bluuebunny/crossref_metadata_2025_split huggingface dataset:
079 Does the timing of IIH diagnosis in relation to pregnancy affect outcomes?
Authors: Thaller Mark , Homer Victoria , Wakerley Benjamin , Mollan Susan , Sinclair Alexandra 
Published: August 2022

IntroductionIIH is a known metabolic neuro-ophthalmologic disorder which is associated with body weight gain. A common reason for increasing weight in child-bearing aged women is pregnancy. The long-term impact of IIH diagnosed during pregnancy is not known.Aims and MethodsEvaluate key outcomes such as visual acuity, visual fields, optical coherence tomog- raphy (OCT) and headache in a prospectively collected cohort within the IIH Life database (2013-2021). Comparison was made to those with a subsequent pregnancy, and those who never become pregnant.ResultsPeople diagnosed with IIH in pregnancy had worse visual outcomes (Mean OCT Retinal Nerve fibre layer and PMD), as compared to the other two groups. None took intracranial pressure lowering medicines, few required temporising lumbar punctures and less required sight saving surgery. Overall, those who were not diagnosed in pregnancy had no sequalae, with the majority improving. All groups had comparable outcomes at 36 months.ConclusionsIIH patient monitoring during pregnancy is important, not only for maternal health but physician communication. Medical intervention is limited due to risk of teratogenicity. Those diagnosed with IIH in pregnancy, or those in whom IIH is exacerbated by pregnancy are more challenging to manage and require individualised care plans.
084 Migraine and sociodemographic factors a review
Authors: Mitchell James , Vidot Micha , Wu Kit , Nitkunan Arani , Carr Georgina 
Published: August 2022

BackgroundEvidence suggests there is variation in the diagnosis, management, and support for people with migraine. To improve equity of service, in line with the aspirations of public policy across the UK, it is imperative to understand how sociodemographic factors affect management and care of migraine.MethodsWe conducted a focused review of literature published between 2000-2021 to outline the evidence describing the relationship between the nine protected characteristics of the Equality Act 2010 and the epidemiology, diagnosis, management, and outcomes of migraine. Other factors such as deprivation, settlement status, education and employment were also explored.ResultsThere is much published literature on the relationship between age and sex in migraine epidemi- ology and management. There is good quality evidence regarding the large disability burden caused globally. There is limited evidence outlining the relationship between gender reassignment, ethnicity, religious and cultural factors, sexual orientation, settlement status, immigration and migraine. Further work should also focus on variation in access to specialist advice, and newer migraine treatments such as CGRP therapy.DiscussionBetter understanding of sociodemographic factors and their relationship with migraine epide- miology and management is key to improving equity of care. This review has identified gaps in knowledge that require further research.
Delivering acute neurology care via the Same Day Emergency Care (SDEC) model
Authors: Balaratnam Michelle , Alim-Marvasti Ali-Jesus , Lane Charlie , Bierrum William , See Isaiah , Schlattl Anne , Chandratheva Arvind , Baruah Timothy , Simister Robert , Haider Salman 
Published: August 2022

SDEC is the provision of same day care for emergency patients who would otherwise be admitted to hospital. Embedded within UCLH Emergency Department (ED), the SDEC cases are referred for consultant review. We aimed to determine whether a Neurology SDEC (N-SDEC) service would have a beneficial impact at UCLH.The service has run a weekday consultant neurologist-led service since May 2021. The service is supported by a nurse practitioner. Investigations are arranged via dedicated SDEC slots. The patient then has a nurse-led telephone follow-up. The service sees approximately 100 neurology referrals a month.The major impact of the service is reduced time to diagnosis and treatment and reduced onward referral. Only 5% of referrals to N-SDEC required onward General Neurology out-patient services. For the new diagnoses that require sub-specialist out-patients (9%), N-SDEC has improved the patient pathway (e.g. for neurovascular, multiple sclerosis, brain tumour, and neuro-vestibular presentations). We have also established new acute pathways (e.g. for status migrainosis and acute functional neurological disorders). Feedback on the new service from ED staff shows that the N-SDEC is also popular.Experience so far with the N-SDEC model indicates that it may provide an effective model for Acute Neurology delivery in the ED.
086 Long-term efficacy of fremanezumab in migraine patients with inadequate response to prior preventive medication classes
Authors: Naegel Steffen , Cohen Joshua , Campos Verena Ramirez , Barash Steve , Ning Xiaoping , Dhiraj Dalbir , Kudrow David 
Published: August 2022

The FOCUS phase 3b study evaluated the long-term efficacy of fremanezumab in patients with chronic or episodic migraine (CM/EM) and prior documented inadequate response to 2-4 preventive treatment classes during 12-week double-blind period (DBP) and open-label extension (OLE).Following 28-day baseline period, patients were randomised (1:1:1) to quarterly or monthly fremanezumab or placebo for DBP. Patients completing DBP entered OLE, where all patients received treatment with monthly fremanezumab. Outcomes are summarised by DBP group.During DBP, least squares mean changes in monthly migraine days (MMD) in placebo, quarterly, and monthly fremanezumab groups, respectively, were –0.8, –3.9, and –4.5 for CM patients (n=509) and –0.6,–3.7, and –3.8 for EM patients (n=328; P<0.0001 vs placebo); during OLE, mean MMD changes were –5.3,–5.1, and –5.8 for CM patients (n=493) and –3.9, –5.1, and –5.1 for EM patients (n=313). Reductions were also observed for CM and EM patients in monthly headache days of at least moderate severity during DBP and increased during OLE. In placebo, quarterly, and monthly fremanezumab groups, respectively, for DBP, ≥50% reduction in MMD were 8%, 27%, and 29% for CM patients and 10%, 47%, and 43% for EM patients (P<0.0001 vs placebo) and for OLE, were 31%, 35%, and 40% for CM patients and 49%, 63%, and 56% for EM patients.Fremanezumab demonstrated long-term efficacy in CM and EM patients with prior inadequate response to multiple preventive classes.
089 Re-admission rate for patients with headache in Southwest London – can this be addressed?
Authors: Kashif Maryam , Nitkunan Arani , Harral Josie , Mansour Nassif 
Published: August 2022

Getting It Right First Time Neurology recommendations were published recently – including reviewing readmission rates for patients with headache with a local audit of any high rates. The aim of this study was to do just that.Data were extracted retrospectively of all patients seen in Emergency Department (ED) or admitted with a primary diagnosis of headache from April 2018 to March 2019 at the four acute trusts in Southwest London. A questionnaire was completed at each hospital to understand current practice.11,649/705,634 (1%) of ED attendances were due to headache; 356/3,652 (9.7% – separated by trust to 2.4%, 9.2%, 10.3% and 13.2%) headache admissions were re-admitted within 30 days. The trust with a specialist nurse whose phone number was given to patients as a safety net and/or who called patients 2 weeks post discharge had the least number of re-admissions. There was no clear correlation between length of stay and re-admission rate.Limitations of this study are: uncertain accuracy of diagnostic coding and the inability to calculate re- admission to other acute trusts.To improve quality of care, data reliability is needed. A nurse specialist who acts as a single point of access could impact on headache readmission rate.
090 Frequency of migraine and the use of preventive medication in a UK primary care population
Authors: Pain Andrew , Mount Julie , Appel Camilla , Ranopa Michael , Gulati Tania , Kernick David 
Published: August 2022

ObjectivesCalcitonin gene-related peptide (CGRP) antagonists are recommended by NICE as 4th line migraine preventive treatment. We report the frequency and preventive treatment patterns of migraine in the UK, focusing on adult patients who cease ≥3 oral preventive medications.MethodsStudy populations were retrieved from the Clinical Practice Research Datalink GOLD database (study period: 19/09/2012−01/01/2020; inclusion criteria: ≥12 months follow-up, current-in-dataset, adult on 01/01/2020). Patients who used ≥1 oral preventive medication with ≥3-year follow-up after first pre- scription were considered preventive users; medication/class cessation was defined as cessation with no evidence of restart within 6 months from end-of-supply date.ResultsOn 01/01/2020, 30.5/1,000 (n=81,190/2,664,306, 95% CI 30.3–30.7) of study population had ≥1 migraine codes recorded over the study period. 42% of patients were preventive users. Of these, 10% had ≥3 preventive medication cessations, and 8% had ≥3 preventive medication class cessations. Patients with ≥3 preventive medication cessations were mostly female (83%), mean age was 46 years and 22% had a referral to a neurologist during the study period.ConclusionsA considerable proportion of patients with migraine cease ≥3 lines of oral preventive medi- cation, pointing to the need for additional therapeutic options.
091 The East London Parkinson’s disease project – engaging a diverse population in research
Authors: Zirra Alexandra , Ben-Joseph Aaron , Haque Tahrina , Gallagher David , Budu Caroline , Frances Brooke , Simonet Cristina , Noyce Alastair 
Published: August 2022

BackgroundParkinson disease (PD) is the second most common neurodegenerative disease and the burden appears to be growing fastest in middle-low and low income countries. In the majority of obser- vational studies of PD, White, well-educated and affluent participants are over-represented.AimsOur aim was to engage a diverse group of people with Parkinson disease (PwP) from East London and build a research platform for previously under-represented groups.MethodsWe created a register of PwP from the Royal London Hospital which includes approximately 400 patients. In parallel, we have recruited participants to the East London Parkinson’s disease (ELPD) project; a case-control study of phenotype, genotype and biomarker characteristics. Clinical manifes- tations, UPDRS scores, data on non-motor symptoms, as well as biospecimens (buccal and skin swabs, serum samples) have been obtained.Results145 patients and 80 controls have been recruited so far. The mean age of PwP was 67.81 (SD 10.4); 62% were male and 59% identified as being from South Asian or Black ethnicity. The most common presenting symptom was tremor (55.9%), followed by gait impairment (16.6%).ConclusionThe ELPD project is a platform study for under-represented patients with PD which provides important opportunities for collaboration and research to improve health inequalities.
092 Brain amylin accumulation in Parkinson’s disease is not driven by type 2 diabetes mellitus
Authors: Cullinane Patrick , Pablo-Fernández Eduardo de , Strand Kate , Bandopadhyay Rina , Silva Rohan de , Jaunmuktane Zane , Warner Thomas 
Published: August 2022

IntroductionType 2 diabetes (T2D) is increasingly recognised as being a risk factor for Parkinson’s disease (PD). One proposed mechanism is an interaction between amylin, a highly amyloidogenic pancre- atic hormone, and α-synuclein. Amylin accelerates α-synuclein aggregation in vitro and interacts with α-synuclein in the locus coeruleus, and neuronal, extracellular and vessel-associated amylin deposits have been reported in Alzheimer’s disease and control brains. However, the molecular link between amylin and PD and the role of T2D remains unclear.MethodsThe burden of amylin accumulation in post mortem anterior cingulate and frontal gyrus tissue from PD and non-neurodegenerative control cases, with and without T2D, was investigated using immu- nohistochemistry and western immunoblotting.ResultsImmunohistochemistry revealed very infrequent amylin labelling of senile plaques and neurofibril- lary tangles along with rare perivascular amylin deposits in PD and control brains, irrespective of T2D status. Although western immunoblotting revealed significantly increased amylin levels in PD cases compared to controls, there was no difference between diabetic and non-diabetic cases.ConclusionOur results do not support the hypothesis that brain amylin accumulation is increased by T2D. Higher amylin levels in PD may result from blood-brain barrier dysfunction but further studies are needed to clarify the relevance to PD pathogenesis.
102 Levodopa and melanoma what do clinicians think?
Authors: Symonds Alexander , Davenport Richard , Breen David 
Published: August 2022

Parkinson’s disease (PD) is associated with an increased risk of melanoma, but the link between levodopa therapy and melanoma is less clear. The Electronic Medicines Compendium (EMC) explicitly contraindi- cates prescribing levodopa in patients with current, or previous, melanoma despite the lack of convinc- ing evidence.To gauge clinical opinions on the perceived link between levodopa and melanoma, we disseminated a short online survey to neurology and geriatrics colleagues locally, as well as through the Association of British Neurologists and British Geriatrics Society.The majority of the 91 respondents were neurologists (84%), mostly consultants (69%). Most were not aware of guidance stating that levodopa should be contraindicated in patients with a history of melanoma (56%), and responded that they did not counsel for the risk of melanoma when initiating levodopa therapy (93%). Conversely, almost one quarter responded that they would not prescribe levodopa to PD patients with a history of melanoma (24%), the majority being non-movement disorder specialists. Six clinicians reported stopping levodopa therapy after the emergence of a suspicious skin lesion or melanoma (7%).In summary, clinicians are generally aware of the increased risk of melanoma in PD, but there is a lack of consensus on levodopa prescribing and counselling practices.
109 Embedding patient voice in trial design: the EJS ACT-PD experience
Authors: Zeissler Marie-Louise , McFarthing Kevin , Gonzalez-Robles Cristina , Chapman Rebecca , Mills Georgia , Foltynie Tom , Carroll Camille 
Published: August 2022

BackgroundPatient-centred trials address patient relevant questions, have protocols that maximise recruitment and retention, as well as effective communication strategies. Involving patients and carers in trial design and oversight is essential for patient-centred research. In the Edmond J Safra ACT-PD ini- tiative we are developing the first multi-arm multi-stage (MAMS) trial for disease modifying Parkinson’s treatments. Here we present our patient-centred approach.MethodsSeven people with Parkinson’s (PwP) and three care partners (CP) (3 male, 7 female) were recruited nationally and two allocated to each of 5 working groups (WG) developing the trial. Together they form a Patient and Public Involvement and Engagement (PPIE) WG chaired by PwP (KMcF). The group iteratively developed processes for supporting their input into WG decisions with an impact evalu- ation plan involving semi-structured interviews and a revised Patient Engagement in Research Scale).ResultsThe PPIE team meets every six weeks online. Standard Reporting Forms facilitate communication between WGs and PPIE members, supporting group input into issues arising. PPIE feedback is an agenda item at all WG meetings. Post-WG PPIE debriefs with the WG chairs ensure a shared understanding of discussions. Monthly PPIE forums provide opportunity for informal education and themed discussions with PwP/CP. A PwP/CP WhatsApp group creates a safe space for sharing experiences and ideas.ConclusionWe have developed a process by which PwP/CP can meaningfully co-design our MAMS trial, ensuring it is truly patient-centred.
117 Who is the culprit – the virus or the anti-virus?
Authors: Elkider Mohammed , Abraham Roby 
Published: August 2022

49 years old gentleman. Had his AstraZeneca vaccine. 2 weeks later he became unwell. He developed fever, headache, and lethargy. Then his symptoms got worse. He became drowsy and quadriplegic. He was subsequently admitted to ITU.His CSF showed high protein of 1.6 g/l and WBCS >400 (100% Lymphocytes). All other CSF constituent were normal. His MRI showed scattered lesions involving the brain and cord suggestive of inflammatory aetiology.Patient was given diagnosis of Post vaccine -Acute disseminated encephalomyelitis (ADEM). He receivedI.V MP followed by plasma exchange (PLEX). He showed remarkable recovery. His encephalopathy com- pletely resolved, and he regain full power in his upper limbs. But unfortunately, he remains paraplegic. A second course of I.V MP and PLEX was given with some recovery of power in his lower limb.We noticed his LFT was consistently abnormal. Hence, we have done full hepatic screen. To our surprised his Hepatitis E IgM and IgG came back positive. Both Microbiology and Hepatology were consulted, and he was given the diagnosis of recent Hepatitis E infection.Now we have 2 possible aetiologies to explain why he developed ADEM. But we feel that AstraZeneca Vaccine is the most likely cause.
118 Acute disseminated encephalomyelitis associated with SARS-CoV-2 vaccine in multiple sclerosis: a case report
Authors: Evans Matthew , Hanbury Georgina , Lim Emma , Dixon Luke , Singh-Curry Victoria , Nicholas Richard 
Published: August 2022

We present a case of acute disseminated encephalomyelitis (ADEM) occurring 3 weeks following the AstraZeneca SARS-CoV-2 vaccine, in a patient previously diagnosed with multiple sclerosis.Case: This 55-year-old lady had a background of multiple sclerosis (MS), but never required disease-modi- fying therapies owing to a mild disease course. She received the first dose of the AstraZeneca SARS-CoV-2 vaccine, and then was admitted with word-finding difficulties and collapse 25 days later. She deteriorated rapidly and became obtunded on day 2, requiring intubation and intensive care admission. CSF analysis revealed mildly high protein (0.76g/L) with 5 white cells/mm3, and magnetic resonance imaging (MRI) showed multifocal demyelination in keeping with acute disseminated encephalomyelitis (ADEM). She received high-dose intravenous methylprednisolone, followed by plasma exchange and tocilizumab. Despite a mild radiological and clinical improvement the patient remained fully dependent for care needs, unable to speak or mobilise.ConclusionsA number of SARS-CoV-2 vaccines have now been associated with ADEM, but this risk still appears very low in comparison with risks of SARS-CoV-2 infection. This is the first reported case of ADEM in a patient with multiple sclerosis after SARS-CoV-2 vaccination. Literature suggests increased risk of multiple sclerosis exacerbations commonly after SARS-CoV-2 infection.
122 A case of posterior reversible encephalopathy syndrome: a rheumatologic conundrum
Authors: Mahmud Zanaib , Samaranayake Manoj , Haq Rabea , Teh Lee-Suan 
Published: August 2022

Posterior reversible encephalopathy syndrome (PRES) is a syndrome characterised by reduced GCS/confusion, seizures and visual disturbance along with characteristic MRI findings. Autoimmune disorders have been identified in one third of patients with PRES.Here we discuss a 33-year-old female with SLE, who presented with reduced GCS and arm weakness. She had an AKI and metabolic acidosis and was admitted to ICU. Although the patients GCS improved, ongoing upper limb weakness remained. MRI imaging to rule out cerebral lupus, showed high T2 and FLAIR signal within the deep white matter of the occipital, frontal and parietal lobes. This was suggestive of PRES. Whilst in ICU the patient developed hypertension and was started on amlodipine. The patient also had a long history of immunosuppression with mycophenolate, hydroxychloroquine and rituximab. A neurology referral was sent for further advice.Although the name suggests, PRES is often not completely reversible and is not limited to the posterior cerebral cortex, as seen here. It still remains unclear whether it is the autoimmune condition or treatment of these conditions with immunosuppressant’s that is the primary association. Case reports linking PRES with immunosuppressant therapy have shown an early onset of symptoms following treatment, rather than years.
129 Multiple sclerosis relapse patterns in a population-based cohort
Authors: Wynford-Thomas Ray , Uzochukwu Emeka , Harding Katharine , Anderson Valerie , Cauchi Marija , Willis Mark , Joseph Fady , Pickersgill Trevor , Robertson Neil , Tallantyre Emma 
Published: August 2022

RationaleRelapses remain a key outcome measure in multiple sclerosis (MS), are targeted by disease- modifying therapies (DMT), and guide treatment. As DMT prescribing continues to increase, it remains unclear what effect this has had on relapse frequency and phenotype over time.AimTo examine relapse patterns using 20 years of longitudinal data and correlate with DMT use.MethodProspectively collected relapse data from the South Wales MS registry was analysed from 2000- 2020. Relapse rate and phenotype according to DMT use were analysed across time epochs.ResultsOf 6,165 relapses in 1,460 patients; 76% were in females and 15% occurred on DMT. Annualised relapse rates (ARR) showed a decreasing trend from 2000 (ARR=0.23) to 2020 (ARR=0.08). Using cross- sectional analysis of data from years 2005 versus 2020, rates of DMT exposure increased from 6% to 31%, and ARR was significantly associated with DMT use (p<0.01). Polysymptomatic relapses and relapses associated with full recovery, were both more likely to occur in people on DMT.ConclusionIncreasing use of DMTs was associated with decreasing ARR in this population-based MS cohort over 20 years. We also demonstrate that relapses occurring on DMTs appear to be associated with more favourable recovery.
133 Multiple sclerosis and the risk of infection: a consensus guideline
Authors: Cauchi Marija , Willis Mark , Backx Matthijs , Brownlee Wallace , Ford Helen , Gran Bruno , Jolles Stephen , Price Sian , Tallantyre Emma 
Published: August 2022

Multiple sclerosis (MS) is an inflammatory condition affecting the central nervous system. Infection is a major consideration in the MS population due to its relevance to several stages of the disease process:(i) it has been suggested that infective processes may be ‘triggering’ or aetiological factors for MS, (ii) concurrent infection is known to exacerbate symptoms in MS, (iii) people with MS are at higher risk of infection when compared to the general population, and this risk is exaggerated in those receiving disease modifying therapies (DMTs).This guidance document was developed by specialists in the field of MS, Immunology, Infectious Disease and Pharmacy. A modified Delphi approach was used to develop clinically relevant, evidence-based consensus guidelines to help physicians navigate the complex interaction between DMTs and infectious diseases.We focus on specific risks predisposing people with MS to infection and how to manage these risks. We also provide recommendations on how to screen for, prevent, and manage infection in this population, in particular tuberculosis, progressive multifocal leukoencephalopathy, hepatitis B, human papillomavirus, herpetic and other opportunistic infections. We also discuss vaccination and the COVID-19 pandemic in people on DMTs.