bluuebunny/crossref_metadata_2025_split huggingface dataset:
033  GLP-1RAs reduce stroke incidence in patients with type 2 diabetes mellitus: a meta-analysis
Authors: Maskery Mark , Wall Jasmine , Holscher Christian , Jones Stephanie , Price Christopher , Strain David , Watkins Caroline , Werring David , Emsley Hedley 
Published: May 2022

BackgroundPatients with Type 2 Diabetes Mellitus (T2DM) are at a relatively higher risk of severe stroke. Glucagon like peptide-1 receptor agonists (GLP-1RAs) are licensed for the management of T2DM. Cardio- vascular outcome trials (CVOTs) have demonstrated that GLP-1RAs can be safely administered to T2DM patients but have also indicated a trend towards a reduction in non-fatal stroke incidence compared to placebo.MethodsWe searched the literature to identify all GLP-1RA CVOTs. We performed a meta-analysis of the incidence of non-fatal stroke and presented the outcomes by Odds Ratio (OR) with 95% confidence intervals (CI).ResultsWe identified 7 GLP-1RA studies. SUSTAIN-6 and REWIND reported statistically significant reductions in non-fatal stroke incidence, whilst LEADER demonstrated a similar, non-significant trend. ELIXA, EXSCEL, HARMONY and PIONEER-6 did not report a reduction in stroke incidence. Meta-analysis of 7 studies, totalling 56,004 participants yielded a significant reduction in non-fatal stroke incidence in patients receiving GLP-1RAs when compared with placebo (OR 0.85, 95% CI 0.76 – 0.94).ConclusionsThis data supports the value of GLP-1RAs in reducing stroke incidence in patients with T2DM. There is potential value in prospective, randomised controlled trials adequately powered to establish the value of GLP-1RAs in stroke prevention in T2DM patients.mark.maskery@doctors.org.uk|ABN Bursary
036  A rare subtype of a rare type of stroke – sulcal artery syndrome
Authors: Win Myat , Hernandez Ana Campos , Fox Robin , Harikrishnan Sreedharan , McWilliam Matthew 
Published: May 2022

A 78 year old man was woken from sleep by a sudden excruciating neck pain. The pain was accompa- nied by left arm and leg weakness and paraesthesia which progressed to maximum intensity over hours. His past medical history was significant for ischaemic heart disease and type 2 diabetes. On examination there was an incomplete Brown-Sequard syndrome localising to the left hemicord. MRI of the cervical spine showed intramedullary T2 hyperintensity and restricted diffusion in the left hemicord at C2-C3 level. CT angiogram of the vertebral arteries excluded dissection.We diagnosed acute spinal cord infarction due to a sulcal artery occlusion, and treated with antiplatelets and secondary stroke prevention. The neurological deficit improved significantly over the following days.Spinal cord strokes are diagnostic challenges and account for only 1.25% of all strokes. Sulcal artery syndrome is a rare cause of spinal cord infarction, involving the territory of the sulcal arteries, which are paired penetrating branches of the anterior spinal artery and perfuse the anterior two-thirds of half the spinal cord. An acute onset with pain is an important clue - otherwise the hemi-distribution and short segment of signal change may be misdiagnosed as an inflammatory lesion.myatwin@nhs.net43
039  Cerebral venous sinus thrombosis and COVID-19: causation or coincidence?
Authors: Crawford James , Taylor Hannah , Iftikhar Hajira , McKee David , Chaouch Amina 
Published: May 2022

Since early in the pandemic, it has been recognised that coronavirus disease 2019 (COVID-19) is associ- ated with an increased risk of thromboembolic complications. Several recent case reports have identified cases of cerebral venous sinus thrombosis (CVST) occurring in conjunction with COVID-19. Given these patients’ increased risk of thromboembolic events, some authors have hypothesised that there may be a causative association between the two conditions.To examine this hypothesis, we collected a retrospective case series of patients with CVST presenting to a large tertiary neurology centre and surrounding trusts in the North West of England between January 2019 and December 2020. The catchment area serves approximately 3.2 million people, of which all confirmed cases of CVST are discussed with tertiary services. We identified 46 cases of CVST during 2020, 5 of which were identified as having been positive for COVID-19 RNA or antibodies at the time of CVST diagnosis (10.87%). A comparative 52 cases of CVST were identified during 2019.We suggest our findings do not provide evidence for an association between CVST and COVID-19 based on overall incidence trends. However, we also suggest that further research should be undertaken regarding this potential association, with particular emphasis on COVID-19 antibody testing.jamiecrawford1995@gmail.com
HTLV-1 encephalomyelitis; a case report of a treatable manifestation of HTLV-1 infection
Authors: King-Robson Josh , Taylor Graham P 
Published: May 2022

IntroductionHuman T-cell lymphotropic virus type-1 (HTLV-1) infection remains asymptomatic in >90% of the 20-million people infected worldwide. However in 3%, chronic inflammation within the thoracic spinal cord leads to progressive spastic paraparesis; HTLV-1 associated myelopathy (HAM). This pathological process is not limited to the thoracic cord. We present a case of HTLV-1 encephalomyelitis.CaseA 53-year-old woman with HAM of 9 years duration presented with subacute cerebellar dysfunc- tion, being unable to feed herself, 3-months after cessation of methotrexate. Investigations demonstrated extensive T2-hyperintensity within the brainstem, cortical and subcortical white matter with punctate contrast enhancement; lymphocytic CSF; and high blood (36%) and CSF (72%) HTLV-1 proviral load (DNA copies per 100 lymphocytes). We diagnosed HTLV-1 encephalomyelitis and commenced high dose methylprednisolone with slow steroid taper following which functional independence in the upper limbs was regained.DiscussionRisk of HAM rises exponentially once HTLV-1 proviral load exceeds 1%, while CSF:blood proviral load ratio ≥2:1 indicates CNS infiltration of HTLV-1 infected lymphocytes. This patient’s high HTLV-1 proviral load and widespread MRI changes indicated HTLV-1 associated inflammation of the brain and spine. Prompt immunosuppression resulted in significant recovery and highlights the importance of early rec- ognition and management of extraspinal manifestations of HTLV-1 infection.j.king-robson@nhs.net
048  Cannabis-based medicinal products for neurological disorders: a study of 75 patients
Authors: Weatherall Mark 
Published: May 2022

Cannabis-based medicinal products (CBMPs) were approved for use by specialist medical practitioners in the UK in 2018. Licensed indications for CBMPs are limited, but studies have suggested potential benefits from the use of CBMPs across a number of neurological conditions. I present details of 75 neurology patients presenting to a UK-based CQC-registered medical cannabis clinic between December 2019 and January 2021.The most common reason for presentation was epilepsy (22 patients), followed by migraine (19), and MS (12). Small numbers of patients were seen with other neurological disorders. 23 patients had never used cannabis or cannabis-based products; 29 had taken OTC products, 17 had used cannabis recreationally, and 6 patients had previous taken prescribed CBMPs.15 patients were not prescribed CBMPs. Of these 5 were deemed unsuitable because other licensed treatment options had not been sufficiently explored. CBMPs were generally well tolerated, only 4 patients experiencing adverse effects from THC (somnolence, nausea).Of 60 patients treated, follow-up is available for 46. Of these, 23 (50%) found CBMPs helpful in treating their neurological symptoms, and 11 (24%) found CBMPs helpful in improving their general quality of life. 12 (26%) patients did not find CBMPs helpful.In a real world setting, therefore, patients can find CBMPs helpful for improving neurological conditions, and quality of life. Further studies would be helpful to determine optimal dose and timing schedules for future clinical trials.markweatherall1@nhs.net49
050  Evaluation of 3 month data for the use of erenumab for chronic migraine in Glasgow
Authors: Dani Krishna , Murray Lesley , Benchiheub Anissa , Gorrie George , Selvarajah Johann , Sharma Sandeep , McKenzie Michael , McCorkell Laura , Rankin Christine , Tyagi Alok 
Published: May 2022

Background andMethodsErenumab, a monoclonal antibody to CGRP, is a new treatment option for preventive treatment of migraine. We audited 3 month outcome data of erenumab for prevention of chronic migraine in Glasgow. Patients are offered erenumab 140mg if they fail 4 migraine prophylactic agents in addition to Botox. Erenumab is continued for a further 9 months if effective at 3 months (≥30% reduction in total headache days or ≥50% reduction in severe headache days, using data from the “best month”). A 3 month extension is occasionally considered if there is a trend for improvement.ResultsData were available for 93 patients (86% female). Previous treatments included: all 4 prespecified prophylactics (76%); flunarizine(63%); GON block(51%); Botox(95%); neuromodulation(25%); dihydroergot- amine infusion (19%). Erenumab was continued in 81% (53% continued for reduction in headache days, 28% for reduced severity/clinical discretion) and discontinued in 19% for dramatic improvement (2%), side effects (2%), and inefficacy (15%). Side effects included constipation(23%), hair loss(3%) injection site reactions, fatigue, cramps, itch (all 2%), itch, blistering, restless legs, rash, nausea, diarrhoea, insomnia, flushes (all 1%).ConclusionA surprisingly high response rate was observed at 3 months. Twelve month data are required to determine if the effect is sustained.krishnadani@icloud.com50
051  Peripheral nerve blocks in combination with onabotulinum toxin A treatment to improve migraine outcomes
Authors: Germain Lewis , Hilton James , Amores Fred , Fernandes Linford , Randall Marc , Idrovo Luis 
Published: May 2022

There is no evidence base on the efficacy of onabotulinum toxin A treatment and peripheral nerve blocks (PNBs) when used in combination to treat chronic migraine. This retrospective single centre evaluation looked at outcomes from 198 headache service users who had been managed with onabotulinum toxin A treatment alone (n=97), PNBs alone (n=43) or both treatments in combination (n=58). 85% of patients who had PNBs alone considered them effective in reducing their headache burden on follow-up, compared to 71% of patients who had onabotulinum toxin A treatment only. In patients who received both headache treatments, due to increased headache burden, 84% of patients found PNBs effective, while 41% of patients found onabotulinum toxin A treatment effective, suggesting that PNB respond- ers don’t always respond to onabotulinum toxin A treatment. There were also differences in the type of headache outcomes reported, with patients who received PNBs more likely to report a reduction in headache severity compared to patients who received onabotulinum toxin A treatment (69% vs. 50%). Patient who received onabotulinum toxin A treatment were more likely to report a reduction in headache days (47% vs 0.31%). Complications rates and side effects were also evaluated.linford.fernandes@nhs.net|ABN Bursary
052  How much weight loss is required to reduce intracranial pressure in idiopathic intracranial hypertension?
Authors: Mollan Susan , Mitchell James , Ottridge Ryan , Yiangou Andreas , Cartwright David , Grech Olivia ,   IIH WT investigators, Tahrani Abd , Brock Kristian , Sinclair Alex 
Published: May 2022

BackgroundThe amount of weight loss required in idiopathic intracranial hypertension to reduce intrac- ranial pressure (ICP) has not been established.MethodsUsing the IIH:weight trial data from 66 active patients randomised to bariatric surgery or community weight management intervention (CWI) (1:1) a linear hierarchical regression model was used to fit to the trial outcomes, adjusted for time, treatment arm, and body weight. This enabled prediction of ICP.ResultsThe greater the reduction in ICP was predicted with greater weight loss, with 24% weight loss resulting in normalisation of ICP in this population. The effect on ICP further improves between 12 to 24 months as the participants continue to lose weight. For expected ICP values to cross the threshold for normal, at 25cmCSF within 2 years, it is generally required that the patient would be allocated to the bariatric surgery arm and achieve a weight of 110kg. Those with a higher starting weight needed to lose more weight to meaningfully reduce ICP. This model also demonstrated that in the CWI arm if no or little weight loss was achieved in those with a high baseline weight an increase in ICP would be expected.ConclusionsThere should be care when exposing women with IIH and BMI≥35kg/m2 to repeated cycles of lifestyle interventions that fail to achieve adequate weight loss, as this approach is unlikely to achieve sustained remission of disease.soozmollan@doctors.org.uk51
Concurrent sodium channel myotonia and amyotrophic lateral sclerosis supports shared pathogenesis
Authors: Franklin John , Cooper-Knock Johnathan , Baheerathan Aravindhan , Moll Tobias , Heverin Mark , Hardiman Orla , Mannikko Roope , Shaw Pamela , Hanna Michael 
Published: May 2022

Amyotrophic lateral sclerosis (ALS) is an invariably fatal adult-onset neurodegenerative disorder; 10% of ALS is autosomal dominant but even sporadic ALS exhibits significant heritability. Dysfunctional voltage- gated sodium channels (NaVs) have been implicated in both sporadic and familial forms of the disease, but it is unclear whether these are an upstream cause or a downstream consequence. Rare missense mutations in the SCN4A gene, encoding NaV1.4, disrupt membrane excitability and cause autosomal dominant muscle channelopathies such as myotonia and hypo/hyperkalaemic periodic paralysis. We report two patients with congenital SCN4A channelopathy due to p.S1159P and p.R672H mutations who developed ALS in later life. Based on our finding we hypothesised that ALS may be linked to genetic mutations in other voltage gated ion channels. Rare-variant burden testing using whole genome sequenc- ing data from 4,495 ALS patients and 1,925 controls within the superfamily of voltage-gated ion channels (Accession: ssf81324) identified one gene, SCN7A, which passed multiple testing correction (p=0.0002, Firth logistic regression) consistent with an enrichment of ALS-associated mutations. We propose that genetic mutations within NaVs leading to neuromuscular excitotoxicity are an upstream cause of ALS. Early identification of ALS patients carrying NaV mutations might lead to personalised therapy with a sodium channel-blocking agent such as riluzole.j.franklin@doctors.org.uk
055  Insights into a secondary care headache service
Authors: Scott James , Bateman Karen , Cottam Rachel , Muddle Lynne , Young Emma , Ridha Basil , Ganesalingam Jeban 
Published: May 2022

BackgroundHeadache is an extremely common presentation to primary care, with some patients requiring referral to general neurology or specialist headache services.AimsHere we describe the cohort of patients who are referred to secondary care for management of headaches.MethodsNeurology outpatient clinics at Brighton and Sussex University Hospitals NHS during June 2019 were retrospectively analysed using electronic records.ResultsOf the 538 patients seen, 123 (23.4%) presented with headache. 48 patients were new referrals and 75 were follow up. 38% of new patients required a follow up appointment.26 patients (21%) had 2 simultaneous headache disorders. 77 patients (63%) presented with migraine while cervicogenic (n=9), cluster (n=8) and idiopathic intracranial hypertension (n=6) were the next most prevalent.22 patients with migraine were initiated on a preventative medication while 7 had a dose adjustment. 11 were prescribed an abortive treatment. 1 patient was prescribed simple analgesia. 10 patients received greater occipital nerve block while 6 received Erenumab. For 9 patients, their headache had resolved by the time they attended clinic.ConclusionAs new treatments such as monoclonal antibodies become available for migraine, ongoing discussion will be vital to ensure headache services can adapt and deliver these therapies effectively.j.scott3@uni.bsms.ac.uk|ABN Bursary
056  Efficacy of fremanezumab in chronic migraine patients with inadequate response to ≥3 preventive medication classes
Authors: Lambru Giorgio , Dhiraj Dalbir , Ning Xiaoping , Campos Verena Ramirez , Barash Steve , Sherwin Eoin , Cohen Joshua 
Published: May 2022

ObjectiveTo evaluate efficacy of fremanezumab in a subgroup of chronic migraine (CM) patients with inadequate response to ≥3 migraine preventive medication classes (CM ≥3 inadequate responses subgroup) from the double-blind, phase 3b FOCUS study.MethodsIn FOCUS, patients with inadequate response to 2–4 migraine preventive treatment classes were randomized (1:1:1) to quarterly fremanezumab, monthly fremanezumab, or placebo for 12 weeks. Changes in monthly migraine days (MMD), 6-item Headache Impact Test (HIT-6) score, and monthly days using acute headache medication and response rates (≥30% reduction in MMD), were evaluated in CM≥3 inadequate responses subgroup.ResultsOf 838 randomized patients, 293 were included in this analysis. Change from baseline in MMD over 12 weeks was significantly greater with fremanezumab (LSM[SE]: quarterly, −4.0[0.56]; monthly, −4.1[0.56]) versus placebo (−1.0[0.59]; P<0.0001), as was ≥30% response rate (44% and 46% vs 18%; P<0.0001). Signifi- cantly greater reductions from baseline were observed in HIT-6 scores during 4 weeks after third study- drug dose with quarterly (−3.8[0.70]) and monthly (−4.9[0.71]) fremanezumab versus placebo (−1.7[0.75]; P<0.01). Reductions in acute medication use days were significantly greater with fremanezumab versus placebo (P<0.0001).ConclusionsIn CM patients with inadequate response to ≥3 migraine preventive medication classes, fremanezumab was well tolerated and effective.mknagge@cellohealth.com53
060  Calcitonin gene-related peptide monoclonal antibody treats headache in patients with active idiopathic intracranial hypertension
Authors: Yiangou Andreas , Mitchell James , Vijay Vivek , Grech Olivia , Bilton Edward , Lavery Gareth , Fisher Claire , Edwards Julie , Mollan Susan , Sinclair Alexandra 
Published: May 2022

BackgroundHeadache is the dominant factor for quality of life related disability in idiopathic intracranial hypertension (IIH) and typically has migraine-like characteristics. There are currently no evidence-based therapeutics for headache in IIH, and consequently this is an important unmet clinical need.Case seriesWe report a series of seven patients in whom headaches were the presenting feature of IIH the headaches had migraine-like characteristics, as is typical in many IIH patients. Papilloedema settled (ocular remission) but headaches continued. These headaches responded markedly to erenumab, a monoclonal antibody targeted against the calcitonin gene related peptide (CGRP) receptor. Of note, there was a recurrence of raised ICP, as evidenced by a return of the papilloedema, however the headaches did not recur whilst treated with erenumab.ConclusionsThose with prior IIH who have their headaches successfully treated with CGRP therapy, should remain under close ocular surveillance (particularly when weight gain is evident) as papilloedema can re-occur in the absence of headache. These cases may suggest that CGRP could be a mechanistic driver for headache in patients with active IIH.a.yiangou@bham.ac.uk|NIHR Bursary55
061  A retrospective cohort study of cavernous sinus/orbital apex syndromes presenting to Imperial College London
Authors: Baheerathan Aravindhan , Huang Yun , Dixon Luke , Everitt Alex 
Published: May 2022

IntroductionThe differential diagnosis of patients presenting with cavernous sinus (CSS) or orbital apex syndromes (OAS) are broad and can be challenging with regards to both diagnosis and treatment.MethodsWe performed a retrospective cohort study of such presentations at our institution from 2015–2021, collecting demographics, investigations and their yield, final diagnosis and management & outcomes.Results30 patientsMean age 50 ± 18.3 yearsProminent pain in 87%Raised ESR in 27% which subsequently normalisedIgG4 subsets raised in 7%Matched oligoclonal bands and raised CSF protein were the commonest CSF anomaliesAll had cross-sectional imaging2 patients with an initially normal MRI had a repeat diagnostic MRI within 2 weeks30% of patients had either lymph node or retro-orbital tissue biopsy76% had idiopathic retro-orbital inflammation, 7% neurosarcoidosis and 7% IgG4 disease10% had a neoplastic processGood recovery seen for idiopathic retro-orbital inflammation treated with IVMP and steroid taperConclusionA high number of patients in our cohort with CSS/OAS have a presumed inflammatory aetiology but with excellent clinical outcome. When clinical suspicion remains high, patients should have interval MR imaging. Bloods & lumbar puncture generally demonstrate non-specific abnormalities and a tissue diagnosis should be obtained if possible for diagnostic security.aravindhan.baheerathan1@nhs.net
064  Preserving vision by optimising surveillance of suprasellar lesions, a consensus statement
Authors: Gilmartin Aisling , Nowak Victoria , Marcus Hani , Grieve Joan , Dorward Neil , Petzold Axel , Acheson James , Baldeweg Stephanie , Bremner Fion , Khaleeli Zhaleh ,   et al
Published: May 2022

IntroductionSuprasellar tumours are a heterogenous group which may compromise the optic apparatus. Serial monitoring and timely intervention preserves vision, but consensus regarding optimal surveillance is lacking. An audit at our tertiary centre found that variation in surveillance intervals and methods leads to under- and over-investigation. We present a novel, evidence- and consensus- based guideline for efficient neuro-ophthalmological monitoring of this cohort.MethodWe searched MEDLINE/Pubmed for ‘visual field’, ‘visual acuity’, ‘pituitary’ and ‘macroadenoma’ with filters: Clinical trial, Meta-analysis, Randomised Control Trial, Review, Systematic review (2000–2020). We constructed a guideline which was reviewed by the multidisciplinary pituitary network consultants (neurosurgery, endocrinology, neuro-ophthalmology).ResultsWe found 18 relevant publications covering pre- and post-operative tumour evaluation. We recommend visual acuity, colour vision, 24–2 Humphrey Visual Field and OCT assessment in a technician- led clinic, supervised by a named neuro-ophthalmology consultant. We recommend baseline and post- operative assessment, then annual for 5 years, progressing to every 2 years. We suggest how to identify patients who may be safely discharged and those requiring re-referral.ConclusionA clear and simple guideline for neuro-ophthalmology surveillance of suprasellar lesions is proposed to optimise safety, efficiency and effectiveness. The guideline will be validated in future through departmental audit.aislinggilmartin@nhs.net57