Dobson Ruth , Jacobs Benjamin M , Schrag Anette , Noyce Alastair J 
Published: August 2022

BackgroundEarly features of Parkinson’s disease (PD) have been described through population-based studies, which over-represent white, affluent groups and may not be generalisable.MethodsA nested case-control study was conducted in East London using primary care health records. A matched analysis with multivariable logistic regression was used to determine associations between risk factors and pre-diagnostic presentations with subsequent PD.Results1,055 patients with PD and 10,550 controls were included. The strongest associations were found for tremor (OR, 145.96; 95% CI, 90.55-235.28) and memory complaints (OR, 8.6; 95% CI, 5.91-12.49) <2 years before PD diagnosis which persisted up to 10 and 5 years prior to PD diagnosis respectively. Hyperten- sion (OR, 1.36; 95% CI, 1.19-1.55) and type 2 diabetes (OR, 1.39; 95% CI, 1.19-1.62) were associated with subsequent PD. Novel associations were found for epilepsy (OR, 2.5; 95% CI, 1.63-3.83) and hearing loss (OR, 1.66; 95% CI, 1.06-2.58) which were then replicated using data from UK Biobank. No association with future PD was found for ethnicity or deprivation index.ConclusionsHere we present evidence for a range of comorbidities and symptoms encountered in primary care prior to PD diagnosis in a diverse population. Convincing novel associations were observed for epilepsy and hearing loss with subsequent PD. The prominence of memory symptoms hints at an excess of early cognitive dysfunction in this population or limited ascertainment in traditionally under- represented groups.
075 Anxiety and depression in women with idiopathic intracranial hypertension: a matched controlled retrospective cohort study
Authors: Sassani Matilde , Mollan Susan , Adderley Nicola , Subramanian Anuradhaa , Perrins Mary , Nirantharakumar Krishnara-jah , Sinclair Alexandra 
Published: August 2022

Incidence rates for depression and anxiety has not been previously evaluated in a large matched cohort study in idiopathic intracranial hypertension (IIH).We analysed data collected between January-1995 and September-2019 from IQVIA Medical Research Data, an anonymised and nationally representative UK database. Crude incident rates for depression and anxiety were calculated in IIH, migraine controls and population controls matched by age and body mass index (BMI). Cox proportional hazards regression was used to calculate hazard ratios (HR) and 95% confidence intervals (CI).Anxiety incidence was 12.4, 12.6 and 8.2 per 1000 person-years in IIH, migraine and controls, respectively. For IIH, the adjusted HR for anxiety was 1.40 (CI=1.19-1.64) compared to controls, and 0.98 (CI=0.83-1.14) compared to migraine. Depression incidence was 20.1, 19.5 and 13.3 per 1000 person-years in IIH, migraine and controls, respectively. Compared to controls, depression adjusted HR in IIH was 1.38 (CI 1.20-1.58); compared to migraine, adjusted HR was 0.98 (CI 0.86-1.13).Anxiety and depression are not more common in IIH compared to matched migraine population, but the hazard of anxiety and depression was approximately 40% higher compared to healthy age and BMI-matched controls. Physician recognition and management of this co-morbidity is an unmet clinical need in IIH.
076 Iatrogenic spinal haematoma post lumbar puncture: A case report and literature review
Authors: Sassani Matilde , Lyons Hannah , Ramalingam Satheesh , Mitchell James , Yiangou Andreas , Sinclair Alexandra , Mollan Susan 
Published: August 2022

Lumbar puncture (LP) is a common diagnostic procedure in clinical neurology. Iatrogenic spinal haema- tomas can be a complication of LPs and range from mild and self-resolving to very severe or even fatal. We describe a case report and review current literature on post-LPs spinal haematomas.A 28-year-old Lady with a background of post-meningitic hydrocephalous treated with a ventriculoperi- toneal shunt had recurrent headaches and blurred vision. For this reason, she had numerous attendances to the emergency department where she had a total of 15 LPs. At the time, there was no coagulopathy, but patient was taking sertraline regularly. She presented again, five days after a traumatic tap, with bilateral sciatica, saddle paraesthesia and urinary incontinence. She was diagnosed with iatrogenic epidural lumbosacral haematoma causing incomplete cauda equina. Following conservative treatment, the haematoma partially resorbed, but the patient was left with residual saddle paraesthesia and urinary incontinence.Between 1974 to 2022, 41 case reports on LP-related spinal haematomas have been published. Coagu- lopathy is the only risk factor identified, although correlations with outcome are confounded by comorbidi- ties. Treating ICP disorder headaches with LP is not recommended due to poor evidence of prolonged efficacy and this case highlights a significant associated risk.
085 Medication overuse reversion following fremanezumab treatment in migraine patients with inadequate response to prior preventives
Authors: Ashina Sait , Campos Verena Ramirez , Cohen Joshua , Janka Lindsay , Krasenbaum Lynda , Blume Lydia 
Published: August 2022

The Phase 3b FOCUS study demonstrated the efficacy and tolerability of fremanezumab, a humanised IgG2Δa monoclonal antibody that selectively targets the calcitonin gene-related peptide, for migraine prevention in patients with documented inadequate response to 2-4 prior preventive treatment classes. This subgroup analysis aimed to evaluate acute medication use in fremanezumab treated patients who had baseline medication overuse (MO; any acute medication ≥15 days/month or triptans, ergots, or combination medications ≥10 days/month).In the double-blind (DB) period (DBP) of FOCUS, patients were randomised (1:1:1) to quarterly/monthly fremanezumab, or placebo. Patients completing the DBP entered the open-label extension (OLE) and received monthly fremanezumab; results from OLE are stratified by DB randomisation group. Changes from baseline in monthly average days of acute medication use and proportions of patients reverting to no MO were evaluated.Patients with MO (427/838) had significant reductions in acute medication use with quarterly (least squares mean change, −3.8) or monthly (−4.7) fremanezumab during the DBP, versus placebo (−0.7; P<0.0001), which increased in OLE (quarterly, −6.1; monthly, −6.9; placebo, −5.0). A higher proportion of patients treated with quarterly or monthly fremanezumab reverted to no MO during the DBP, versus placebo (39% and 42% vs 13%), which further increased during the OLE (quarterly, 48%; monthly, 46%; placebo, 41%).Fremanezumab patients with prior inadequate response to 2-4 prior classes of preventive medications and MO experienced a reduction in acute headache MO.
087 A rarity of a rare condition – do we have a HaNDL on it?
Authors: Kalra Seema , Ho Shing , Kioulachidis Konstantinos , Davies Brendan 
Published: August 2022

A 31-year old male with a background of occasional Migraine without aura and mechanical lower back pain, presented with recurrent transient episodes of generalised headache, speech impairment, confusional state, and hemi-body sensory-motor symptoms. He had 9-10 episodes over a 2-week period. These were sudden, non-stereotypical, and lasted between 30-120 minutes. He was well in between and the very first episode happened just before his travel to the Canaries for holidays. He had 3 separate admissions with these episodes.Routine blood tests were normalContrast CT head and MRI brain showed transient generalised leptome- ningeal enhancement, CSF showed sequential WCC of 420 and 200 before returning to normal. Repeat EEG showed no epileptiform abnormality. Extensive tests for infectious agents including viral serology were all either negative or suggestive of previous exposure. Only HSV-7 PCR was positive. Inflammatory and paraneoplastic tests were negative. He fully recovered from these in 2 months with no sequelae.The clinical Syndrome of transient Headache and Neurological Deficits with cerebrospinal fluid Lympho- cytosis (HaNDL) is well described, rarely seen and poorly understood. Proposed mechanisms include migraine pathophysiology, post-infectious and immunological phenomenon. This is the first report of an active HSV-7 infection, causing HaNDL.
093 Screening of non-motor symptoms of Parkinson’s disease and dementia with Lewy bodies: clinical audit
Authors: Gurney Rowan , Weil Rimona 
Published: August 2022

Non-motor manifestations of Parkinson’s disease (PD) are common and contribute a significant burden to patients and carers. They include constipation, depression, hallucinations, urinary symptoms, dysphagia, weight loss and drooling of saliva. Recognising and treating non-motor symptoms of PD reduces hospital admissions.AimsTo assess screening of non-motor symptoms in a specialist Parkinson’s dementia outpatient clinic.MethodsWe conducted a closed-loop audit of a Parkinson’s dementia clinic, using the 2019 Parkinson’s UK Audit as gold standard. We collected data regarding enquiry about non-motor symptoms. Data were collated and analysed, and presented at a departmental meeting.ResultsA total of 38 patients with PD and Dementia with Lewy Bodies (DLB) were included. They attended the clinic over a 3-month period. Hallucinations (89%), urinary symptoms (68%) and mood (62%) were addressed the most frequently in the consultation. Malnutrition (24%) and problems with saliva (5%) were screened for rarely. Following this audit, a checklist tool was incorporated into the clinic proforma. A re-audit revealed increased rates of screening for non-motor symptoms after the new clinic checklist was introduced.ConclusionsNon-motor symptoms are important features of PD and DLB but are often overlooked. Simple interventions can effectively improve screening of these symptoms.
106 Critical ischaemia without infarction presenting as progressive hemichorea: a case study and literature review
Authors: Wrigley Sarah , Killeen Ronan , O’Riordan Sean 
Published: August 2022

A 69 year old lady with COPD presented with a 3-week history of progressive worsening involuntary movements of her right limbs, beginning in her right hand, and spreading to involve her right leg after 1 week. Three days prior to admission, she had an episode of dysarthria and orolingual numbness lasting five minutes. On examination, she was hypertensive (200/105mmHg), and had marked right hemiballismus/hemichorea, with subtle orolingual chorea. Her neurological and cognitive examination was otherwise normal. The hemichorea worsened with commencement of antihypertensive therapy.It seemed likely that our patient’s presentation with subacute hemichorea/hemiballismus and a superim- posed recent TIA-like event was due to an ischaemic stroke affecting the left basal ganglia. However, CT and MRI brain imaging did not demonstrate acute ischaemia or a prior stroke of the left basal ganglia. But on further investigation, CT angiogram revealed short segment 95% stenosis of the left internal carotid artery. The patient underwent a left carotid endarterectomy. Six weeks later, there was complete resolu- tion of hemichorea.The progressive nature of her clinical signs over three weeks, the transient worsening with antihypertensive therapy, and the gradual resolution post-operatively suggests that critical cerebral hypoperfusion due to severe internal carotid artery (ICA) stenosis can present unusually as progressive hemichorea.
110 Outcome and mortality of hospital admission with COVID-19 for individuals with parkinsonian syndromes
Authors: Sorrell Lexy , King Angela , Inches Jemma , Rideout Jane , Sneyd Robert , Kobylecki Christopher , Chaudhuri Ray , Walker Richard , Martin Hannah , Carroll Camille 
Published: August 2022

ObjectiveTo evaluate features of Parkinson’s disease (PD) and atypical Parkinson’s syndromes (APS) associated with poor outcome and mortality in people with COVID-19 in a hospital setting.BackgroundPrevious studies have demonstrated increased mortality of COVID-19 in people with PD. However, it is not known whether this is associated with disease-related factors (eg autonomic dysfunc- tion, dysphagia).MethodsAn online survey tool captured anonymised patient data from hospital admission records of people with PD and APS who tested positive for COVID-19 between February 2020 and July 2021. We will use Cox proportional hazards and linear regression models to evaluate which characteristics are associ- ated with mortality, increased care requirement and more severe COVID-19 infection. Models will be adjusted for known associations with poor outcome, such as co-morbidities, age and sex.ResultsData were collected from 556 admissions from 21 UK sites: 66.2% male; median (IQR) age 80 (11) years; median disease duration 5 (7) years. 19.2% were asymptomatic, 28.8% had mild symptoms and 52.5% required respiratory support. 38.3% died within 4 weeks of a positive COVID-19 test. Preliminary Kaplan-Meier curves suggest that co-existing dementia, marked motor fluctuations and more advanced Hoehn and Yahr stage may be associated with 28-day mortality. Full statistical analysis is in progress.ConclusionsIdentification of Parkinson’s features associated with poor in-hospital COVID-19 outcome will allow a more informed discussion relating to individual COVID-19 risk.
113 Assessing predictors of NEDA in RRMS patients initiating dimethyl fumarate in a real-world setting
Authors: Al-Araji Sarmad , Bianchi Alessia , Eshaghi Arman , Zhang Le , Kanber Baris , Jha Ashwani , Goodkin Olivia , Barkhof Frederik , Nachev Parashkev , Ciccarelli Olga 
Published: August 2022

IntroductionNo evidence of disease activity (NEDA) is a treatment goal when using disease modifying therapy for treating relapsing remitting multiple sclerosis (RRMS).1 However, predicting which patients may achieve NEDA is challenging.ObjectiveTo identify the baseline clinical and MRI features that predict NEDA in patients initiating dimethyl fumarate (DMF).Method: In our observational study, we retrospectively collected clinical and radiological data acquired for patients with RRMS initiating DMF. Demographics and clinical details at MS onset and at DMF initiation (baseline) were evaluated. We investigated the associations between all the baseline clinical and MRI findings and NEDA at 24 months using a combined multiple logistic regression.ResultsWe had a total of 670 patients in our cohort and only 339 (50%) achieved NEDA at 24 months. Lower EDSS (Log odds[95%CI]= -0.19[-0.30 to -0.03], p=0.01), lower number of new MRI lesions at baseline (Log odds[95%CI]= -0.14[-0.32 to -0.04], p=0.01) and lower number of relapses in the previous 12 months (Log odds[95%CI]= -0.39[-0.77 to -0.26], p=0.0001) significantly predicted NEDA at 24 months.ConclusionSignificant predictors for achieving NEDA were the number of relapses in the previous year, the number of new MRI lesions and the EDSS at DMF initiation. This could be useful in clinical practice to counsel patients regarding their potential response to DMF.
116 Evaluating the introduction of subcutaneous natalizumab to a cohort of patients with multiple sclerosis
Authors: Edwards Marc , Pearson Owen , Ingram Gillian 
Published: August 2022

Natalizumab was approved for use in the UK as an intravenous (IV) infusion for rapidly evolving multiple sclerosis in August 2007; with the subcutaneous (SC) formulation available in June 2021. This project aimed to assess changes in patient care in Swansea, since the institution of SC natalizumab, assessing patient satisfaction and unit flow. Anonymous data was collected using a questionnaire completed in December 2021.Of 78 patients, 64 (82%) had switched to, or started treatment with SC. Average combined infusion and sur- veillance time for IV was 142 minutes, reducing to average 61 minutes for SC. Of 50 SC patients completing questionnaires, 7 reported mild adverse reactions including pain, swelling, nausea and fatigue. 84% of SC patients reported increased convenience and 96% patients were satisfied or very satisfied with switching.ConclusionSubcutaneous natalizumab is a well-tolerated alternative to the intravenous infusion. In this cohort of patients, the majority were satisfied with switching, finding the SC injection more convenient, although some patients reported more pain especially when delivered in the arm. A major benefit to patients and staff is reduced delivery time, improving access to valuable infusion space. Monitoring will be reduced further to 15 minutes, once patients have received 6 injections.
119 A novel kinematic tool to assess upper limb dysfunction in multiple sclerosis
Authors: Fernandes Linford , Coats Rachel , Mon-Williams Mark , Ford Helen 
Published: August 2022

IntroductionWe assessed upper limb function in people with progressive MS (pwPMS) using a novel kinematic 3D motion capture methodology.Methods42 pwPMS and 15 healthy controls reached-and-grasped different objects while movement trajectories were captured with a kinematic assessment system. Clinical measures included the nine hole peg test (9HPT), Expanded Disability Status Scale (EDSS), and patient reported outcomes at baseline and six months.ResultsPwPMS had longer reaction and reach times, took longer to pick-up objects and move them between pre-defined positions, and spent more time placing objects, compared to controls. PwPMS had lower peak wrist velocities when reaching for and moving objects. Kinematic assessment demonstrated consistent differences between the mild and severe patients, driven by object grasp dimensions, which weren’t captured by 9HPT. There was no correlation between upper limb performance and EDSS, with wide variation in performance across a narrow EDSS range. There was moderate correlation between kinematic assessment and 9HPT. There was no significant change in most of the kinematic or clinical parameters at six months compared to baseline.ConclusionsOur study has created and tested a novel upper limb function assessment tool with better sensitivity and behaviour capture than the EDSS and 9HPT. For the first time, we have captured the spa- tiotemporal patterns of hand function impairment in pwPMS.