bluuebunny/crossref_metadata_2025_split huggingface dataset:
Atomoxetine and citalopram alter brain network organisation in Parkinson’s disease
Authors: Borchert Robin , Rittman Timothy , Rae Charlotte , Passamonti Luca , Jones Simon , Vatansever Deniz , Rodríguez Patricia Va´zquez , Ye Zheng , Rowe James ,   et al
Published: May 2022

Recent evidence has shown potential cognitive benefits in Parkinson’s disease from restoring neuro- transmitter deficits including noradrenergic and serotonergic transmission. Here, we study global and regional brain network organization using task-free imaging, which minimizes performance confounds and the bias towards predetermined networks. Thirty-three patients with idiopathic Parkinson’s disease were studied three times in a double-blinded, placebo-controlled crossover design, following placebo, 40mg oral atomoxetine or 30mg oral citalopram. Seventy-six controls were scanned without medication to provide normative data. Relative to controls, patients on placebo had executive impairments, which was reflected in dysfunctional network dynamics in terms of reduced clustering coefficient, hub degree and hub centrality. In patients, atomoxetine improved fluency in proportion to plasma concentration (P=0.006, r2=0.24), and improved response inhibition in proportion to increased hub Eigen centrality (P=0.044, r2=0.14). Citalopram did not improve fluency or inhibitory control, but its influence on network integration and efficiency depended on disease severity: clustering (P=0.01, r2=0.22), modularity (P=0.043, r2=0.14) and path length (P=0.006, r2=0.25) increased in patients with milder forms of Parkinson’s disease, but decreased in patients with more advanced disease (UPDRSIII>30). This study supports the use of task-free imaging of brain networks in translational pharmacology of neurodegenerative disorders. We propose that hub connectivity contributes to cognitive performance in Parkinson’s disease, and that noradrenergic treatment strategies can partially restore the neural systems supporting executive function.robinborchert@gmail.com
152  Automating the assessment of first seizure care pathways and clinical outcomes using electronic patient records
Authors: Shek Anthony , Theochari Evangelia , Searle Thomas , Kraljevic Zeljko , Viana Pedro , Bruno Elisa , Teo James , Dobson Richard , Richardson Mark P 
Published: May 2022

PurposeElectronic Patient Records (EPR) are ideal sources of information to provide evidence for the optimisation of health management. However, beyond direct patient care, their use for secondary purposes such as research or service improvement has been limited.AimsWe aimed to explore the feasibility of using novel patient data analytics tools (CogStack & MedCAT) at King’s College Hospital trust (KCH) to identify suspected first seizure patients and compare their man- agement against NICE guidelines.MethodWe utilised CogStack to search 1.4 billion EPR documents at KCH to identify suspected first seizure patients. We then retrieved their subsequent records, and used a combination of manual extraction and a natural language processing tool (MedCAT), to extract information about their symptomatic presenta- tion, final diagnosis, timing of investigations, and specialist appointments.Results226 patients attended the emergency department with suspected first seizures. MedCAT could be feasibly trained with expert knowledge to increase the accuracy of automatically extracting relevant textual information from EPR. Our analysis of patient records identified steps in the clinical pathway that frequently fell short of the NICE guidelines.ConclusionEPR are feasible to be mined at scale for the rapid analysis of service demand and monitoring patient health trajectories. The insights of this study have been used to improve first seizure management in KCH, demonstrating the value of NLP application in healthcare.anthony.shek@kcl.ac.uk107
168  Asymptomatic dengue illness complicated by Guillain Barre syndrome
Authors: Siddiqui Sarah , Midgley Laura , Poole Olivia , Redmond Ian , Alkufri Fadi , Harikrishnan Sreedharan , Moran Nicholas 
Published: May 2022

Arboviral infection Dengue can cause a spectrum of disease varying from asymptomatic illness to dengue fever to the severe dengue hemorrhagic fever. Neurological complications are rarely reported in the lit- erature (0.5–6%), mostly from dengue-endemic areas in tropics and subtropical regions. We report a case of a 59-year-old man who returned from a recent work-related travel from India. Three weeks following a mild viral prodrome, he developed bilateral lower motor neuron facial palsy with absent deep tendon reflexes. CSF showed albuminocytologic dissociation and electrophysiological studies showed demyeli- nating neuropathy. Routine GBS screen for common etiological viruses was negative and subsequently additional testing based on recent travel was performed which showed positive Dengue IgM and RNA in serum. The patient was treated with plasma exchange for 5 days and his facial weakness improved to a great extent.This case demonstrates the importance of considering arboviral infections such as Dengue in patients with GBS particularly in people living in or travelling from endemic areas. Additionally, like many other viral illnesses, there may not be clear clinical evidence of Dengue fever and the prodrome may go unnoticed and undiagnosed, hence a high index of suspicion is required.s_hasan_s@yahoo.com
169  Adult brainstem glioma mimicking as a neuro-infectious process: case report and literature review
Authors: Wu Kit , Coulden Amy , Mahmood Amira , Kentley Jonathan , Salam Sharfaraz , Ghosh Rhia , Reisz Zita , Bodi Istvan , Britton Tom 
Published: May 2022

Background andAimBrainstem gliomas are rare, accounting for less than 2% of adult gliomas. They are difficult to diagnose and challenging to treat [Hu et al, 2016]. Here, we report a patient with an unusual clinical presentation of brainstem glioma, supported by radiological and histopathological findings.Clinical presentationA 61-year old male retired diver presented with 2-month history of worsening occipital headache, described as a constant pressure worse on lying down with migrainous features of nausea and light-sensitivity, and intermittent episodes of double vision and poor balance.Neurological examination on admission was normal. He progressed to develop double vision, left-sided weakness and worsening swallowing and respiratory function.InvestigationsBlood tests for infections and vasculopathy were negative. Two CSF samples taken showed high protein (1.7g and 3.25g respectively) with the first showing 100% lymphocytes and the latter 56% monocytes and 42% lymphocytes. There were no malignant cells on immunophenotyping.MRIs demonstrated progressive of ring-enhancing lesions in brainstem in keeping with inflammatory con- ditions. Biopsy was not possible due to the centrally-located lesions. Despite receiving wide spectrum antimicrobials, steroids and respiratory support, he died 2 months later. Autopsy of the brain showed a glioblastoma with brainstem infiltration and cystic necrosis in the pons.SummaryGliomatosis pattern and leptomeningeal and nerve root spreading of brainstem glioblastoma can be misleading signs with neuro-infections as a differential. Early neurosurgical intervention may aid diagnosis.kitwu@doctors.org.uk
171  Systemic infections and acute admission in long-term neurological conditions
Authors: Saldanha Ramos Ana Rita , Varatharaj Aravinthan , Galea Ian 
Published: May 2022

BackgroundPeople living with a long-term neurological condition (LTNC) make up nearly one-fifth of hospital admissions in the UK. Though LTNCs are diverse, the common trigger for deterioration is often systemic infection. More data on the problem is required to inform service planning.MethodsThe case notes of 157 consecutive patients with an LTNC presenting to University Hospital South- ampton for urgent care, were reviewed, as part of an ongoing and prospective service evaluation. Data was collected on mode of presentation, acute diagnosis, specialty input, length of stay, complications, and change in social needs.ResultsDementia (43%) and stroke (27%) were the most common LTNCs. Systemic infection was the trigger for admission in 52% of patients. The mode of presentation was most commonly deterioration in func- tional abilities and cognition. Mean length of stay was 5.7 days. Care needs increased in 11% of patients.ConclusionThis data provides a snapshot of the urgent care needs of people with LTNCs, which should help inform future service planning. In particular, the impact of systemic infection is significant and strate- gies to mitigate this are discussed.ritaramos.jc4@gmail.com
172  Quality improvement project on the peri-procedural management of lumbar punctures
Authors: Mousele Christina , Gillingham Alexandra , Mummery Catherine , Carr Aisling 
Published: May 2022

IntroductionCancellation rate of elective lumbar punctures (LPs) due to inappropriate management of antithrombotic medications and lack of adequate training of junior doctors in the peri-procedural man- agement of LPs encouraged us to conduct a quality improvement project aiming to address these issues.MethodsRetrospective review of day case elective LPs (01/10/2018 - 01/01/2019) Junior doctor surveys aiming to assess LP related knowledge and confidenceResults37.5% (75/200) of the scheduled LPs were cancelled due to mistakes in the pre-procedural man- agement of patients’ blood-thinning medication. Junior doctors’ knowledge of consent and antithrom- botic management was suboptimal. As was self-reported confidence and competency in independent performance of LPs at CMT/SHO level.Change implementedImplementation of Trust-approved Guidelines on peri-procedural management of LPs based on systematic review of literatureLP training clinicRe-audit.LP cancellation rate fell to 8% after implementation of these measures (15/04/2019 - 15/07/2019) with meaningful improvement in LP knowledge/confidence of junior doctors. christinamousele92@gmail.com
177  Outpatient letter writing in the neurology department
Authors: Lock Felicity , Wardle Mark 
Published: May 2022

ObjectiveAs a predominantly outpatient-based specialty, neurology clinic letters are a vital, yet often overlooked, communication tool. This study aims to evaluate whether current Neurology outpatient letters in University Hospital of Wales meet the standards suggested by the Academy of Medical Royal Colleges and the Professional Records Standards Body.MethodsAn assessment proforma was created based on the standards. A retrospective sample of consult- ant letters from General Neurology, Epilepsy and Multiple Sclerosis outpatient clinics throughout January 2019 were assessed. 2–4 letters were randomly selected from each clinic, aiming for equal numbers of follow-up and new cases.Results187 clinic letters were assessed, from 12 different anonymised consultants. Letters universally achieved ‘mandatory’ PRSB headings, fewer meeting non-mandatory headings. There was a wide variety in style and content, with consultants’ mean word counts ranging from 89 to 537. Turnaround delay between clinic and typing ranged from 0 to 79 days, with 79.7% of letters copied to the patient.ConclusionThough mandatory content was achieved, consistency and clarity often lacked. Present- ing the results at audit meeting prompted much interest and discussion. Many supported implementing a departmental letter structure and exploring reducing turnaround delay to improve the quality and efficiency of outpatient letters.LockFJ@cardiff.ac.uk
179  Improving respiratory screening and NIV assessment in motor neuron disease
Authors: Rice-Wilson Daniel , Ealing John 
Published: May 2022

Motor neurone disease (MND) commonly causes death from respiratory muscle weakness. Non-invasive ventilation (NIV) is currently the most life-prolonging treatment, and its inclusion in NICE guidelines has increased respiratory function testing, respiratory referrals and usage. Earlier referral to respiratory services results in more hospital appointments before NIV initiation. We aimed to assess whether patients were receiving NICE-compliant respiratory screening and calculate the NIV uptake rate of those referred. We also sought to measure the effect of NIV on survival. We retrospectively examined 194 patient records from the SRFT MND care centre between 1st January and 31st December 2016. A Kaplan-Meier analysis was used to calculate survival. All appropriate patients received NICE-compliant respiratory screening, with 27% patients referred for NIV. Of those referred 33% were started on NIV at initial assessment, and 12% during follow up. Non-invasive ventilation increased survival by 265 days. The result of NICE-compli- ant practice is a low rate of NIV uptake, burdening patients and services with extra appointments. NIV significantly increases life expectancy and patients must receive it as soon as it is indicated. We plan to incorporate NIV assessment by respiratory physicians within the MND clinic to complement the screening process and reduce unnecessary referrals.daniel.rice-wilson@nhs.net
185  An assessment of perceived gender disparity in platform and poster presenters at ABN conferences
Authors: Patel Faheemah , Lawrence Joanne 
Published: May 2022

Background anecdotal observation of Edinburgh 2019 platform presenters suggested reduced repre- sentation of female neurologists. We compared the gender distribution of authors with the 2018/19 RCP Census1; 33% of consultant and trainee neurologists were female, but this varied with status (29% consult- ant, 44% trainee neurologists being female1).Method2015–2019 authors sorted by position, then gender attributed to first names using online databases including genderize.io. The proportions of first, last and other female authors were compared with RCP data1 for consultant and trainee neurologists.ResultsIn 2019, women accounted for 39% of all abstract authors, 41% of first authors and 29% last authors. Gender distribution generally reflected that of the RCP census*, particularly when adjusted for status, given the dominance of early career researchers (ECR) as first authors and consultant neurologists as last authors. Female first author numbers peaked in 2018 (50% of first authors for all abstracts, 55% for all ECR abstracts, 49% for ECR platforms) but fell to 41%, 45% and 35% respectively in 2019.Conclusion the gender distribution of ABN abstract authors typically correlates well with that of UK neurolo- gists reported in the RCP census*. However Edinburgh2019 saw a significant drop in abstracts submitted by women. Contributing factors for investigation include the influence on attendance of accessibility from other neuroscience centres.faheemah.patel@abn.org.uk
187  Variation in training: Results from a survey of UK neurology trainees
Authors: Ross Russell Amy L , Zarkali Angeliki , Shribman Samuel , Alexander Sian K , Warner Thomas T , Jones Matthew , Pereira Anthony , Hughes Tom AT , Kipps Christopher , Mummery Catherine J 
Published: May 2022

BackgroundNeurology training in the UK is governed by a national curriculum defining the outcomes every trainee must achieve. However, the delivery of neurology training and trainee satisfaction differs significantly across the UK1.The Association of British Neurologists Trainees (ABNT) recently completed a qualitative study of the highest and lowest performing trusts for neurology training across the UK and identified key indicators associated with trainee satisfaction2.AimTo establish the variation in these indicators across the country.MethodsWe conducted a survey of UK neurology trainees to audit regional performance against the indicators identified in the previous qualitative study.ResultsWe had responses from 50 trainees, covering all deaneries.There was consultant supervision reported >98% of the time. 56% of supervising consultants were on-site during working hours, and 66% were present during clinics. In 74% of cases, the supervising consultant for inpatient referrals also had pre-booked clinics.Adaptation of daily roles according to trainee level was only reported by 26% of trainees, with <20% reponses reporting variation in clinic lists, or examples of ST3 shadowing.52% of trainees were required to relocate during training.There was significant variation within deaneries, suggesting these factors are often determined at a trust level.1. Shribman S, Alexander SK, Zarkali A, et al. doi:10.1136/practneurol-2018–002129 amyrossrussell@gmail.com
190  Placebo – to use or not to use? Survey on the use of placebo treatments
Authors: Huys Anne-Catherine ML , Franklin Hannah D , Bhatia Kailash P , Stone Jon , Edwards Mark J 
Published: May 2022

Patients´ and healthcare professionals´ attitudes to deceptive and open-label placebo treatments in clinical practice were evaluated by means of an anonymous survey.The overall attitude to deceptive placebo treatments was favourable amongst the 310 neurological patients and 100 medical patients/healthy participants taking part in the survey. The 90 healthcare pro- fessionals and 140 patients with a functional neurological disorder were more conservative, with equal numbers being in favour and against.An even more crucial factor is the considerable percentage being strongly opposed to deceptive placebo– 16% of neurological patients and 30% of patients with a functional neurological disorder.The majority of healthcare professionals had never used deceptive placebo, with an even smaller pro- portion ever having used open-label placebo. There was marked scepticism with regards to open-label placebo in all groups, with the general underlying belief that open-label placebo is fairly ineffectiveThe prohibition of deceptive placebo use in the UK seems to be in line with general concerns and oppo- sition to placebo. Future studies will show if the negative attitude to open-label placebo is justified or if this ethically viable option deserves more consideration.The survey is ongoing (to take part, visit https://is.gd/hcp_placebosurvey). The final numbers and conclu- sions may thus change.anne-catherine.huys.15@ucl.ac.uk
Quantitative volumetric analysis of piriform cortex on MRI and its clinical correla- tion in drug-refractory TLE
Authors: Iqbal Sabahat , Rojas-Leon Jose , Galovic Marian , Vos Sjoerd B , Hammers Alexander , Tisi Jane De , Koepp Mathias J , Duncan John S 
Published: May 2022

IntroductionIn animal studies, an area known as the piriform cortex (PC) has been implicated to be a critical area of epileptogenesis. However, this has seen limited translation to human studies.ObjectiveTo understand the degree of damage to PC in patients with temporal lobe epilepsy (TLE) as well as to correlate clinical characteristics of TLE with PC volumetry.MethodsManual segmentation of the PC on structural MR images of 60 consecutive adults with drug- refractory unilateral TLE and 20 age matched control subjects was performed. Univariate and multivari- ate regression models were employed to examine the relationship of PC and hippocampal volumes with clinical variables collected.ResultsIn controls, consistent asymmetry between the left and right PC was found. The right PC was consistently larger than the left across all study groups. Notably, the inter-rater and intra-rater variability were in good agreement. This study found that both the ipsilateral (r=-0.291, p=0.012) and contralateral (r=-0.338, p= 0.008) PC volumes have a negative correlation with the duration of epilepsy. Therefore, evidencing the damage of PC in mesial TLE. The temporal atrophy of the PC correlated with temporal atrophy of the hippocampus. This study could not strongly establish the correlation between any other clinical variable studied.ConclusionFurther longitudinal studies are required to confirm the findings of this study to enable the PC to be considered in treatment strategies for patients with drug-refractory TLE.siqbal2482@gmail.com
193  Factors that promote well-being in 5 long-term neurological conditions: a patient and carer perspective
Authors: Head Claudia , Fearn Sarah , Kipps Christopher 
Published: May 2022

BackgroundNeurological long-term conditions (LTCs) are associated with decreased psychological well-being. Identifying factors that promote well-being is crucial for improving quality of life. Existing research has identified common well-being factors, but investigating patient/carer perspectives allows for personalised insight into less-recognised factors.AimsTo identify and analyse well-being factors across 5 neurological LTCs - Parkinson’s disease (PD), multiple sclerosis, (MS) motor neuron disease (MND), Huntington’s disease (HD) and epilepsyMethodsQualititative data was analysed from the NeuroLTC study for 1,490 participants who were asked what factors helped maintain their well-being. A total of 2405 well-being factors, identified from 846 free-text responses were categorised using inductive thematic analysis, and then analysed by condition. PD responses (n=387) were further analysed to determine whether patient gender or disease progression affected well-being factors cited.ResultsSocial support, exercise, lifestyle and supportive equipment were the most common well-being factors across all conditions. Less-recognised factors (patient attitude, diet, alternative therapies) were also noted. Response frequencies in MND were the most dissimilar to other conditions. In PD, analysis showed the evolution of relevant well-being factors over time, whereas no notable difference was found between factors cited by each gender.ConclusionThis study of patient/carer perspectives on well-being factors, found variation across neuro- logical conditions and disease progression (for PD). This could inform advice given by healthcare profes- sionals to promote patient well-being.ckipps@nhs.net
196  Evidence and the assisted suicide debate
Authors: Nath Uma , Regnard Claud , Lee Mark , Wiblin Lou , Lloyd Kiran 
Published: May 2022

Assisted Suicide (AS) inspires strong opinions on all sides of the debate. There is no consensus around the terminology. When medical policy on PAS (physician assisted suicide) is being considered in several countries, as it is at present, there is a need for high quality evidenceA Medline search for Assisted Suicide brings up 5,550 results, but a large proportion of these are com- mentaries, opinions, case reports and discussion. There are relatively few objective studies on its practice that have been published in peer reviewed journals. For example, there are very few studies published on complication rates of the drugs used in AS. There is little comparative data on the quality of life in AS and non AS deaths. There are several official data sources in areas where AS is legal but the extent and quality of the data collected varies considerably with much missing data. In Oregon, data regarding complications in AS cases is missing in 63% of cases. All areas where AS is legal, use retrospective monitor- ing systems. It can be difficult to gather accurate information. The lack of well-conducted, high quality objective research is a challenge for all those involved in the AS debate.uma.nath@btinternet.com