Online Neurology Education for Primary Care
E-Brain, developed with the Joint Neurosciences Council (a UK registered charity, of which P-CNS are members) continues to develop and offer excellent education modules to complete online and for which you receive CPD points. There a modules on headaches (developed with the input of Dr Andy Dowson, who was our Chair for many years), epilepsy and movement disorders to name but a few. What is more, you can access e-brain for free once you join the Primary Care Neurology Society, which we hope you will consider, if you’ve not already joined us. The joining fees we receive (one-off fee of £45) are a significant help in funding the running of the society.
If you want to read more about the recent e-brain developments, please click here. If you wish to join us, then please register via our website, www.p-cns.org.uk. Once we receive your joining fee, which can be paid online, we will activate your access to our website and also send your details to have you set up with an e-brain account.
You may also be interested to learn of the Neurology Learning Plan from MIMS Learning. Learning plans provide key learning points on diagnosis, management, follow-up and referral. You can undertake the whole plan to demonstrate that you have studied this area in depth, or use individual modules from the plan to complement your existing learning. For details of this plan and the topic covered click here.
Sleep duration and risk of CVD and Stroke Mortality
A study presented at the Sleep Research Society annual meeting in Boston which collected data from over 1700 patients has found that cardiovascular and cerebrovascular mortality risks significantly increased in individuals with short duration sleep (classed as less then 6 hours) but not in individuals with normal sleep duration. The researchers suggest “It is likely that adults with CVD or stroke and short sleep duration suffer from greater central autonomic and metabolic dysregulation,” They also stated that “Clinical trials should test whether lengthening sleep improves the long-term prognosis of adults with CVD or stroke.”
Polyneuropathy and Parkinson’s
Data from a study presented at the 2017 International Congress of Parkinson’s Disease and Movement Disorders has highlighted a lesser known issue with Parkinson’s, which is that polyneuropathy is fairly common, with an overall prevalence of 19% to 55% compared with 8% to 9% in people without Parkinson’s. However, the mechanism behind this prevalence is not clear. The recent study also the Parkinson’s Polyneuropathy (PD-PNP) is independently associated with cognitive impairment (P =.008), autonomic dysfunction (P =.035), nonmotor symptoms (P =.042), and axial motor features (P =.045) compared with those without PD-PNP. Further details of this study can be found from here.
Another study presented at the 2017 International Congress of Parkinson’s Disease and Movement Disorders has highlighted a growing interest in a the capacity of the microbiota to impact on neurological conditions. The data from the study presented suggest that “an imbalance in gut microbiota at baseline may be associated with the progression of Parkinson’s disease at 2-year follow-up. You can read more about this study from here. In a related study progression of Parkinson’s has also been linked to Metabolic Syndrome. Details of that study can be found here
Migraine – is zolmatriptan nasal spray (ZNS) an effective treatment in adolescents?
A paper presented at 2017 American Headache Society, which reported on a study of close to 800 adolescents found that treatment with ZNS, 5 mg significantly increased the percentage of patients who were pain-free at the 2-hour post-treatment mark compared with placebo (29.4%, placebo: 14.0%; P <05). To read more about this work click here
A study presented at the 2017 Consortium of Multiple Sclerosis Centers Annual Meeting has shown that overall, treatment with ocrelizumab a new MS treatment improves cognitive performance in measures of processing speed and working memory better than interferon beta-1a. Full details of the study are available from here.
Published 10th July 2017.
Effective and sustained neuropathic pain relief with 8% capsaicin patch
In a study of 420 patients who received at least one treatment with the capsaicin 8% patch, response to treatment was seen as early as week 2. The authors also stated that long-term follow up of patients enabled the observation that the median time to second treatment was more than 26 weeks and increased to over 43 weeks from second to third treatment. You can read the full paper from here.
Pre-diabetes and Cognitive Decline
The findings of a recent study have lead the authors to conclude that “Prevention and treatment of insulin resistance might help reduce cognitive decline later in life”. The study, published in Diabetes Care, found that that higher serum fasting insulin and insulin resistance predict poorer verbal fluency and a steeper decline in verbal fluency during 11 years in a representative sample of an adult population. You can read more about this study from here.
Vitamin D Deficiency and Cognitive Impairment in MS
A study published in Nature Scientific Reports initially evaluated the cognitive performance in MS patients with deficient 25 (OH)D (<25 ng/ml) compared to patients with sufficient levels (>35 ng/ml). Then change in cognitive performance after 3 months of vitamin D3 oral replacement was measured. The authors concluded from the findings that Vitamin D3 replacement improves cognitive performance. You can read more about this study from here.
Chinese herb in frequent night-time urination in Parkinson’s Disease
A paper published in Evidence-Based Complementary and Alternative Medicine concludes that Lian-Se forumula (LSF) treatment has clear clinical effects in patients with sialorrhea and frequent overnight urination. The authors state that’LSF thus appears to be a potential choice as an additional drug that can improve the sialorrhea and frequent overnight urination symptoms of PD patients.’To read more about this work click here
Diabetes and Risk of Dementia with Anticholinergic Drugs
A study recently published in PLOS One suggests an association between taking oxybutynin, solifenacin and tolterodine (treatment for OverActive Bladder) and the subsequent diagnosis of dementia in Diabetes Mellitus patients. The highest risk was seen with oxybutynin. Further details of this study can be found here.
Tackling Sudden Unexpected Death in Epilepsy – a new guideline
A new guideline released that the American Academy of Neurology Annual meeting offers a number of recommendations to help address SUDEP, which includes recommending health care professionals treating patients with epilepsy inform them about the small risk for SUDEP, and that controlling seizures, particularly GTCS, may reduce the risk for SUDEP. Further details of the study can found here.
Benzodiazepine Use in Alzheimer’s – Risk of Pneumonia
A recent study of people with Alzheimer’s living in the community has found that benzodiazepine use was significantly associated with an increased risk of pneumonia. The read to the full paper, published in the Canadian Medical Association Journal, and freely available go to here
Neurology charities express disappointment with the Government’s failure to priorities neurology services
The Neurological Alliance put out a recent statement pointing out that ‘The Public Account Committee’s report made it clear that services for people with neurological conditions “are not consistently good enough”, and ‘the Department of Health’s response was a very disappointing reflection of the low level of priority given to neurology within the NHS. Likewise the Epilepsy Society also stated their disappointment, although David Marshall welcomed the Department of Health’s decision to accept new commissioning for value data packs which could help clinical commissioning groups recognise and address poor outcomes for people with epilepsy in their areas. To read the Neurological Alliance’s response in full, click here
Red Flags workshop – a great success!
The feedback from the delegates at our half day red flags workshop with Dr Martin Turner was very encouraging. It was clear from the comments provided that Dr Turner provided a very helpful and practical session. Delegates particularly commented on the helpful use of case studies and the opportunity to discuss their own case studies. Over 90% of delegates rated the workshop as excellent and comments included ‘very interactive and a good learning experience‘, ‘Excellent presentations and nuggets of very useful information‘. If you would like us to arrange a ‘Red Flags’ workshop in your area then please email firstname.lastname@example.org.
Brain Tumours in Children – a Priority for the RCGP
The Royal College of General Practitioners have announced that the topic of their new clinical spotlight project will be Brain Tumours in Children. The project is designed to help primary care professionals in identifying symptoms and signs of childhood brain tumours, and will run from 2016 to 2017. You can read the full news story from here.
Recognising MND early to speed up referral.
The MND Association have recently reported that unfortunately, 1 in 5 people with MND have to wait a year or more for a neurologist referral. Of these people, more than half (52%) had been referred to other healthcare professionals first, most commonly physiotherapists, orthopaedic surgeons or Ear Nose and Throat (ENT) specialists instead of straight to a neurologist. To help professionals to be more alert to the possibility of MND, the MND Association in partnership with the RCGP have produced a very helpful ‘Red Flags’ A4 sheet which you can download from here
News from NICE
NICE Guideline on Dementia
This final addendum has now been published on the NICE website. You can also find the supporting evidence, as well as all the stakeholder comments that we received during consultation and the responses to these comments. NICE have also produced an equality impact assessment to support the addendum.
Increase in strong opioid prescriptions continues
For the second year running there was a drastic increase in prescriptions for strong opioids. The total quantity of strong opioids prescribed went up by 10% relative to 2014. This is according to Cogora’s annual review of ‘General Practice Prescribing Trends in England and Wales’. If you would like to read the full report click here.
‘Satiety Hormone’, leptin linked with Migraine with AuraA recent study published in Cephalagia has found that leptin levels were found to be significantly higher in subjects with migraine. To read about this study click here.
Early dementia diagnosis and patient safety.
A recent study has highlighted the hidden dangers that are associated with people engaging in unsafe activities when remaining undiagnosed with dementia. The paper, details of which you can read here, concluded that ‘Understanding the prevalence of potentially unsafe activities and living conditions can help clinicians focus safety screening and counseling in older adults with diagnosed or suspected dementia’
Are we measuring the right outcomes in epilepsy trials?
Results from a study published this month have found there are 3 domains that patient and carers feel are critically important when evaluated new treatments, that healthcare professionals failed to identify in the International League Against Epilepsy’s Commission on Outcome Measurement (COME). Namely, ‘depression’, ‘anxiety’ and ‘independence/need for support’. The study authors concluded that ‘their results could inform a core outcome set for epilepsy that represents the domains that should be reported as a minimum by all trials’.
Ketogenic dietary therapies in adults with epilepsy: a practical guide
Interest in the use of ketogenic diets for epilepsy continues to grow, and so the recent review by Natasha Schoeler and Helen Cross in Practical Neurology is very timely. In the review they aim to familiarise the reader with the evidence base for these diets and give practical advice on starting and maintaining them in adults. To find out more about the review click here and if you are looking for support in setting up a ketogenic diet service, you may wish to read the recent article published on Neurodigest.
‘Patients with type 1 diabetes are at an increased risk of developing epilepsy’
This is the conclusion from a study in Taiwan, recently reported in Diabetologia and which found that, after adjustment for potential confounders, the type 1 diabetes cohort was 2.84 times as likely to develop epilepsy than the control cohort . Further details are available from here.
Published 11th May 2016. Originally published in ACNR (Advances in Clinical Neuroscience & Rehabilitation). See www.acnr.co.uk for more information.
New data intelligence report analyses how people with neurological conditions in Wessex use hospital services and why
A new Neurology Intelligence Report provides insight into how people with various neurological conditions can be better supported to stay well. The report is the work of NHiS in partnership with Wessex Strategic Clinical Network and CLAHRC, and The National Institute for Health Research. It was launched at an event in Southampton on the 19 April 2016 and can be accessed at www.nhis.com/wessex-neurology-report?utm_ source=announcement&utm_medium=email-and-share&utm_campaign= Wessex-Report-Launch
News from NICE
Suspecting Neurological Conditions – Recognition and Referral
The final scope and equality impact assessment for this NICE guideline have now been published, along with all the stakeholder comments that were received during consultation and NICE’s responses to these comments. See www.nice.org.uk/guidance/indevelopment/gid-cgwave0800/documents http://bit.ly/1WmcIGU
Stroke in Adults Quality Standard update released
The Stroke in adults quality standard has just been updated and is available from www.nice.org.uk/guidance/qs2/chapter/Update-information
Neurological care in England criticised by MPs report
The BBC recently reported that the Department of Health and the NHS are to be held to account in the months and years ahead with regard to provision of neurological care, following the publication of a Public Account Committee report. According to the BBC, the report recommends that NHS England find a way of tackling the problem of variation in services and explain how it will offer everyone with a long-term condition a personalised care plan. It also urges NHS England to make better use of the 650 neurologists in England, as well as other specialist nurses, to improve access to care for patients. Read the report at www.publications.parliament.uk/pa/cm201516/cmselect/cmpubacc/502/50202.htm
Parkinson’s Disease and sleep
According a new global study, sleep is the number one factor influencing well-being in people with Parkinson’s. Other factors highlighted were exercise, pain, stress and mood. You can read more about this study at http://parkinsonslife.eu/global-parkinsons-study-reveals-sleep-as-biggest-influence-on-wellbeing/
Improving outcomes for people with neurological
The Neurological Alliance is working with the NHS England Long Term Conditions Support Unit and the Strategic Clinical Network Neurology Collaborative to deliver a coordinated programme of work to improve care and outcomes for people living with neurological conditions. www.neural.org.uk/nhs-england-community- project-for-neurology
Improving neurological function in MS
Recent research with the disease modifying MS drug, alemtuzumab, has shown it improves pre-existing disability in people with relapsing-remitting multiple sclerosis. This is according to the commonly used scale in MS, known as the Expanded Disability Status Scale (EDSS). The results lead the authors to conclude that ‘the findings may influence treatment decisions in patients with early, active relapsing-remitting MS displaying neurological deficits’. See www.jns-journal.com/article/S0022-510X(16)30090-9/abstract?rss=yes