Migraine and epilepsy account for more than 40% of neurology outpatients and are leading causes of disability. They often co-exist and can be confused, because of shared clinical features. The borderlands and links between migraine and epilepsy have fascinated neurologists for centuries, and unresolved questions remain. Greater understanding of the relationship between migraine and epilepsy may give insight into shared mechanisms. It is already clear that treating co-existing migraine is an important therapeutic opportunity and may improve epilepsy.
{"title":"Migraine in people with epilepsy: a treatable and neglected co-morbidity","authors":"H. Angus-Leppan","doi":"10.47795/ishy1373","DOIUrl":"https://doi.org/10.47795/ishy1373","url":null,"abstract":"Migraine and epilepsy account for more than 40% of neurology outpatients and are leading causes of disability. They often co-exist and can be confused, because of shared clinical features. The borderlands and links between migraine and epilepsy have fascinated neurologists for centuries, and unresolved questions remain. Greater understanding of the relationship between migraine and epilepsy may give insight into shared mechanisms. It is already clear that treating co-existing migraine is an important therapeutic opportunity and may improve epilepsy.","PeriodicalId":34274,"journal":{"name":"Advances in Clinical Neuroscience Rehabilitation","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75530950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Russell, L. Butler, C. Lovegrove, Colm Owens, Lisa Roberts, Phil Yates, Rachael Carrick, A. Amoako, Chris Price
Functional neurological disorders remain common presentations to both outpatient and inpatient NHS services, but little consensus exists with respect to how such services and clinical pathways for patients should be structured and should function. This article sets out a model for an integrated multidisciplinary approach that takes full account of the number of specialties involved, constraint on resources and time involved, and that has functioned well in the NHS despite a pandemic.
{"title":"Developing a multidisciplinary pathway for functional neurological disorders in a UK National Health Service: The Exeter model","authors":"L. Russell, L. Butler, C. Lovegrove, Colm Owens, Lisa Roberts, Phil Yates, Rachael Carrick, A. Amoako, Chris Price","doi":"10.47795/kazj3546","DOIUrl":"https://doi.org/10.47795/kazj3546","url":null,"abstract":"Functional neurological disorders remain common presentations to both outpatient and inpatient NHS services, but little consensus exists with respect to how such services and clinical pathways for patients should be structured and should function. This article sets out a model for an integrated multidisciplinary approach that takes full account of the number of specialties involved, constraint on resources and time involved, and that has functioned well in the NHS despite a pandemic.","PeriodicalId":34274,"journal":{"name":"Advances in Clinical Neuroscience Rehabilitation","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72702606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A growing body of evidence exists advocating the value of physical activity and exercise for people with Parkinson’s. Such is the importance of being active, participation in exercise is perceived to be of equal importance to medication in the long-term management of Parkinson’s. Despite a substantial body of evidence, the optimal prescription of exercise or mode of delivery remains underdetermined. This article aims to discuss the current evidence and provide guidance of prescription of exercise during each of three commonly-referred to stages of Parkinson’s: newly diagnosed, maintenance and complex.
{"title":"Physical activity and exercise for people with Parkinson’s","authors":"Julie Jones, K. Baker, B. Ramaswamy","doi":"10.47795/fenh4822","DOIUrl":"https://doi.org/10.47795/fenh4822","url":null,"abstract":"A growing body of evidence exists advocating the value of physical activity and exercise for people with Parkinson’s. Such is the importance of being active, participation in exercise is perceived to be of equal importance to medication in the long-term management of Parkinson’s. Despite a substantial body of evidence, the optimal prescription of exercise or mode of delivery remains underdetermined. This article aims to discuss the current evidence and provide guidance of prescription of exercise during each of three commonly-referred to stages of Parkinson’s: newly diagnosed, maintenance and complex.","PeriodicalId":34274,"journal":{"name":"Advances in Clinical Neuroscience Rehabilitation","volume":"71 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83955290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
While modafinil is licensed to treat narcolepsy as a psychostimulant, there is widespread use as a “smart drug” in the young to help study and interest in older populations as a cognitive enhancer. This review considers both the evidence for benefit and potential for harm. If it is as effective as it seems, should we all be using it? Should Neurologists recommend it, and should we worry if our patients are taking it? In this review the evidence base behind psychostimulants, in particular modafinil as a cognitive enhancer, is discussed.
{"title":"Psychostimulants as cognitive enhancers – the evidence for the use and abuse of smart drugs","authors":"Poppy Goldsmith, K. Anderson","doi":"10.47795/cuun2886","DOIUrl":"https://doi.org/10.47795/cuun2886","url":null,"abstract":"While modafinil is licensed to treat narcolepsy as a psychostimulant, there is widespread use as a “smart drug” in the young to help study and interest in older populations as a cognitive enhancer. This review considers both the evidence for benefit and potential for harm. If it is as effective as it seems, should we all be using it? Should Neurologists recommend it, and should we worry if our patients are taking it? In this review the evidence base behind psychostimulants, in particular modafinil as a cognitive enhancer, is discussed.","PeriodicalId":34274,"journal":{"name":"Advances in Clinical Neuroscience Rehabilitation","volume":"71 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79996384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
It has long been recognised that sleep and deprivation of it have important consequences for cortical excitability, the electroencephalogram and seizure control. However, in the management of people with epilepsy, it is also important to recognise that epilepsy and its treatment may also have significant implications for sleep. Lack of consideration for this bidirectional relationship between sleep and epilepsy may have negative consequences on individuals’ seizure control, quality of life, and other aspects of their health.
{"title":"Seizures and Sleep: Not such strange bedfellows","authors":"G. Leschziner","doi":"10.47795/qtgn2231","DOIUrl":"https://doi.org/10.47795/qtgn2231","url":null,"abstract":"It has long been recognised that sleep and deprivation of it have important consequences for cortical excitability, the electroencephalogram and seizure control. However, in the management of people with epilepsy, it is also important to recognise that epilepsy and its treatment may also have significant implications for sleep. Lack of consideration for this bidirectional relationship between sleep and epilepsy may have negative consequences on individuals’ seizure control, quality of life, and other aspects of their health.","PeriodicalId":34274,"journal":{"name":"Advances in Clinical Neuroscience Rehabilitation","volume":"67 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74115318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vestibular migraine is an under-diagnosed but increasingly recognised neurological condition that causes episodic vertigo, associated with migrainous features. Making a diagnosis of VM relies on a clinical history, including the presence of recurrent episodes of vertigo or dizziness, on a background of migraine headaches, and associated migraine features that accompany the vestibular symptoms. It is the most common cause of spontaneous (non-positional) episodic vertigo, affecting up to 1% of the population, but remains under-diagnosed outside specialist centres, partly due to an absence of diagnostic biomarkers. Its pathophysiology remains poorly understood, and there is a paucity of high-quality treatment trials. Here we review the clinical features of vestibular migraine, highlight current theories that account for vestibular symptoms, and outline treatment guidelines.
{"title":"Vestibular migraine","authors":"N. Patel, Kulvinder Talewar, A. Bahra, D. Kaski","doi":"10.47795/litm2615","DOIUrl":"https://doi.org/10.47795/litm2615","url":null,"abstract":"Vestibular migraine is an under-diagnosed but increasingly recognised neurological condition that causes episodic vertigo, associated with migrainous features. Making a diagnosis of VM relies on a clinical history, including the presence of recurrent episodes of vertigo or dizziness, on a background of migraine headaches, and associated migraine features that accompany the vestibular symptoms. It is the most common cause of spontaneous (non-positional) episodic vertigo, affecting up to 1% of the population, but remains under-diagnosed outside specialist centres, partly due to an absence of diagnostic biomarkers. Its pathophysiology remains poorly understood, and there is a paucity of high-quality treatment trials. Here we review the clinical features of vestibular migraine, highlight current theories that account for vestibular symptoms, and outline treatment guidelines.","PeriodicalId":34274,"journal":{"name":"Advances in Clinical Neuroscience Rehabilitation","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78266150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Few Neurologists will be unfamiliar with referral letters stating that the patient has “Rhomberg’s sign” or some “mild rhombergism” (capitalisation variable), a particularly irritating misnomer for the pedants among us. As Henry Higgins the fictional Professor of Phonetics [1] observed: ‘Does the same thing hold true in India, Pickering? Is there the peculiar habit of not only dropping a letter like the letter “h”, but using it where it doesn’t belong, like “hever” instead of “ever”?’ My Fair Lady – Act 1, Scene 5, p58 [1]. Or Rhomberg instead of Romberg! So, who was “Rhomberg,” and what did he describe?
{"title":"Rehabilitating Romberg","authors":"M. Baker, T. Williams, A. Larner","doi":"10.47795/eonw6640","DOIUrl":"https://doi.org/10.47795/eonw6640","url":null,"abstract":"Few Neurologists will be unfamiliar with referral letters stating that the patient has “Rhomberg’s sign” or some “mild rhombergism” (capitalisation variable), a particularly irritating misnomer for the pedants among us. As Henry Higgins the fictional Professor of Phonetics [1] observed: ‘Does the same thing hold true in India, Pickering? Is there the peculiar habit of not only dropping a letter like the letter “h”, but using it where it doesn’t belong, like “hever” instead of “ever”?’ My Fair Lady – Act 1, Scene 5, p58 [1]. Or Rhomberg instead of Romberg! So, who was “Rhomberg,” and what did he describe?","PeriodicalId":34274,"journal":{"name":"Advances in Clinical Neuroscience Rehabilitation","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74691673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Angus-Leppan, Alice Caulfield, Melika M Moghim, J. Nightingale, Robert F. Sloan, Tom Stables, Michael Oates, B. Porter, A. Schrag
COVID-19 and its aftermath highlight the importance of patient self-care and involvement in monitoring and improving their health. Resources to guide this are essential. Our objective was to create a web-based patient education tool, to facilitate patient education and empowerment for people with epilepsy, multiple sclerosis and Parkinson’s disease, available without cost to patients, carers and clinicians. This project was conducted within community and secondary neurology services. Patients and their carers were involved in designing, reviewing and revising the tool, as equal partners with clinicians and digital engineers. A web-based design template was developed with graphics and links to enable patients to create personalised plans. Participants are patients, carers, clinicians (neurology consultants and specialist nurses), neurological charities, the London Neuroscience Clinical Network, NHS England and Shift.ms (a service design team with experience in creating digital services for individuals living with neurological conditions). Shift.ms conducted in-depth interviews. Clinicians used evidence from personal and PubMed databases. Shift.ms analysed and co-ordinated the responses, and designed the pilot tool. Confidence College provides a delivery model for patient education relating to multiple sclerosis, epilepsy and Parkinson’s disease. It requires follow-up evaluation regarding uptake. This web-based accessible patient empowerment tool has no limit on recurrent use, low maintenance costs and no additional costs in up-scaling the number of users. It is ideally suited for use during and after the COVID-19 pandemic.
{"title":"Confidence College – an online education tool for neurology patients","authors":"H. Angus-Leppan, Alice Caulfield, Melika M Moghim, J. Nightingale, Robert F. Sloan, Tom Stables, Michael Oates, B. Porter, A. Schrag","doi":"10.47795/irgc6828","DOIUrl":"https://doi.org/10.47795/irgc6828","url":null,"abstract":"COVID-19 and its aftermath highlight the importance of patient self-care and involvement in monitoring and improving their health. Resources to guide this are essential. Our objective was to create a web-based patient education tool, to facilitate patient education and empowerment for people with epilepsy, multiple sclerosis and Parkinson’s disease, available without cost to patients, carers and clinicians. This project was conducted within community and secondary neurology services. Patients and their carers were involved in designing, reviewing and revising the tool, as equal partners with clinicians and digital engineers. A web-based design template was developed with graphics and links to enable patients to create personalised plans. Participants are patients, carers, clinicians (neurology consultants and specialist nurses), neurological charities, the London Neuroscience Clinical Network, NHS England and Shift.ms (a service design team with experience in creating digital services for individuals living with neurological conditions). Shift.ms conducted in-depth interviews. Clinicians used evidence from personal and PubMed databases. Shift.ms analysed and co-ordinated the responses, and designed the pilot tool. Confidence College provides a delivery model for patient education relating to multiple sclerosis, epilepsy and Parkinson’s disease. It requires follow-up evaluation regarding uptake. This web-based accessible patient empowerment tool has no limit on recurrent use, low maintenance costs and no additional costs in up-scaling the number of users. It is ideally suited for use during and after the COVID-19 pandemic.","PeriodicalId":34274,"journal":{"name":"Advances in Clinical Neuroscience Rehabilitation","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85548523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The novel coronavirus severe acute respiratory syndrome coronavirus 2, SARS-CoV-2, responsible for the ongoing COVID-19 pandemic, is associated with a broad manifestation of neurological disease, including Acute Disseminated Encephalomyelitis (ADEM) and Guillain-Barré Syndrome (GBS), amongst other forms of autoimmune encephalitis, stroke, encephalopathy, delirium, and cranial neuropathies. These phenomena are not limited to human coronaviruses but are also seen in a minority of patients in response to other viral infection. There is good evidence that an autoimmune mechanism hypothesis is likely. The final pathology is probably the culmination of mixed mechanisms such as vascular and immune dysregulation as well as direct viral invasion of neurons – though there is little if any evidence of viral invasion in the literature to date. The aim of this review is to elucidate the emerging evidence about this subset of COVID-19-associated neurological disease. This unique opportunity to study the interactions between virus and host immune and central nervous system (CNS) to gain novel insights applicable to other probable autoimmune neurological disease. I have conducted a literature search as well as drawn on my own observations from the COVID-19 and encephalitis multidisciplinary meetings at Queen Square National Hospital for Neurology and Neurosurgery, London, UK.
{"title":"Putative autoimmune mechanisms for Acute Disseminated Encephalomyelitis (ADEM) and Guillain-Barré Syndrome (GBS) associated with SARS-CoV-2 infection","authors":"F.V. Massey","doi":"10.47795/vjfz4701","DOIUrl":"https://doi.org/10.47795/vjfz4701","url":null,"abstract":"The novel coronavirus severe acute respiratory syndrome coronavirus 2, SARS-CoV-2, responsible for the ongoing COVID-19 pandemic, is associated with a broad manifestation of neurological disease, including Acute Disseminated Encephalomyelitis (ADEM) and Guillain-Barré Syndrome (GBS), amongst other forms of autoimmune encephalitis, stroke, encephalopathy, delirium, and cranial neuropathies. These phenomena are not limited to human coronaviruses but are also seen in a minority of patients in response to other viral infection. There is good evidence that an autoimmune mechanism hypothesis is likely. The final pathology is probably the culmination of mixed mechanisms such as vascular and immune dysregulation as well as direct viral invasion of neurons – though there is little if any evidence of viral invasion in the literature to date. The aim of this review is to elucidate the emerging evidence about this subset of COVID-19-associated neurological disease. This unique opportunity to study the interactions between virus and host immune and central nervous system (CNS) to gain novel insights applicable to other probable autoimmune neurological disease. I have conducted a literature search as well as drawn on my own observations from the COVID-19 and encephalitis multidisciplinary meetings at Queen Square National Hospital for Neurology and Neurosurgery, London, UK.","PeriodicalId":34274,"journal":{"name":"Advances in Clinical Neuroscience Rehabilitation","volume":"33 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72409800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
People with aphasia are often unable to access healthcare due to difficulties understanding and using spoken and written language, which impacts every step of their healthcare journey and outcomes. This article argues that it is important to apply the principles of the NHS England Accessible Information Standards (2017) to people with aphasia so they can meet their health information needs and rights. The processes to enable people with aphasia to access and participate in spoken and written communication in healthcare and the methods for training and supporting healthcare staff need to be considered at an individual, service, and organisational level.
{"title":"Making information accessible for people with aphasia in healthcare","authors":"Simon Grobler, Sarah Casey, E. Farrell","doi":"10.47795/wkdo3084","DOIUrl":"https://doi.org/10.47795/wkdo3084","url":null,"abstract":"People with aphasia are often unable to access healthcare due to difficulties understanding and using spoken and written language, which impacts every step of their healthcare journey and outcomes. This article argues that it is important to apply the principles of the NHS England Accessible Information Standards (2017) to people with aphasia so they can meet their health information needs and rights. The processes to enable people with aphasia to access and participate in spoken and written communication in healthcare and the methods for training and supporting healthcare staff need to be considered at an individual, service, and organisational level.","PeriodicalId":34274,"journal":{"name":"Advances in Clinical Neuroscience Rehabilitation","volume":"92 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76186266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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