Pub Date : 2019-05-01DOI: 10.1136/JNNP-2019-BNPA.32
Georgios P. D. Argyropoulos, L. Moore, C. Loane, A. Roca-Fernández, C. Lage-Martinez, C. Butler
Objective/Aims Autoimmune limbic encephalitis (LE) is commonly associated with cognitive and psychiatric disturbances at the acute stage of the disease, and with residual episodic memory impairment. While behavioural and psychiatric symptoms generally dissipate post-acutely, very little is known about the profile of persistent neuropsychiatric symptoms. In particular, emotional lability represents an elusive entity that may be misdiagnosed as a manifestation of comorbid mood or personality change and can have disabling consequences, due to the stigma attached to the loss of emotional control. We aimed to assess the post-acute profile of emotional lability and its neuroanatomical correlates in LE. Methods We analysed acute neuroradiological reports, clinical notes, scores on post-acute neuropsychological tests and self-administered questionnaires on mood, emotion, and affect (including the Centre for Neurologic Study-Lability Scale; CNS-LS), along with structural MRI and resting-state fMRI datasets in relation to emotional lability in a large cohort of patients (n=36) that had received a neurological diagnosis of LE, presented with focal hippocampal structural abnormalities in the acute phase, and post-acute hippocampal atrophy and thalamic volume reduction. Results Emotional lability was present in 50% of the patients. It was associated with increased tearfulness compared with non-labile patients and healthy controls, whereas no patient presented with labile laughter (CNS-LS). Patients with emotional lability (n=18) did not differ from those without (n=18) in any demographic or clinical details in their acute or post-acute presentation (autoantibodies, immunosuppressive therapy, seizures, antidepressant medication, age at or delay from symptom onset), or in residual depression, anxiety, impulsiveness, memory impairment, or executive dysfunction, or in hippocampal and thalamic volumes. Instead, the presence and extent of emotional lability across patients was associated with reduced resting-state hemodynamic activity in and hippocampal functional connectivity with regions in the inferior and superior parietal lobules. Conclusions We present the first investigation of persistent affective dysregulation in LE. Emotional lability is common following LE, but is not a manifestation of depression, anxiety, impulsiveness, or executive dysfunction. The type of emotional lability seen in LE is semiologically distinct from pseudobulbar affect observed in other neurological diseases. While LE is characterised by focal hippocampal atrophy, functional abnormalities in regions interacting with the hippocampus may provide a more parsimonious explanation of emotional lability than the volume of medial temporal lobe structures. Functional abnormalities in parietal regions supporting perspective taking and social-affective processing may compromise patients’ emotion regulation.
{"title":"32 Emotional lability in hippocampal atrophy due to autoimmune limbic encephalitis","authors":"Georgios P. D. Argyropoulos, L. Moore, C. Loane, A. Roca-Fernández, C. Lage-Martinez, C. Butler","doi":"10.1136/JNNP-2019-BNPA.32","DOIUrl":"https://doi.org/10.1136/JNNP-2019-BNPA.32","url":null,"abstract":"Objective/Aims Autoimmune limbic encephalitis (LE) is commonly associated with cognitive and psychiatric disturbances at the acute stage of the disease, and with residual episodic memory impairment. While behavioural and psychiatric symptoms generally dissipate post-acutely, very little is known about the profile of persistent neuropsychiatric symptoms. In particular, emotional lability represents an elusive entity that may be misdiagnosed as a manifestation of comorbid mood or personality change and can have disabling consequences, due to the stigma attached to the loss of emotional control. We aimed to assess the post-acute profile of emotional lability and its neuroanatomical correlates in LE. Methods We analysed acute neuroradiological reports, clinical notes, scores on post-acute neuropsychological tests and self-administered questionnaires on mood, emotion, and affect (including the Centre for Neurologic Study-Lability Scale; CNS-LS), along with structural MRI and resting-state fMRI datasets in relation to emotional lability in a large cohort of patients (n=36) that had received a neurological diagnosis of LE, presented with focal hippocampal structural abnormalities in the acute phase, and post-acute hippocampal atrophy and thalamic volume reduction. Results Emotional lability was present in 50% of the patients. It was associated with increased tearfulness compared with non-labile patients and healthy controls, whereas no patient presented with labile laughter (CNS-LS). Patients with emotional lability (n=18) did not differ from those without (n=18) in any demographic or clinical details in their acute or post-acute presentation (autoantibodies, immunosuppressive therapy, seizures, antidepressant medication, age at or delay from symptom onset), or in residual depression, anxiety, impulsiveness, memory impairment, or executive dysfunction, or in hippocampal and thalamic volumes. Instead, the presence and extent of emotional lability across patients was associated with reduced resting-state hemodynamic activity in and hippocampal functional connectivity with regions in the inferior and superior parietal lobules. Conclusions We present the first investigation of persistent affective dysregulation in LE. Emotional lability is common following LE, but is not a manifestation of depression, anxiety, impulsiveness, or executive dysfunction. The type of emotional lability seen in LE is semiologically distinct from pseudobulbar affect observed in other neurological diseases. While LE is characterised by focal hippocampal atrophy, functional abnormalities in regions interacting with the hippocampus may provide a more parsimonious explanation of emotional lability than the volume of medial temporal lobe structures. Functional abnormalities in parietal regions supporting perspective taking and social-affective processing may compromise patients’ emotion regulation.","PeriodicalId":438758,"journal":{"name":"Members’ POSTER Abstracts","volume":"73 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126709235","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}
Pub Date : 2019-05-01DOI: 10.1136/JNNP-2019-BNPA.25
A. Al-Diwani, R. Linighan, C. Perkins, G. Critchlow, B. Lennox, M. Leite, S. Manohar, D. Okai, S. Irani
Objectives/Aims NMDAR-antibody encephalitis frequently presents with psychiatric symptoms. However, new-onset mental illness does not usually receive detailed biomedical investigations. Yet, early diagnosis and treatment correlates with improved outcomes. Here we used detailed psychiatric phenotyping to explore the nature of mental state abnormalities in this immunologically-defined illness. Methods Prospective and retrospective semi-structured interviews with patients, carers, and clinicians in five consecutive cases of definite NMDAR-antibody encephalitis (all female, median age=20 years, range=16–30, ovarian teratoma in 4). Weekly multi-disciplinary assessment using the Neuropsychiatric Inventory Nursing Home version (NPI-NH) in 2/5. Network analysis was used to evaluate connectedness of psychopathologic features and a qualitative synthesis distilled recurrent psychopathologic features. Finally, each time point was compared with operationalised diagnoses using an automated classifier and plotted with corresponding symptom complexes over time. Results All had psychiatric features at onset and were seen first by general practitioners or emergency departments. All received an incorrect initial diagnosis (1 neurological, 4 primary psychiatric). Two patients were referred to mental health services and detained while three were admitted to a general hospital. Psychiatric diagnoses spanned psychotic, mood, and stress categories. None had a personal or family history of serious mental illness or substance misuse. Despite the atypicality all were ascribed to non-specific psycho-social aetiologies. Autoimmune encephalitis was then first suspected between 4–28 days from onset (median=21 days) because of the psychopathology (n=2) or development of clear-cut seizures or movement disorder (n=3). 10 consistently reported features were identified: sleep disturbance, nightmares, mixed unstable mood, perplexity, incoherent repetitive speech, musical ±visual hallucinosis, catatonic facies, possession-like/drugged, dissociative-disorganised, and regressed behaviour. The symptom complex peaked rapidly (within 3 weeks). The peak burden was large and crossed multiple psychopathologic domains. Overall the syndrome is poorly-described by any single primary disorder; mixtures of mixed mood-psychotic-catatonic disorders performed best. Furthermore, it showed clear qualitative and hence diagnostic shifts between onset, peak, and resolution. Conclusions The psychopathology of NMDAR-antibody encephalitis is complex and dynamic, likely contributing to diagnostic difficulties. However, it appears stereotyped between individuals, hence sensitive features can be derived. Inconsistency with psychosis and/or mood disorder constructs and better approximation with ‘mixtures of mixtures’ suggests specificity is possible but similar studies with primary disorder comparators are needed. As the disease can only be ruled out with cerebrospinal fluid antibody testing the practical impli
{"title":"25 On being autoimmune in psychiatric places: 10 characteristic mental state features in patients with definite NMDAR-antibody encephalitis","authors":"A. Al-Diwani, R. Linighan, C. Perkins, G. Critchlow, B. Lennox, M. Leite, S. Manohar, D. Okai, S. Irani","doi":"10.1136/JNNP-2019-BNPA.25","DOIUrl":"https://doi.org/10.1136/JNNP-2019-BNPA.25","url":null,"abstract":"Objectives/Aims NMDAR-antibody encephalitis frequently presents with psychiatric symptoms. However, new-onset mental illness does not usually receive detailed biomedical investigations. Yet, early diagnosis and treatment correlates with improved outcomes. Here we used detailed psychiatric phenotyping to explore the nature of mental state abnormalities in this immunologically-defined illness. Methods Prospective and retrospective semi-structured interviews with patients, carers, and clinicians in five consecutive cases of definite NMDAR-antibody encephalitis (all female, median age=20 years, range=16–30, ovarian teratoma in 4). Weekly multi-disciplinary assessment using the Neuropsychiatric Inventory Nursing Home version (NPI-NH) in 2/5. Network analysis was used to evaluate connectedness of psychopathologic features and a qualitative synthesis distilled recurrent psychopathologic features. Finally, each time point was compared with operationalised diagnoses using an automated classifier and plotted with corresponding symptom complexes over time. Results All had psychiatric features at onset and were seen first by general practitioners or emergency departments. All received an incorrect initial diagnosis (1 neurological, 4 primary psychiatric). Two patients were referred to mental health services and detained while three were admitted to a general hospital. Psychiatric diagnoses spanned psychotic, mood, and stress categories. None had a personal or family history of serious mental illness or substance misuse. Despite the atypicality all were ascribed to non-specific psycho-social aetiologies. Autoimmune encephalitis was then first suspected between 4–28 days from onset (median=21 days) because of the psychopathology (n=2) or development of clear-cut seizures or movement disorder (n=3). 10 consistently reported features were identified: sleep disturbance, nightmares, mixed unstable mood, perplexity, incoherent repetitive speech, musical ±visual hallucinosis, catatonic facies, possession-like/drugged, dissociative-disorganised, and regressed behaviour. The symptom complex peaked rapidly (within 3 weeks). The peak burden was large and crossed multiple psychopathologic domains. Overall the syndrome is poorly-described by any single primary disorder; mixtures of mixed mood-psychotic-catatonic disorders performed best. Furthermore, it showed clear qualitative and hence diagnostic shifts between onset, peak, and resolution. Conclusions The psychopathology of NMDAR-antibody encephalitis is complex and dynamic, likely contributing to diagnostic difficulties. However, it appears stereotyped between individuals, hence sensitive features can be derived. Inconsistency with psychosis and/or mood disorder constructs and better approximation with ‘mixtures of mixtures’ suggests specificity is possible but similar studies with primary disorder comparators are needed. As the disease can only be ruled out with cerebrospinal fluid antibody testing the practical impli","PeriodicalId":438758,"journal":{"name":"Members’ POSTER Abstracts","volume":"259 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115010601","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}
Pub Date : 2019-05-01DOI: 10.1136/jnnp-2019-bnpa.52
Max Fend, L. Williams, A. Carson, J. Stone
Objectives Hysteria was once a topic of research for leading neurologists; however this interest faded over the course of the twentieth century. Little has been written about the presentation and management of functional disorders in the post Charcot period, and some have gone so far as to suggest that the patients ‘disappeared’. This project aims to shed light on how Edinburgh neurologists interacted with and managed this cohort during the period from 1930–1970. Methods The Lothian Health Services Archive holds 28 000 case files written by Norman Dott CBE, the first chair of Neurosurgery in Scotland, and the department he built around him, with cases spanning the years between 1930–1970. Cases pertaining to hysteria or hypochondriasis were analysed, recording demographics, symptoms, diagnostic and management processes, and evidence for any attitude or opinion exhibited by the physicians. Retired neurologists from Edinburgh and elsewhere also provided oral histories on how they interacted with this group. Results 209 cases were analysed, of which 178 were relevant, and 100 of which included a diagnosis of hysteria. Of these 100, it is of note that 42 were referred to psychiatry. The majority of the remaining patients were given advice or reassurance (48). Conclusions Hysteria in Dott’s department was both a diagnosis based on positive findings of inconsistency, and a personality trait. Although there is evidence of a negative sentiment towards functional patients, there is equal evidence of sympathetic responses, and it is likely that neurologists of the mid twentieth century were often less cautious and more candid in their remarks. Whilst the management of hysteria was not seen as a neurologist’s job, patients were regularly referred to psychiatry, signifying an acceptance of the legitimacy of the condition. Abstract 51 Table 1
{"title":"52 The arc de siècle- an examination of attitudes to hysteria in twentieth-century medicine, through the eyes of norman dott and his pupils","authors":"Max Fend, L. Williams, A. Carson, J. Stone","doi":"10.1136/jnnp-2019-bnpa.52","DOIUrl":"https://doi.org/10.1136/jnnp-2019-bnpa.52","url":null,"abstract":"Objectives Hysteria was once a topic of research for leading neurologists; however this interest faded over the course of the twentieth century. Little has been written about the presentation and management of functional disorders in the post Charcot period, and some have gone so far as to suggest that the patients ‘disappeared’. This project aims to shed light on how Edinburgh neurologists interacted with and managed this cohort during the period from 1930–1970. Methods The Lothian Health Services Archive holds 28 000 case files written by Norman Dott CBE, the first chair of Neurosurgery in Scotland, and the department he built around him, with cases spanning the years between 1930–1970. Cases pertaining to hysteria or hypochondriasis were analysed, recording demographics, symptoms, diagnostic and management processes, and evidence for any attitude or opinion exhibited by the physicians. Retired neurologists from Edinburgh and elsewhere also provided oral histories on how they interacted with this group. Results 209 cases were analysed, of which 178 were relevant, and 100 of which included a diagnosis of hysteria. Of these 100, it is of note that 42 were referred to psychiatry. The majority of the remaining patients were given advice or reassurance (48). Conclusions Hysteria in Dott’s department was both a diagnosis based on positive findings of inconsistency, and a personality trait. Although there is evidence of a negative sentiment towards functional patients, there is equal evidence of sympathetic responses, and it is likely that neurologists of the mid twentieth century were often less cautious and more candid in their remarks. Whilst the management of hysteria was not seen as a neurologist’s job, patients were regularly referred to psychiatry, signifying an acceptance of the legitimacy of the condition. Abstract 51 Table 1","PeriodicalId":438758,"journal":{"name":"Members’ POSTER Abstracts","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121384837","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}
Pub Date : 2019-05-01DOI: 10.1136/JNNP-2019-BNPA.18
T. Cronin, R. Pearce
Objective The published literature on headache epidemiology comes from specialist headache clinics, compared to the general neurology clinic. This study set out to investigate the characteristics and diagnoses of patients with headaches attending a general neurology clinic in the UK. Methods Data were collected retrospectively from a two-year period on 217 patients with headaches referred to a general neurology clinic at a UK district-general hospital seen by a single consultant. Clinic letters were reviewed, and information was inputted using a pre-formed Microsoft Excel spreadsheet. All data were anonymised, with no identifiable patient characteristics being recorded. Results A total of 217 were seen in this period. The mean age was 42% and 72% were female. In 56% of cases, more than one diagnosis was made. The most frequent diagnosis was migraine (72%), followed by tension-type headache (56%). Dizziness and/or vertigo was a commonly reported co-existing symptom, with 24% reporting this. For 13% (n=29) of cases, it was documented that time was taken out of work or studies due to headache symptoms. In 205 patients it was reported whether sleep was affected, with 70% (n=144) of cases indicating it was. For 195 cases, 80% (n=155) reported a normal appetite, 16% (n=32) a decrease, and 4% (n=8) an increase in appetite. In 195 patients, 65% (n=126) reported reduced energy levels. For 21% (n=46) there was documentation of anxiety. Regarding mood, in 176 cases where this was recorded, 33% gave a negative mood description. Conclusion To the authors’ knowledge, this study is the first to report on headache characteristics in patients presenting to a UK general neurology clinic. The diagnostic frequency of different headaches presented in this study are comparable to those described in specialist headache clinics. Our population demonstrate significant psychiatric morbidity associated with headaches, with 33% reporting negative mood value and in addition higher proportions reporting energy and sleep disturbance. To conclude, this study has shown the common headache diagnoses encountered in a general neurology clinic, and indeed is comparable to headaches managed in primary care. Improved integration between these services is key to ensuring effective care for such patients.
{"title":"18 High levels of anxiety and depression in patients attending with headaches to a UK general neurology clinic","authors":"T. Cronin, R. Pearce","doi":"10.1136/JNNP-2019-BNPA.18","DOIUrl":"https://doi.org/10.1136/JNNP-2019-BNPA.18","url":null,"abstract":"Objective The published literature on headache epidemiology comes from specialist headache clinics, compared to the general neurology clinic. This study set out to investigate the characteristics and diagnoses of patients with headaches attending a general neurology clinic in the UK. Methods Data were collected retrospectively from a two-year period on 217 patients with headaches referred to a general neurology clinic at a UK district-general hospital seen by a single consultant. Clinic letters were reviewed, and information was inputted using a pre-formed Microsoft Excel spreadsheet. All data were anonymised, with no identifiable patient characteristics being recorded. Results A total of 217 were seen in this period. The mean age was 42% and 72% were female. In 56% of cases, more than one diagnosis was made. The most frequent diagnosis was migraine (72%), followed by tension-type headache (56%). Dizziness and/or vertigo was a commonly reported co-existing symptom, with 24% reporting this. For 13% (n=29) of cases, it was documented that time was taken out of work or studies due to headache symptoms. In 205 patients it was reported whether sleep was affected, with 70% (n=144) of cases indicating it was. For 195 cases, 80% (n=155) reported a normal appetite, 16% (n=32) a decrease, and 4% (n=8) an increase in appetite. In 195 patients, 65% (n=126) reported reduced energy levels. For 21% (n=46) there was documentation of anxiety. Regarding mood, in 176 cases where this was recorded, 33% gave a negative mood description. Conclusion To the authors’ knowledge, this study is the first to report on headache characteristics in patients presenting to a UK general neurology clinic. The diagnostic frequency of different headaches presented in this study are comparable to those described in specialist headache clinics. Our population demonstrate significant psychiatric morbidity associated with headaches, with 33% reporting negative mood value and in addition higher proportions reporting energy and sleep disturbance. To conclude, this study has shown the common headache diagnoses encountered in a general neurology clinic, and indeed is comparable to headaches managed in primary care. Improved integration between these services is key to ensuring effective care for such patients.","PeriodicalId":438758,"journal":{"name":"Members’ POSTER Abstracts","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129612893","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}
Pub Date : 2019-05-01DOI: 10.1136/JNNP-2019-BNPA.33
R. Charles, B. Sridharan
Objectives/Aims This aim of case report is to discuss the clinical conundrum and diagnostic challenges in a young patient presenting with First Episode Psychosis. Investigations revealed Extensive Leukoencephalopathy due to a rare metabolic disorder- 3-methyloglutaconic aciduria (3-MGA) type IV. Several studies have shown that 3-MGA type IV can present with psychosis, epilepsy or depression as part of the spectrum of symptoms. The role of Organic Brain condition in the onset of first episode psychosis in this patient is discussed in this report. Methods A 23-year-old female presented with insidious onset of paranoid delusions and auditory hallucinations over an 18 month period on a background of a diagnosis of 3-methylgutaconic aciduria type IV confirmed on urine testing. On admission under Section 2 of the Mental Health Act, she expressed little spontaneous speech and echolalia. She was flat in affect. She appeared vacant in expression, stared inappropriately and was very self-isolating. She was responding to external stimuli. She lacked insight into her condition. Physical examination was unremarkable. An MRI brain scan was performed, and comparison made to scan done previously to demonstrate any interval change and to correlate changes if present to deterioration of clinical symptoms. Results MRI scan showed extensive diffuse leukoencephalopathy. Comparison to MRI scan done 6 years previously did not show any change or progression to the white matter lesions. An EEG showed a mild degree of general cerebral dysfunction with no interictal epileptiform activity. There was no correlation found between her clinical symptoms of acute onset psychosis and her diagnosis of 3-MGA Type IV. She was commenced on Aripiprazole and her presentation improved significantly. Both Auditory hallucinations and Paranoid delusions improved considerably, with moderate improvement in mood, affect and apathy. Some Catatonic symptoms persisted but were less intense. She was given a diagnosis of Undifferentiated Schizophrenia under ICD 10, as she displayed features of Paranoid, Hebephrenic and Catatonic without clear predominance of particular subtype of Schizophrenia. She was discharged home with follow-up from Neuropsychiatry and community Mental health teams. She continues to be investigated for the genetic cause of 3-methylglucatonic aciduria Type 4. Conclusions To conclude, although often metabolic disorders, including 3-methylglucaconic aciduria, can present with psychosis, it is prudent to establish a causative link in order to manage appropriately and effectively.
{"title":"33 First episode psychosis in a patient with extensive leukoencephalopathy due to 3-methylglutaconic aciduria type 4","authors":"R. Charles, B. Sridharan","doi":"10.1136/JNNP-2019-BNPA.33","DOIUrl":"https://doi.org/10.1136/JNNP-2019-BNPA.33","url":null,"abstract":"Objectives/Aims This aim of case report is to discuss the clinical conundrum and diagnostic challenges in a young patient presenting with First Episode Psychosis. Investigations revealed Extensive Leukoencephalopathy due to a rare metabolic disorder- 3-methyloglutaconic aciduria (3-MGA) type IV. Several studies have shown that 3-MGA type IV can present with psychosis, epilepsy or depression as part of the spectrum of symptoms. The role of Organic Brain condition in the onset of first episode psychosis in this patient is discussed in this report. Methods A 23-year-old female presented with insidious onset of paranoid delusions and auditory hallucinations over an 18 month period on a background of a diagnosis of 3-methylgutaconic aciduria type IV confirmed on urine testing. On admission under Section 2 of the Mental Health Act, she expressed little spontaneous speech and echolalia. She was flat in affect. She appeared vacant in expression, stared inappropriately and was very self-isolating. She was responding to external stimuli. She lacked insight into her condition. Physical examination was unremarkable. An MRI brain scan was performed, and comparison made to scan done previously to demonstrate any interval change and to correlate changes if present to deterioration of clinical symptoms. Results MRI scan showed extensive diffuse leukoencephalopathy. Comparison to MRI scan done 6 years previously did not show any change or progression to the white matter lesions. An EEG showed a mild degree of general cerebral dysfunction with no interictal epileptiform activity. There was no correlation found between her clinical symptoms of acute onset psychosis and her diagnosis of 3-MGA Type IV. She was commenced on Aripiprazole and her presentation improved significantly. Both Auditory hallucinations and Paranoid delusions improved considerably, with moderate improvement in mood, affect and apathy. Some Catatonic symptoms persisted but were less intense. She was given a diagnosis of Undifferentiated Schizophrenia under ICD 10, as she displayed features of Paranoid, Hebephrenic and Catatonic without clear predominance of particular subtype of Schizophrenia. She was discharged home with follow-up from Neuropsychiatry and community Mental health teams. She continues to be investigated for the genetic cause of 3-methylglucatonic aciduria Type 4. Conclusions To conclude, although often metabolic disorders, including 3-methylglucaconic aciduria, can present with psychosis, it is prudent to establish a causative link in order to manage appropriately and effectively.","PeriodicalId":438758,"journal":{"name":"Members’ POSTER Abstracts","volume":"131 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116210495","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}
Pub Date : 2019-05-01DOI: 10.1136/JNNP-2019-BNPA.42
Angeliki Zarkali, M. Edwards, M. Edwards, M. Yogarajah, M. Yogarajah
Objectives/Aims Functional neurological disorders (FND) account for 20% of patients in neurology clinics and can lead to functional impairment, multiple re-attendances and significant cost. However, diagnosing FND remains challenging; identifying associated factors could aid earlier diagnosis. We aimed to determine the value of self-reported multi-allergies as predictor for FND. Methods We retrospectively reviewed records of consecutive patients from two clinics (General Neurology and FND), St George’s Hospital, January 2015–June 2018. A logistic regression model was used in conditional fashion; statistically significant variables in univariate analysis were included. Results Of 720 patients with definitive diagnosis, 243 (33.8%) had FND and 477 (66.3%) another neurological disorder. Mean age was 43 years (range 16–93), 63.9% (453) were female. 81 patients with FND (33%) had Non-epileptic attack disorder (NEAD). In multivariate analysis, factors associated with FND were female sex (Odds Ratio [95% Confidence Intervals], OR=0.49 [0.33, 0.73], p Increased number of allergies increased the probability of FND: one allergy OR=4.53 [3.08, 6.65, p Conclusions Previous studies highlighted the increased prevalence of allergies in NEAD compared to epilepsy. Our study expand this to all FND, as only 1 in 3 FND patients had NEAD. Presence of allergies, particularly to multiple agents, should raise the suspicion of FND.
{"title":"42 Multi-agent allergies as predictor of functional neurological disorder","authors":"Angeliki Zarkali, M. Edwards, M. Edwards, M. Yogarajah, M. Yogarajah","doi":"10.1136/JNNP-2019-BNPA.42","DOIUrl":"https://doi.org/10.1136/JNNP-2019-BNPA.42","url":null,"abstract":"Objectives/Aims Functional neurological disorders (FND) account for 20% of patients in neurology clinics and can lead to functional impairment, multiple re-attendances and significant cost. However, diagnosing FND remains challenging; identifying associated factors could aid earlier diagnosis. We aimed to determine the value of self-reported multi-allergies as predictor for FND. Methods We retrospectively reviewed records of consecutive patients from two clinics (General Neurology and FND), St George’s Hospital, January 2015–June 2018. A logistic regression model was used in conditional fashion; statistically significant variables in univariate analysis were included. Results Of 720 patients with definitive diagnosis, 243 (33.8%) had FND and 477 (66.3%) another neurological disorder. Mean age was 43 years (range 16–93), 63.9% (453) were female. 81 patients with FND (33%) had Non-epileptic attack disorder (NEAD). In multivariate analysis, factors associated with FND were female sex (Odds Ratio [95% Confidence Intervals], OR=0.49 [0.33, 0.73], p Increased number of allergies increased the probability of FND: one allergy OR=4.53 [3.08, 6.65, p Conclusions Previous studies highlighted the increased prevalence of allergies in NEAD compared to epilepsy. Our study expand this to all FND, as only 1 in 3 FND patients had NEAD. Presence of allergies, particularly to multiple agents, should raise the suspicion of FND.","PeriodicalId":438758,"journal":{"name":"Members’ POSTER Abstracts","volume":"324 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134382625","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}
Pub Date : 2019-05-01DOI: 10.1136/JNNP-2019-BNPA.30
I. Cary, M. Nadler, M. Dilley, C. Symeon
Objective/Aims Functional Neurological Disorder (FND) affects 10-30% of neurology outpatients. Symptoms commonly include sensory, motor and cognitive changes without structural nervous system damage. Fixed equinovarus dystonia (FEVD) of the foot and ankle is a common feature of FND characterised by plantar flexion and inversion of the foot which cannot be corrected passively. This prevents weight-bearing often causing permanent wheelchair dependence. FEVD correction is necessary for patients to walk again. Consensus opinion is that invasive treatments are ill-advised and potentially detrimental in patients with FND. However, we have developed a novel approach that may challenge this opinion for a specific patient group, combining invasive treatments and neuropsychiatry interventions. Methods A patient-led, goal oriented, multidisciplinary approach guided treatment. Treatments included functional electrical stimulation, botulinum toxin, tibial nerve block, serial casting and surgical intervention as an adjunct to specialist physiotherapy, occupational therapy, psychology. Standardised outcome measures of gait and mobility, balance, anxiety and depression were performed on admission and discharge. Patient consent was obtained for photo and video recording. Results For three, wheelchair-dependent patients with FND and FEVD admitted to The Wolfson Neuro-rehabilitation Centre for 12-24 week inpatient treatment, our approach resulted in two walking independently and one with supervision. Care needs were reduced and wheelchair dependence was eliminated. Patients reported improvement in independence and quality of life with one patient returning to part- time employment as a PA (See Table 1). Conclusions With selective psychological and medical screening, invasive treatment for FEVD in FND patients delivered through a careful, stepwise treatment pathway produced excellent results for this subgroup of patients. Though such interventions are usually avoided for patients with FND, there may be a subgroup of patients for whom they remain useful as a treatment adjunct in order to maximise rehabilitation and functional outcomes.
{"title":"30 Best foot forward? successful multi-disciplinary novel treatment of fixed equinovarus dystonia in three patients with functional neurological disorder","authors":"I. Cary, M. Nadler, M. Dilley, C. Symeon","doi":"10.1136/JNNP-2019-BNPA.30","DOIUrl":"https://doi.org/10.1136/JNNP-2019-BNPA.30","url":null,"abstract":"Objective/Aims Functional Neurological Disorder (FND) affects 10-30% of neurology outpatients. Symptoms commonly include sensory, motor and cognitive changes without structural nervous system damage. Fixed equinovarus dystonia (FEVD) of the foot and ankle is a common feature of FND characterised by plantar flexion and inversion of the foot which cannot be corrected passively. This prevents weight-bearing often causing permanent wheelchair dependence. FEVD correction is necessary for patients to walk again. Consensus opinion is that invasive treatments are ill-advised and potentially detrimental in patients with FND. However, we have developed a novel approach that may challenge this opinion for a specific patient group, combining invasive treatments and neuropsychiatry interventions. Methods A patient-led, goal oriented, multidisciplinary approach guided treatment. Treatments included functional electrical stimulation, botulinum toxin, tibial nerve block, serial casting and surgical intervention as an adjunct to specialist physiotherapy, occupational therapy, psychology. Standardised outcome measures of gait and mobility, balance, anxiety and depression were performed on admission and discharge. Patient consent was obtained for photo and video recording. Results For three, wheelchair-dependent patients with FND and FEVD admitted to The Wolfson Neuro-rehabilitation Centre for 12-24 week inpatient treatment, our approach resulted in two walking independently and one with supervision. Care needs were reduced and wheelchair dependence was eliminated. Patients reported improvement in independence and quality of life with one patient returning to part- time employment as a PA (See Table 1). Conclusions With selective psychological and medical screening, invasive treatment for FEVD in FND patients delivered through a careful, stepwise treatment pathway produced excellent results for this subgroup of patients. Though such interventions are usually avoided for patients with FND, there may be a subgroup of patients for whom they remain useful as a treatment adjunct in order to maximise rehabilitation and functional outcomes.","PeriodicalId":438758,"journal":{"name":"Members’ POSTER Abstracts","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116021876","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}
Pub Date : 2019-05-01DOI: 10.1136/jnnp-2019-bnpa.28
Brendan Sargent, L. Mcwhirter, J. Stone, A. Carson
30 Table 1 Functional Electrical Stimulation to common peroneal nerve (FES). Botulinum Toxin to posterior tibial muscles (BoNT). Tibial Nerve Block (TNB) Abstracts A14 JNNP 2019;90(Suppl 2):A1–A24 on M arch 1, 2020 by gest. P rocted by coright. httpjnnp.bm jcom / J N erol N euosurg P syiatry: frst pulished as 10.113nnp-2019-B N P A 29 on 28 M ay 219. D ow nladed fom
{"title":"28 Using experimental simulation of dementia to understand functional cognitive disorders","authors":"Brendan Sargent, L. Mcwhirter, J. Stone, A. Carson","doi":"10.1136/jnnp-2019-bnpa.28","DOIUrl":"https://doi.org/10.1136/jnnp-2019-bnpa.28","url":null,"abstract":"30 Table 1 Functional Electrical Stimulation to common peroneal nerve (FES). Botulinum Toxin to posterior tibial muscles (BoNT). Tibial Nerve Block (TNB) Abstracts A14 JNNP 2019;90(Suppl 2):A1–A24 on M arch 1, 2020 by gest. P rocted by coright. httpjnnp.bm jcom / J N erol N euosurg P syiatry: frst pulished as 10.113nnp-2019-B N P A 29 on 28 M ay 219. D ow nladed fom","PeriodicalId":438758,"journal":{"name":"Members’ POSTER Abstracts","volume":"77 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123018356","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}
Pub Date : 2019-05-01DOI: 10.1136/jnnp-2019-bnpa.48
J. Moonga
{"title":"48 Understanding the current challenges in neuropsychiatry: modelling care and treatment","authors":"J. Moonga","doi":"10.1136/jnnp-2019-bnpa.48","DOIUrl":"https://doi.org/10.1136/jnnp-2019-bnpa.48","url":null,"abstract":"","PeriodicalId":438758,"journal":{"name":"Members’ POSTER Abstracts","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127638685","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}
Pub Date : 2019-05-01DOI: 10.1136/jnnp-2019-bnpa.50
D. Bindman, J. Foong, P. Thompson
{"title":"50 Predicting psychiatric and cognitive outcomes after surgery for frontal lobe epilepsy","authors":"D. Bindman, J. Foong, P. Thompson","doi":"10.1136/jnnp-2019-bnpa.50","DOIUrl":"https://doi.org/10.1136/jnnp-2019-bnpa.50","url":null,"abstract":"","PeriodicalId":438758,"journal":{"name":"Members’ POSTER Abstracts","volume":"94 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126233903","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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