bluuebunny/crossref_metadata_2025_split huggingface dataset:
197  Window of opportunity to save cost, rationalise use and improve monitoring of IVIG: a tertiary-care-audit
Authors: Sherman Danielle , Packwood Shirley , Hewamadduma Channa 
Published: May 2022

BackgroundIVIG is now widely used to treat immune-mediated neurological conditions with annual expenditure on IVIG within Neurosciences directorates exceeding several millions of pounds. IVIG use is strictly monitored by the Department of Health (DOH) due to its cost-burden and supply shortages. This audit evaluates large tertiary centre IVIG use in line with DOH guidelines.Methodology and ResultsThe paper and electronic records of the 57 patients receiving regular IVIG for a chronic neuromuscular condition were reviewed against the set criteria and standards. In the last year only: 79% of the patients had an annual review of IVIG therapy; 39% had ³1 clinical outcome measure checked to assess effectiveness of IVIG; and 37% of those classified as clinically stable/improved had an attempt at dose/frequency reduction of IVIG. This audit raised issues of requiring greater monitoring visits to ensure compliance and enforce trial of dose down-titration.ConclusionOur data demonstrate a definite opportunity for optimisation of monitoring and rationalisa- tion of IVIG use in order to reduce the treatment burden on patients and reduce IVIG expenditure. To achieve these objectives and to increase efficient use of consultant clinics, a best practice algorithmic protocol driven by a nurse-led IVIG monitoring service is proposed.daniellerachael@googlemail.com
200  A randomized, placebo-controlled study of galcanezumab in patients with treatment-resistant migraine: double-blind results from CONQUER
Authors: Mulleners Wim , Kim ByungKun , Láinez Miguel , Lanteri-Minet Michel , Aurora Sheena , Nichols Russell , Wang Shufang , Tockhorn-Heidenreich Antje , Pain Andrew 
Published: May 2022

ObjectiveCONQUER assessed galcanezumab efficacy and safety in patients with episodic or chronic migraine who had multiple migraine preventive treatment failures.MethodsIn this phase 3, double-blind study, patients (aged 18–75 years) met criteria for migraine, had 4–29 monthly migraine headache days, and 2–4 migraine preventive medication category failures in the past 10 years. Patients were randomized to receive galcanezumab 120mg/month (with 240-mg loading dose; N=232) or placebo (N=230). Primary endpoint: overall mean change from baseline in number of monthly migraine headache days across Months 1–3. Key secondary endpoints: ≥50%, ≥75%, or 100% reduction in monthly migraine headache days and change on Migraine-Specific Quality of Life-Role Function Restrictive domain.ResultsGalcanezumab-treated patients averaged 4.1 fewer monthly migraine headache days from a baseline of 13.4 versus placebo patients’ average of 1.0 fewer from a baseline of 13.0 (between-group difference 3.1; p<0.0001; 95%CI: -3.9, -2.3; effect size=0.72). Galcanezumab was superior to placebo on all key secondary endpoints and did not differ from placebo in terms of safety.ConclusionGalcanezumab was superior to placebo in preventive treatment of migraine and was safe and well tolerated in patients with previous failures to standard-of-care preventive treatments.pain_andrew@lilly.com
Ethnic and socioeconomic determinants of dementia risk: a nested case-con- trol study in East London
Authors: Bothongo Phazha , Jitlal Mark , Parry Eve , Foote Isabelle , Waters Sheena , Dobson Ruth , Noyce Alastair , Bestwick Jonathan , Marshall Charles 
Published: May 2022

BackgroundThe influence of ethnicity and socioeconomic status on dementia risk remain incom- pletely understood. We addressed this issue using data from over a million people in the diverse population of East London (<50% White and >50% in the most deprived UK quintile).MethodsWe identified 4137 cases of dementia, and matched on age and gender to controls with ratio 1:4. We calculated odds ratios (ORs) for ethnicity and Index of Multiple Deprivation (IMD), before and after adjustment for established risk factors (diabetes, hypertension, smoking, BMI, depression and hearing loss). We calculated weighted population attributable fractions (PAF) for each factor.ResultsRisk of dementia was higher for Black and South Asian groups than White (ORs Black 1.43, South Asian 1.17). Risk of dementia was reduced in all IMD quintiles relative to most deprived (ORs 2nd 0.71, 3rd 0.52, 4th 0.71, 5th 0.59). The effects of ethnicity and deprivation persisted after adjusting for known risk factors. Weighted PAFs for modifiable risk factors were notably higher in this popu- lation for depression (9.2%) and diabetes (6.2%) than those estimated in the Lancet Commission meta-analyses (4% and 1.2% respectively).ConclusionsEthnicity and socioeconomic deprivation are important determinants of dementia risk, with effects larger than many of the more established risk factors. Depression and diabetes are of greater relative importance, and should be prioritised as targets for dementia prevention efforts in more diverse and deprived populations.drcharlesmarshall@gmail.com
205  Is it a brain tumour? Assessment on performance of the CNS two week wait pathway
Authors: Shanmugalingam Thurkaa , Quattrocchi Graziella 
Published: May 2022

BackgroundIn June 2015, NICE published updated two week wait (2WW) referral guidelines for general practitioners (GPs) for patients with suspected central nervous system (CNS) tumours. These include guidance on relevant clinical information and recommendations for using brain imaging. We reviewed all cases referred to Lewisham and Greenwich (L&G) NHS Trust sites (University Hospital Lewisham (UHL) and Queen Elizabeth Hospital (QEH)) through this pathway with the aim of identifying the appropriate- ness of referrals and reflect on ways to improve this pathway.Methods andResultsA total of 233 cases were referred onto the 2WW pathway for suspected CNS cancer across L&G NHS Trust between April and October 201; of which 62 were referred to UHL and 161 to QEH. Electronic records and clinic letters were reviewed. Demographics, reason of referrals, target times, and clinical outcome were recorded. 97.7% of these referrals were seen within the target wait of two weeks. Headache was the most common cause for referral.DiscussionThe annual GPs consultation for headache is 4.4 per 100 patients, of which 2% are referred to secondary care. Compliance may be improved by implementing educational programmes in the primary care setting or redesigning the form to optimise referrals.thurkaa.shanmugalingam@doctors.org.uk
206  Use of non-invasive vagal nerve stimulation in a tertiary headache service
Authors: Lowe Michael , Gorrie George , Dani Krishna , Selvarajah Johann , Tyagi Alok 
Published: May 2022

IntroductionNon-invasive vagal nerve stimulation (nVNS) is a novel treatment modality for primary headache disorders. There is some clinical trial evidence to support its use, both as an abortive and pre- ventative treatment, in cluster headache and migraine. We evaluated the use of this novel treatment in a regional tertiary headache service.MethodsA retrospective analysis of case notes of all patients currently using nVNS in our service was undertaken. Other current and previous headache treatments were recorded. A subjective assessment of response to nVNS was made based on available clinical data.Results21 patients currently using nVNS were identified. Diagnoses were chronic cluster headache (n=12), episodic cluster headache (n=1), migraine (n=4), hemicrania continua (n=3) and SUNCT (n=1). All current users reported some degree of positive response to nVNS, with 14 (67%) assessed as having a large improvement. The most frequently reported improvement parameter was reduction in headache frequency (15, 71%). Those reporting a large improvement used significantly fewer concurrent preventa- tive medications (median 0 vs. 2.5, p=0.033).ConclusionsIn this small group of patients with a variety of headache diagnoses nVNS has been an effective treatment; this appears to be due to efficacy as a preventative treatment.michaelcmlowe@gmail.com
207  OnabotA for CM: benefits beyond headache-day reduction
Authors: Blumenfeld Andrew M , Diener Hans-Christoph , Lipton Richard B , Dodick David W , DeGryse Ronald E , Adams Aubrey Manack , Sommer Katherine , Silberstein Stephen D 
Published: May 2022

ObjectiveEvaluate the impact of onabotulinumtoxinA treatment in adults with chronic migraine.MethodsPost-hoc analysis of pooled data from the 24-week, placebo-controlled, PREEMPT (NCT00156910,NCT00168428) and single-arm, 108-week COMPEL (NCT01516892) studies. Percentages of participants meeting responder status at 24, 48, or 108 weeks for clinically meaningful changes in headache days (≥50% reduction), Headache Impact Test (HIT-6; ≥5-point improvement), Migraine-Specific Quality-of-Life Questionnaire Role Function-Restrictive (MSQ-RFR; ≥10.9-point improvement), and either Average Daily Headache Severity (ADHS; ≥1-point improvement; PREEMPT) or Migraine Disability Assessment Scale (≥5-point improvement) were calculated.ResultsParticipants (N=1384) were randomized to onabotulinumtoxinA (n=688) or placebo (n=696) in PREEMPT; 716 participants were enrolled in COMPEL. In PREEMPT, significantly more participants treated with onabotulinumtoxinA than placebo met responder criteria for change in headache days (44.8% vs 34.2%), HIT-6 (40.8% vs 25.3%), MSQ-RFR (59.0% vs 40.2%), and ADHS (35.5% vs 22.4%) scores at 24 weeks (allP<0.001). At least 1 domain was met by 72.1% and 56.6% of PREEMPT participants treated with onabotu- linumtoxinA and placebo, respectively (P<0.001), and 87% of onabotulinumtoxinA-treated participants at year 2 in COMPEL.ConclusionsOnabotulinumtoxinA-treated participants demonstrated clinically meaningful improvements across multiple domains in the PREEMPT studies and up to 2 years in COMPEL.Sommer_Kathrine@Allergan.com
211  The prevalence and characteristics of multiple sclerosis-associated uveitis in UK biobank
Authors: Taylor Thomas , Jacobs Benjamin , Giovannoni Gavin , Dobson Ruth 
Published: May 2022

BackgroundUveitis describes intraocular inflammation of the uveal tract. It may be associated with auto- immune diseases (e.g. ankylosing spondylitis), inflammatory diseases (e.g. Crohn’s), infections (TB, toxoplas- mosis) or it may be idiopathic, however an association with Multiple Sclerosis (MS) has also been observed.Methods2151 individuals with MS were identified within UK Biobank via ICD-10 code G35 and self-reported diagnosis, and compared to the remainder of the Biobank cohort. Uveitis was defined using ICD-10 codes H20, H30, and H22.1 along with self-report. We used multivariate logistic regression to model uveitis diagnosis on MS status and control for confounding factors (age, sex, and socio-economic status).ResultsUveitis prevalence in people with MS was 0.60%, compared to 0.18% in controls. 3 individuals with MS and uveitis had an additional diagnosis associated with uveitis (ankylosing spondylitis and sarcoid) and were excluded, leaving a prevalence of 0.48%. The odds ratio (OR) of uveitis in MS was 2.73, 95%CI 1.46–5.10, p = 0.0068. 90% people with dual diagnosis were female. 30.0% were DRB1*15 heterozygotes, while 70.0% carried no copies of the DRB1*15 risk allele.ConclusionsThese findings support the suggested association of these two conditions and demonstrate a comparable predominance of white females with both conditions.thomasrptaylor@gmail.com
217  Histiocytes and the brain: a rare case of Rosai-Dorfman disease responsive to trametinib
Authors: Hawken Jonathan , Hu Mo , Johnston Ann , Edwards Marc 
Published: May 2022

Rosai-Dorfman Disease (RDD) is a rare heterogenous systemic condition caused by histiocyte over-prolif- eration within various organ systems, which may manifest with neurological symptoms.We report the case of a 70-year-old female who presented with pan-hypopituitarism, and was found to have leptomeningeal enhancement and an infundibular mass lesion on MRI. Brain biopsy confirmed a histological diagnosis of RDD, and initially she was managed conservatively.Four years later her cognition, gait and level of functioning deteriorated. Serial MRIs showed slow progres- sion of the lesions. Treatment with pulsed methylprednisolone followed by an oral taper proved ineffec- tive. A multi-disciplinary team decision was made to start treatment with Trametinib (1mg once daily).A repeat MRI after 6 months showed a reduction in enhancing lesions with no new lesions. Her mobility and cognition also improved objectively. Treatment is ongoing and has been well tolerated with only a mild skin rash as a possible adverse reaction.Trametinib is an inhibitor of mitogen-activated extracellular signal regulated kinase enzymes (MEK1 and MEK2). It is typically used for melanoma, but there is emerging evidence of its effectiveness in RDD. Optimal treatment duration is not yet clearly established, and further research is needed to elucidate underlying disease mechanisms.drhawken@outlook.com
218  Cerebral lipiodol embolisation following lymphangiography – a rare neurologi- cal presentation
Authors: Batcheller Lisa , Thaller Mark , Wright Benjamin 
Published: May 2022

PresentationA 73-year-old gentleman was admitted for 2 stage oesophagectomy (laparascopic abdominal and open thoracic) which was reported as uneventful. The tumour was subsequently confirmed T2N0M0 therefore cured by the operation. 3 days post operation increasing chest drain output was noted, this became milky with coarse creps on auscultation and this was confirmed later as a chyle leak.InterventionInterventional radiology performed lymphangiography under local anaesthesia on day 26 post op.ComplicationThe day after the procedure his GCS dropped with bilateral miotic pupils, increased tone and double incontinence. Initial bloods, arterial blood gas and glucose were normal. Naloxone was given with limited response. His surgical team requested CT head and neurology review.ResultsCT head showed patches of high density throughout basal ganglia, cortex and cerebellum but no infarct in keeping with embolization of lipiodol contrast medium. MRI head confirmed maturing ischaemic cortical and subcortical change.ManagementThe neurological picture showed an encephalopathy with more left sided upper motor neuron signs than on the right. He was managed initially in intensive care with supportive management however prognosis was unclear with no evidence-based treatment. There was also risk of late inflamma- tory reaction analogous to arachnoiditis seen post myelography.OutcomeHe subsequently had thoracotomy with clipping/suturing of the left thoracic duct. He was discharged home after three months in hospital.lisabatch1@gmail.com
220  Cochrane review of interval brain imaging in adults with cerebral glioma
Authors: Thompson Gerry , Lawrie Tess , Kernohan Ashleigh , Jenkinson Michael , Grant Robert 
Published: May 2022

BackgroundIt is not known whether imaging at pre-specified time points after glioma diagnosis and treatment leads to better outcomes than triggered imaging performed in response to new or worsening symptoms.ObjectivesTo systematically review the effect of different imaging strategies on health and economic outcomes for adults with cerebral glioma (grade 2 to 4).MethodsCENTRAL, MEDLINE and Embase were searched up to 18/06/2019 for relevant RCTs and non- randomised studies comparing imaging strategies in adults with glioma. The NHS Economic Evaluation Database (EED) was also searched for relevant economic evaluations. We used standard Cochrane review methodology.FindingsWe included one retrospective study comparing early post-operative imaging (within 48 hours) with no early post-operative imaging among 125 adults with glioblastoma. Evidence suggested little or no difference in survival between approaches at one year (RR 0.86, 95% CI 0.61 to 1.21; 48% vs 55% died, respectively) and two years after diagnosis (RR 1.06, 95% CI 0.91 to 1.25; 86% vs 81% died, respectively) but was assessed as very low quality. No economic evaluations were found.ConclusionsThe effect of different imaging strategies on survival and other health outcomes remains largely unknown. Existing imaging schedules seem to be pragmatic rather than evidence-based.robin.grant@luht.scot.nhs.uk
224  Parkinson’s UK – connecting the Parkinson’s research community and increase participation
Authors: Hursey Amelia 
Published: May 2022

Before Parkinson’s UK went through its rebrand in 2010, we asked our members how we were perceived. The results highlighted the need for us to communicate, collaborate and involve people affected by Parkinson’s in more areas of our work. Today everything we do as an organisation includes people affected by Parkinson’s.Within the research directorate we have focused on 3 key initiatives over the last decade; the Research Support Network (RSN), Research Involvement and Participation. The Parkinson’s UK RSN is an online network of currently over 6000+ people affected by Parkinson’s who are interested in research.We surveyed our RSN membership and 70% of them wanted to take part in research but only 24% had. Many Parkinson’s research trials have failed to recruit participants to time and target, causing the research to go over budget and sometimes fail to reach significance. Data from the 2018 Parkinson’s audit report found only 20% of people affected by Parkinson’s are told about research by their health care profes- sional. By working with people affected by Parkinson’s, Health Care Professionals and Researchers, we developed the Participation work stream to address this discrepancy. The tools we’ve created help researchers to connect with potential participants, patients to take control and health care professionals to signpost people to find research in their area using our Take Part Hub, improving outcomes for patients and research performance.ahursey@parkinsons.org.uk
225  A rare case of recurrent unsteadiness due to Miller Fisher syndrome
Authors: Levinson Gavriella , Wei Diana , Warner Graham 
Published: May 2022

A 71-year-old male presented to the emergency department with unsteadiness, blurred vision, slurred speech and sensory changes. He had progressive loss of reflexes. After initial horizontal nystagmus he developed bilateral ophthalmoplegia with bilateral ptosis and impaired coordination with an ataxic gait. This was preceded by productive cough and loose stools.The patient was diagnosed with Miller Fisher Syndrome (MFS), with a positive anti-GQ1b antibody and CSF albuminocytologic dissociation supporting the diagnosis. This was the patient’s second episode of MFS. The first had occurred twenty-seven years earlier with a similar presentation and examination findings.This poster then reviews the clinical presentation, management and recurrence of Miller Fisher Syndrome. gavriella.levinson@nhs.net
233  Working towards an adaptive trial platform for Parkinson’s disease
Authors: Zeissler Marie-Louise , Dominey Thea , Morris Huw , Bandmann Oliver , Schrag Annette , Foltynie Tom , Carroll Camille 
Published: May 2022

BackgroundNo intervention for Parkinson’s disease (PD) has been unequivocally proven to be neuro- protective. Setting up phase 2 and 3 clinical trials in isolation is costly, time consuming and inefficient. An adaptive trial design may allow streamlining clinical evaluation, with interim analyses allowing for early detection and replacement of ineffective arms. We were interested to explore the practicalities of developing an adaptive trial for PD.MethodWe consulted with experts in disease areas where adaptive trials have been initiated and sought support from national and international Parkinson’s experts, charities, and input from patient advocates.ResultsFollowing consultation, we have adapted the process successfully employed by the multiple sclerosis (MS) Society in the development of the STOP MS initiative. Initial steps involve a review of recent trial methodologies and a Delphi study involving multi-organisational stakeholders, including patients and international experts. These results will inform the function of working groups responsible for drug selection, trial design, outcome measure selection and infrastructure.ConclusionsDeveloping a adaptive trial for PD is challenging. However, we now have a process to take this forward, building on the success of similar initiatives in other neurodegenerative diseases.marie-louise.zeissler@plymouth.ac.uk
236  Systemic mitochondrial dysfunction in monogenic Parkinson’s disease as a potential biomarker for stratification
Authors: Campbell Philip , Harvey John , Morris Huw , Schapira Anthony 
Published: May 2022

To investigate the use of PBMCs as a biomarker of mitochondrial dysfunction in Parkinson disease (PD) fresh peripheral blood mononuclear cells (PBMCs) were isolated using Ficoll gradient separation from PD patients with pathogenic biallelic parkin mutations as well as healthy controls (HC). PBMC mitochondrial function was analysed using Seahorse XF respirometry and flow cytometric assessment of mitochondrial membrane potential (Δψm) using TMRE staining.Nine parkin PD patients (average age 45.2yrs, 66% male) and 41 healthy controls (average age 57.8yrs, 58% female) were sampled for the study. Parkin patients had increased oxygen consumption related to proton leak, reduced maximal respiration and reduced spare respiratory after correction for age (p<0.01). Additionally Parkin patients were found to have reduced resting Δψm and reduced oxygen consumption related to ATP production (p<0.01). Basal oxygen consumption was similar between Parkin patients and healthy controls.These findings are in keeping with parkin’s role in removing dysfunctional mitochondria through mitophagy. The finding of normal basal oxygen consumption suggests that dysfunction is most pronounced when cells are under stress, during high ATP demand. This ‘signature’ of mitochondrial dysfunction could be applied to idiopathic PD patients to define a mitochondrial subgroup, in which personalised, stratified therapeutics could be targeted.p.campbell@ucl.ac.uk
246  Timing is everything: improving inpatient levodopa administration at the National Hospital for Neurology and Neurosurgery
Authors: Ceronie Bryan , Stockford Lindsey , Korlipara Prasad , Foltynie Thomas 
Published: May 2022

BackgroundThe mainstay of treatment in Parkinson’s Disease (PD) is levodopa replacement therapy. Variation in the timing of administration can lead to worsening motor fluctuations, falls and medical emergencies.The National Hospital for Neurology and Neurosurgery treats advanced PD patients with complex medical management and deep brain stimulation, admitting up to 250 neurological and 120 neurosurgical PD patients per year.MethodsWe audited the medication administration of PD inpatients over a two month period, aiming to assess the frequency of clinically significant variations and consider how these might be reduced. We included PD patients on levodopa therapy a minimum of 4 times daily, not self-administering medication and admitted for at least 10 days.ResultsA total of 404 episodes of administration were identified. Across all episodes, 18% of levodopa was given later than 30 minutes and 6.5% given more than 30 minutes early. Variations tended to be greater in the neurosurgical division. Survey of the nursing teams identified a number of barriers to timely administration.DiscussionWe plan to implement change by highlighting PD patients at handover, implementing bedside visual aids with medication timings and encouraging the use of medication alarms. The impact of these changes will be re-audited.bryan.ceronie@gmail.com