Ooi M.H.,University of Liverpool |
Ooi M.H.,University Malaysia Sarawak |
Wong S.C.,Sibu Hospital |
Lewthwaite P.,University of Liverpool |
And 3 more authors.
The Lancet Neurology | Year: 2010
Although poliomyelitis has been mostly eradicated worldwide, large outbreaks of the related enterovirus 71 have been seen in Asia-Pacific countries in the past 10 years. This virus mostly affects children, manifesting as hand, foot, and mouth disease, aseptic meningitis, poliomyelitis-like acute flaccid paralysis, brainstem encephalitis, and other severe systemic disorders, including especially pulmonary oedema and cardiorespiratory collapse. Clinical predictors of severe disease include high temperature and lethargy, and lumbar puncture might reveal pleocytosis. Many diagnostic tests are available, but PCR of throat swabs and vesicle fluid, if available, is among the most efficient. Features of inflammation, particularly in the anterior horns of the spinal cord, the dorsal pons, and the medulla can be clearly seen on MRI. No established antiviral treatment is available. Intravenous immunoglobulin seems to be beneficial in severe disease, perhaps through non-specific anti-inflammatory mechanisms, but has not been tested in any formal trials. Milrinone might be helpful in patients with cardiac dysfunction. © 2010 Elsevier Ltd.
Elliott N.S.J.,Curtin University Australia |
Bertram C.D.,University of New South Wales |
Martin B.A.,University of Akron |
Brodbelt A.R.,The Walton Center Foundation Trust
Journal of Fluids and Structures | Year: 2013
Syringomyelia is a neurological disorder caused by the development of one or more macroscopic fluid-filled cavities in the spinal cord. While the aetiology remains uncertain, hydrodynamics appear to play a role. This has led to the involvement of engineers, who have modelled the system in silico and on the bench. In the process, hypotheses from the neurosurgical literature have been tested, and others generated, while aspects of the system mechanics have been clarified. The spinal cord is surrounded by cerebrospinal fluid (CSF) which is subject both to the periodic excitation of CSF expelled from the head with each heartbeat, and to intermittent larger transients from cough, sneeze, etc., via vertebral veins. The resulting pulsatile flow and pressure wave propagation, and their possible effects on cord cavities and cord stresses, have been elucidated. These engineering contributions are here reviewed for the first time. © 2013 Elsevier Ltd.
Iniesta I.,The Walton Center Foundation Trust
Practical Neurology | Year: 2011
The term Jacksonian epilepsy was coined by Jean Martin Charcot following John Hughlings Jackson's 1870 paper 'A study of convulsions', where he had defined a convulsion as "a symptom resulting from an occasional, an excessive and a disorderly discharge of nerve tissue on muscles". His earlier writings had included cases of syphilis related epilepsy, and the introduction of the fi rst successful antiepileptic drugs-the bromides. Based on careful clinical observation or, as Hughlings Jackson himself put it, on the "experiments performed by disease", 'A study of convulsions' was a synthesis of those previous reports which has contributed to our practical understanding of epilepsy, a contribution which continues to inform our thinking to the present day.
Nicolson A.,The Walton Center Foundation Trust |
Marson A.G.,University of Liverpool
Practical Neurology | Year: 2010
Juvenile myoclonic epilepsy is one of the most common types of epilepsy seen in an adult epilepsy clinic. Most patients have a good prognosis, particularly when treated with valproate, but a significant minority are more difficult to treat. In this article, we will focus on a management strategy when the initial antiepileptic drug is unsuccessful and outline an approach that translates directly to the clinic.
Grant L.,The Walton Center Foundation Trust
Nursing times | Year: 2011
A vast amount of information relating to standards of patient care is collated from hospital wards, yet there is not always evidence that this information is discussed or acted upon by ward staff. Involving ward staff in setting up systems to monitor performance and then deciding how to address shortcomings uses their insights into care provision and gives them ownership over standards of care. The balanced scorecard is an effective tool for monitoring quality that can be applied to healthcare. This article discusses how to use it to develop and implement systems of measuring the quality of care.
McIvor K.,The Walton Center Foundation Trust |
Moore P.,University of Liverpool
Clinical Neuropsychologist | Year: 2016
Objective: Anti N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune disorder that was only fully discovered recently and neuropsychological outcome data remains sparse. We present the case of BA, a 19-year-old male, which illustrates the cognitive outcome in an untreated case over a time period of over 2½ years. Method: We conducted three cognitive assessments, including tests of memory and executive functioning, over this time period and considered the evidence for reliable change in memory function using the Wechsler Advanced Clinical Solutions (ACS) serial assessment package. Results: Our findings revealed mild memory problems 6 months post-discharge with, at best, static and potentially declining memory functioning at follow-up assessment 12 months post-discharge. However, the results of testing at 30 months post-discharge revealed significant improvements in immediate and delayed memory index performances. Conclusions: Our report of a case of anti-NMDAR encephalitis provides evidence for spontaneous improvements in memory functioning occurring more than 2 years after initial assessment and also demonstrates both the utility and potential limitations of the ACS serial assessment software when used in a relatively typical clinical assessment situation. © 2016 Informa UK Limited, trading as Taylor & Francis Group
Sathasivam S.,The Walton Center Foundation Trust
Progress in Neurology and Psychiatry | Year: 2014
Myasthenia gravis is the most common primary disorder of neuromuscular transmission and one of the most treatable neurological disorders. In this review, Dr Sathasivam examines the epidemiology, presentation, aetiology, diagnosis and treatment of myasthenia gravis. © 2014 John Wiley & Sons, Ltd.
Sathasivam S.,University of Malaya |
Sathasivam S.,The Walton Center Foundation Trust
Journal of Cardiology | Year: 2013
There is conflicting evidence on the causal relationship of patent foramen ovale (PFO) in migraine. This review will examine the pathophysiological relevance of PFO in migraine, the epidemiological evidence of PFO causing migraine, and the existing evidence on the effectiveness of closure of PFO on the symptomatology of migraine. From the current available evidence, the role of PFO in migraine is debatable, and interventions such as closure of PFO cannot yet be considered routine treatment of migraine. © 2013 Japanese College of Cardiology.
Johnson S.,The Walton Center Foundation Trust
European journal of pain (London, England) | Year: 2012
There is good evidence from studies conducted in a single-centre research setting for the efficacy of graded motor imagery (GMI) treatment, a complex physiotherapy intervention, to reduce pain in long-standing complex regional pain syndrome (CRPS). However, whether GMI is effective in clinical practice is not established. To establish whether GMI is effective in clinical practice. We undertook a prospective audit of GMI treatment at two UK centres with a special interest in the management of patients with CRPS. All patients received GMI, in conjunction with a range of other 'best practice' physical and psychological interventions. The patients' average pain intensities did not improve with treatment [centre 1: n = 20, pre-post numeric rating scale (NRS) difference 0.6 [confidence interval (CI) -0.3 to 1.5]; centre 2: n = 12, pre-post NRS difference 0.2 (CI: -0.9 to 1.2)]. Patients at centre 1 reported significant functional improvement. Improved performance on left/right judgement replicated in both centres seen in the clinical trials. The failure of our real-world implementation of GMI suggests that better understanding of both the GMI methodology and its interaction with other treatment methods is required to ensure that GMI research results can be translated into clinical practice. Our results highlight challenges with the translation of complex interventions for chronic pain conditions into clinical practice. © 2011 European Federation of International Association for the Study of Pain Chapters.
Bonnett L.,University of Liverpool |
Smith C.T.,University of Liverpool |
Smith D.,The Walton Center Foundation Trust |
Williamson P.,University of Liverpool |
And 2 more authors.
The Lancet Neurology | Year: 2012
Background: Epilepsy is a heterogeneous disorder, with outcomes ranging from immediate remission after taking a first antiepileptic drug to frequent unremitting seizures with multiple treatment failures. Few prognostic models enable prediction of outcome; we therefore aimed to use data from the SANAD study to predict outcome overall and for patients receiving specific treatments. Methods: The SANAD study was a randomised controlled trial in which standard antiepileptic drugs were compared with new treatments. Arm A included patients for whom carbamazepine was considered the first-line treatment, most of whom were newly diagnosed with focal epilepsy. Patients were randomly assigned to receive carbamazepine, gabapentin, lamotrigine, oxcarbazepine, or topiramate. Outcomes were time to treatment failure overall, because of inadequate seizure control, and because of adverse events, and time to 12 months of remission from seizures. In this post-hoc study we used regression multivariable modelling to investigate how clinical factors affect the probability of treatment failure and the probability of achieving 12 months of remission. Findings: For time to treatment failure, we identified several significant risk factors: sex (male vs female, hazard ratio [HR] 0·86, 95% CI 0·75-0·99), treatment history (taking non-SANAD antiepileptic drugs [other than those listed above] vs treatment naive, 1·27, 1·05-1·53), age (eg, older than 71 years vs 10 years or younger, 0·68, 0·51-0·91), total number of seizures (eg, four to 11 seizures vs two or fewer, 1·08, 1·05-1·11), electroencephalogram results (epileptiform abnormality vs normal, 1·26, 1·07-1·50), seizure type (eg, secondary generalised vs simple or complex partial only, 0·78, 0·66-0·91), site of onset (not localised vs temporal lobe, 1·25, 1·06-1·47), and treatment (lamotrigine vs carbamazepine, 0·76, 0·61-0·95). Significant factors for time to 12 months of remission were sex (male vs female, 1·19, 1·05-1·35), treatment history (taking a non-SANAD antiepileptic drug vs treatment naive, 0·64, 0·52-0·78), age (eg, older than 71 years vs 10 years or younger, 1·60, 1·26-2·03), time from first seizure (60-239 months vs ≥2 months, 1·14, 1·01-1·29; >240 months vs ≤2 months, 1·39, 1·04-1·86), neurological insult (present vs absent, 0·75, 0·61-0·93), total number of seizures before randomisation (eg, four to 11 vs two or fewer, 0·87, 0·85-0·90), and treatment (gabapentin vs carbamazepine, 0·71, 0·59-0·86; topiramate vs carbamazepine, 0·81, 0·68-0·98). Interpretation: We present a thorough investigation of prognostic factors from a large randomised controlled trial in patients starting antiepileptic monotherapy. If validated, our models could aid in individual patient risk stratification and the design and analysis of epilepsy trials. Funding: National Institute for Health Research (UK). © 2012 Elsevier Ltd.