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13

Inadequate neurology services undermine patient care in the UK

“Neurology for the masses” announced The BMJ’s then editor, Richard Smith, in 1999.1 Old stereotypes may associate neurology with rare syndromes and a fondness for diagnosis not treatment, he went on, but it is also a specialty of common illnesses such as epilepsy and Parkinson’s disease. He might also have mentioned that neurological symptoms include some of the commonest complaints such as headache and fatigue. Sixteen years on and despite a doubling of consultants, a damning parliamentary report,2 thrombolysis for stroke, and an awareness of increasing neurodegenerative disease only people living in select areas, or able to travel, will encounter a neurologist. The Neurological Alliance, a patients’ organisation in England, reports that 31% of patients had to see their primary care doctor five or more times, and 40% waited more than 12 months with symptoms before seeing one.3 The UK is the only developed nation with this problem. We have one neurologist per 90 000 people4; the European average is one per 15 000,5 and in the United States concern has been expressed that one per 19 000 isn’t enough.6  
feeds.bmj.com
about 4 years ago
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16

Corticosteroids including ACTH (adrenocorticotrophin hormone) for childhood epilepsy other than epileptic spasms | Cochrane

We wanted to assess whether corticosteroids including ACTH are an effective treatment for children with epilepsy. Corticosteroids are sometimes used as an additional therapy to antiepileptic drugs in children with uncontrolled epilepsy. The role of corticosteroids in children with epilepsy is yet to be established.  
cochrane.org
about 4 years ago
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11

Art of Medicine: Discussing simple febrile seizures with parents

The next video in the Art of Medicine series focuses on how to talk with parents about simple febrile seizures. These can be incredibly scary, but fortunately the prognosis is almost uniformly great.  
pemcincinnati.com
about 4 years ago
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14

Surgery for epilepsy | Cochrane

Focal epilepsies are caused by abnormal electrical discharges in specific (localised) parts of the brain. In most people the resulting epileptic seizures can be controlled with medication. In up to 30% of people these seizures are not controlled by medication. If the site of origin of these signals (the epileptogenic zone) can be located from the description of the seizures, or from magnetic resonance imaging (MRI) (a medical imaging scan that uses strong magnetic fields and radio waves to produce detailed images of the inside of the body) and electroencephalography (EEG) findings (recording of electrical activity along the scalp) the person should be offered the chance of having the epileptogenic zone removed. We studied the factors (characteristics of the people undergoing surgery and details of surgery type) that might be linked to the best chance of surgical cure of epileptic seizures.  
cochrane.org
about 4 years ago
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19

Propofol versus thiopental sodium for the treatment of refractory status epilepticus (RSE) | Cochrane

Persistent convulsions (lasting 30 minutes or more) are a major medical emergency associated with significant morbidity and mortality. At times, these convulsions fail to respond to first- and second-line drug therapy and may occur in up to 31% of patients suffering from persistent seizure or convulsive activities. Persistent seizure activity may become unresponsive to antiepileptic drugs. Anaesthetics such as thiopental sodium and propofol are frequently given for control of seizures in such situations. Both agents have their own side effects and complications. This review evaluates the evidence for the use of these anaesthetic drugs in controlling seizure activity in patients with RSE.  
cochrane.org
about 4 years ago
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12

Amitriptyline for neuropathic pain in adults | Cochrane

Neuropathic pain is pain coming from damaged nerves, and can have a variety of different names. Some of the more common are painful diabetic neuropathy, postherpetic neuralgia, or post-stroke pain. It is different from pain messages that are carried along healthy nerves from damaged tissue (for example, a fall, or cut, or arthritic knee). Neuropathic pain is treated by different medicines to those used for pain from damaged tissue. Medicines such as paracetamol or ibuprofen are not usually effective in neuropathic pain, while medicines that are sometimes used to treat depression or epilepsy can be very effective in some people with neuropathic pain.  
cochrane.org
about 4 years ago
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10

Milnacipran for neuropathic pain in adults | Cochrane

Neuropathic pain is pain coming from damaged nerves. It is different from pain messages that are carried along healthy nerves from damaged tissue (for example, a fall, or cut, or arthritic knee). Neuropathic pain is treated by different medicines to those used for pain from damaged tissue. Medicines such as paracetamol or ibuprofen are not usually effective in neuropathic pain, while medicines that are sometimes used to treat depression or epilepsy can be very effective in some people with neuropathic pain.  
cochrane.org
about 4 years ago
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8

Epilepsy charity criticises Twitter for flashing ads - BBC News

An epilepsy charity criticises Twitter for uploading two online videos that feature a looping, rapid succession of flashing colours.  
bbc.co.uk
about 4 years ago
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10

Neuropsychological and psychological treatments for adults with newly diagnosed epilepsy | Cochrane

Epilepsy is a neurological condition characterised by involuntary activity of the brain which manifests in seizures. People with newly diagnosed epilepsy often report psychological (such as symptoms of depression or anxiety) and neuropsychological (for example, memory or thinking problems) difficulties. Despite this, there is little research into interventions for these difficulties for people with newly diagnosed epilepsy. We reviewed the available evidence for these interventions within this population  
cochrane.org
about 4 years ago
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12

Carbamazepine versus phenobarbitone monotherapy (single drug treatment) for epilepsy | Cochrane

Epilepsy is a common neurological disorder in which abnormal electrical discharges from the brain cause recurrent seizures. We studied two types of epileptic seizures in this review: generalised onset seizures in which electrical discharges begin in one part of the brain and move throughout the brain, and partial onset seizures in which the seizure is generated in and affects one part of the brain (the whole hemisphere of the brain or part of a lobe of the brain). For around 70% of people with epilepsy, a single antiepileptic drug can control generalised onset or partial onset seizures. Worldwide, phenobarbitone (PB) and carbamazepine (CBZ) are commonly used antiepileptic drugs; however, CBZ is used more commonly in the USA and Europe because of concerns over side-effects associated with PB, particularly concerns over behavioural changes in children treated with PB. Phenobarbitone is still commonly used in developing countries in Africa, Asia, and South America because of the low cost of the drug.  
cochrane.org
about 4 years ago
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10

Cerebral mass in HIV infection

A 34 year old woman from the Republic of Congo with known HIV infection presented with a one day history of sudden weakness of the right arm and mild headache. She had a history of cardiomyopathy, hypertension, and epilepsy. She had not travelled abroad since she had moved to the United Kingdom 10 years ago. Other than weakness in the extensor muscles of the right arm grade 4/5 on the Medical Research Council scale, the physical examination was unremarkable.  
feeds.bmj.com
about 4 years ago
Www.bmj
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19

A young woman presenting with severe headache

A 20 year old woman with a history of migraine with visual aura in the form of both positive (fortification spectrum) and negative features was admitted to hospital because of unilateral pulsatile right sided headache of one day’s duration. The headache was associated with photophobia, intense nausea and vomiting, right sided facial and upper arm numbness, and a right sided temporal visual field defect. She described the headache as similar to her habitual migraines in character but “the worst ever.” On examination she was normotensive and her Glasgow coma scale was 15. On neurological examination the visual field defect was confirmed and she reported reduction in light touch over the right side of her face and right upper limb.  
feeds.bmj.com
about 4 years ago
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15

FDA approves first 3-D printed drug

WASHINGTON — The Food and Drug Administration has approved the first prescription drug made through 3-D printing: a dissolvable tablet that treats seizures. Aprecia Pharmaceuticals said Monday the FDA approved its drug Spritam for adults and children who suffer from certain types of seizures caused by epilepsy. The tablet is manufactured through a layered process via 3-D printing and dissolves when taken with liquid. The Ohio-based company says its printing system can package potent drug doses of up to 1,000 milligrams into individual tablets. It expects to launch Spritam in the first quarter of 2016. The FDA has previously approved medical devices — including prosthetics — made with 3-D printing. An agency spokeswoman confirmed the new drug is the first prescription tablet approved that uses the process. Aprecia said in a statement it plans to develop other medications using its 3-D platform in coming years, including more neurological drugs. The company is privately owned. Doctors are increasingly turning to 3-D printing to create customized implants for patients with rare conditions and injuries, including children who cannot be treated with adult-size devices. The FDA held a workshop last year for medical manufacturers interested in the technology.  
nypost.com
about 4 years ago
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1

Pfizer and Flynn Pharma accused of overcharging by CMA - BBC News

Pharmaceutical firms Pfizer and Flynn Pharma are accused of charging "excessive and unfair" prices for an anti-epilepsy drug by the UK's competition watchdog.  
bbc.co.uk
about 4 years ago
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7

Medicines for preventing epilepsy following traumatic head injury | Cochrane

Traumatic head injury is a frequent event and can injure the brain. This severe injury is often followed by seizures (fits), which may worsen the damage and can lead to chronic epilepsy, a neurologic disorder characterized by frequent recurrent seizures. Antiepileptic drugs are usually given to suppress already diagnosed seizures. Their role in curing the disease and preventing the development of epilepsy in people who are considered at risk for seizures after any brain injury, including head trauma, is not well understood.  
cochrane.org
about 4 years ago
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4

In brief

UK competition watchdog investigates price of phenytoin: The drug companies Pfizer and Flynn Pharma have been accused by the Competition and Markets Authority of charging “excessive and unfair” prices for the epilepsy drug phenytoin. Before September 2012, when Pfizer made and sold phenytoin under the brand name Epanutin, the NHS spent about £2.3m (€3.3m; $3.6m) on the drug. But, after it sold distribution rights to Flynn Pharma, it increased the price by as much as a factor of 17, and Flynn then hiked the price again to 25 times what Pfizer had been charging, which cost the NHS £50m in 2013. The authority will now decide whether competition law was infringed.  
feeds.bmj.com
about 4 years ago
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1

In brief

UK competition watchdog investigates price of phenytoin: The drug companies Pfizer and Flynn Pharma have been accused by the Competition and Markets Authority of charging “excessive and unfair” prices for the epilepsy drug phenytoin. Before September 2012, when Pfizer made and sold phenytoin under the brand name Epanutin, the NHS spent about £2.3m (€3.3m; $3.6m) on the drug. But, after it sold distribution rights to Flynn Pharma, it increased the price by as much as a factor of 17, and Flynn then hiked the price again to 25 times what Pfizer had been charging, which cost the NHS £50m in 2013. The authority will now decide whether competition law was infringed.  
feeds.bmj.com
about 4 years ago
Preview
0
1

In brief

UK competition watchdog investigates price of phenytoin: The drug companies Pfizer and Flynn Pharma have been accused by the Competition and Markets Authority of charging “excessive and unfair” prices for the epilepsy drug phenytoin. Before September 2012, when Pfizer made and sold phenytoin under the brand name Epanutin, the NHS spent about £2.3m (€3.3m; $3.6m) on the drug. But, after it sold distribution rights to Flynn Pharma, it increased the price by as much as a factor of 17, and Flynn then hiked the price again to 25 times what Pfizer had been charging, which cost the NHS £50m in 2013. The authority will now decide whether competition law was infringed.  
feeds.bmj.com
about 4 years ago
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4
54

Kanner’s infantile autism and Asperger’s syndrome -- Pearce 76 (2): 205 -- Journal of Neurology, Neurosurgery & Psychiatry

Recent much publicised attention to autism and its putative relation to the measles, mumps, and rubella (MMR) vaccination reminds us that autism affects approximately 4 in 10 000 of the population. It is characterised by impairments in reciprocal social interaction and communication, restricted and stereotyped patterns of interests and activities, and the presence of developmental abnormalities by 3 years of age. Much of the psychiatric literature appears to overlook the organic basis,1 with subtle neurological signs evident in many examples: learning difficulties, a high incidence of epilepsy, viral infections, tuberous sclerosis, and fragile X syndrome are known associations.  
jnnp.bmj.com
about 4 years ago
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Calcium Channel Blockers in Pregnancy Don't Up Neonatal Seizure Risk

Contrary to prior research, a new study reports no increased risk of seizures in neonates born to mothers exposed to CCBs in late pregnancy.  
neurologyadvisor.com
about 4 years ago