Managing epilepsy is hard work. The detailed history of events, trying to work out if each seizure is the same type of event or if there are many different semiologies… not easy, not easy at all. Then there is the issue of anticonvulsants and monitoring not only their effectiveness, but also their potential adverse effects. […]
Category: Uncategorized
Single nerve conduction study in GBS: is it sufficient?
The diagnosis of GBS is a clinically based. Nerve conduction studies are utilized to confirm the type of GBS, i.e. demyelinating versus axonal. Serial nerve conduction studies have been proposed as a means of confirming whether an”apparently” axonal form of GBS represent distal demyelination. Such confirmation has prognostic implications for the patients. In addition, previous […]
Alcohol and seziures: A bad mix!!
Alcohol fulled violence and head trauma has potentially devastating medical & social impacts. The development of new-onset seizures post head trauma is well recognized, although it has been poorly researched. In the June issue of JNNP, a Finnish group tackle this vexing issue. In a large database study, the authors report on the risk factors […]
Intracerebral haemmorhage (ICH): Grave prognosis indeed
Strokes are invariably a clinical biomarker of “unwellness” of the central nervous system leading potentially life long disability and shorter survivial. While there is good prognostic data peratining to ischeamic strokes, that of ICH remains unknown. As a neurology trainee it was implied, largely from consensus, that ICH strokes exhibit a better prognosis. In this […]
Autologous haematopoietic stem cell transplantation in CIDP: Taking a hammer to the walnut?
Chronic inflammatory demyelinating neuropathy (CIDP) remains a difficult disorder to treat, particularly when patients fail to respond to one of the first line therapies. In addition, complications relating steroid and impressive treatments remain high and disability for this disorder is invariably a difficult management problem. In the June issue of JNNP, the utility of […]
Making a correct diagnosis in ALS matters!
The diagnosis of amyotrophic lateral sclerosis (ALS) is one of exclusion, relying on the identification of upper and lower motor neuron features. Far too often ALS patients are midiagnosed with radiculoapthy potenitally resulting in unncessary surgery. While this was seen as a inconvnience, in the June issue of JNNP Pinot and colleagues report on a […]
Natiluzimab therapy: Safe after all?
The efficacy of natiluzimab therapy was established in clinical trials. It soon, emerged, however that this “life changing” medication was potentially associated with a devastating infectious disorder of the brain, progressive multifocal leucoencephalopathy (PML). This side-effect resulted in withdrawal of the medication from clinical use for a period of time. Since re-introduction rigorous screening and […]
Perivascular hyperintensities and cognitive impairment: No link
The detection of T2 hyperintensities within the CNS, often termed small vessel disease, has been linked to development of cognitive impairment and is though to be driven by vascular risk factors such as hypertension. MRI-visible perivascular spaces (PVS), see fig below, appear to be reliable MRI bio-markers of small vessel disease and have been associated […]
Deep brain stimulation: an effective treatment for essential tremor.
An accurate diagnosis in Neurology, possibly more than any other specialty in Medicine, relies on astute observation. I tell students that a good many diagnoses are made before you even lay a hand on a patient. Neurologists are also an unusual group of people. Around 15 years ago when I was a wannabe neurologist, I […]
Neurofilament proteins: Biomakers for ALS!
Neurofilament proteins, involved in the axonal transport processes, are biomarkers of axonal loss and are elevated in biological tissues, such as plasma and CSF. In ALS, NF levels may be significantly elevated, especially in the CSF. In the March issue of JNNP, Puentes and colleagues report on the utility of NF as a biomarker of […]