Day 2 – 8th March 2019最新文献

{"title":"11 The bladder and the brain: exploring functional urological symptoms","authors":"I. Hoeritzauer","doi":"10.1136/JNNP-2019-BNPA.11","DOIUrl":"https://doi.org/10.1136/JNNP-2019-BNPA.11","url":null,"abstract":"Ingrid Hoeritzauer is a neurologist who also has a degree in psychology. She works with the Functional Research Team led by Jon Stone and Alan Carson in Edinburgh and received an ABN/Patrick Berthoud Clinical Research Training Fellowship. Her research interests are observational studies in functional neurological disorders and cauda equina syndrome and her current research focuses on the interface between Uro-Neurology and functional neurological disorders. This talk will review the current understanding of the bladder-brain axis, and the evidence linking functional disorders, including Functional Neurological Disorder (FND), to bladder symptoms including urinary retention and in the study of patients who present with cauda equina syndrome but have normal scans. Uro-Neurology is the connection between urological symptoms and the neurological system, comprising a complex bladder-brain network involving the brain, spinal cord, sacral nerves and peripheral (pelvic) nerves. Since the time of Charcot there have been hypotheses that urological symptoms, particularly idiopathic urinary retention and overactive bladder symptoms, were part of a functional disorder. However, in the 1980s urethral EMG changes in women with idiopathic urinary retention led to a view that so called ‘psychogenic’ urinary retention was a primary disorder of the urethral sphincter. Changing views of FND in the last 10 years mean that urological symptoms are once again being investigated as a potential part of functional disorders. Patients presenting with chronic idiopathic urinary retention, diagnosed as Fowler’s syndrome, or presenting with acute urinary retention and possible cauda equina syndrome, have been found to have high levels of functional disorder and FND comorbidity1 2. Additionally, recent papers have suggested central sensitisation as the mechanism of action in patients with idiopathic overactive bladder symptoms.3 This newly re-energised field of study requires further exploration, such as investigation of the effect of pathomechanical and medication induced urological symptoms on patients with functional disorders. A practical guide to how to discuss likely functional urological symptoms based on the current level of knowledge will conclude the talk. References Hoeritzauer I, Stone J, Fowler C, Elneil-Coker S, Carson A, Panicker J. Fowler’s syndrome of urinary retention: A retrospective study of co-morbidity. Neurourol Urodyn2016;35:601–3. Hoeritzauer I, Pronin S, Carson A, Statham P, Demetriades AK, Stone J. The clinical features and outcome of scan-negative and scan-positive cases in suspected cauda equina syndrome: a retrospective study of 276 patients. J Neurol2018;265:2916–26. Leue C, Kruimel J, Vrijens D, Masclee A, Van Os J, Van Koeveringe G. Functional urological disorders: A sensitized defence response in the bladder-gut-brain axis. Nat. Rev. Urol. 2017;14:153–63.","PeriodicalId":171927,"journal":{"name":"Day 2 – 8th March 2019","volume":"70 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":"134043833","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}

{"title":"14 The language disorder in semantic dementia: does it matter which language you speak?","authors":"K. Patterson","doi":"10.1136/jnnp-2019-bnpa.14","DOIUrl":"https://doi.org/10.1136/jnnp-2019-bnpa.14","url":null,"abstract":"From its inception, Karalyn Patterson has shaped the field of cognitive neuropsychology - the study of how the brain’s structure and function relates to mental processes concerning the generation and use of knowledge. Specifically, Karalyn has used the effects of brain disease and injury to improve our understanding of language and memory. Her approaches are varied and rigorous, combining computer modelling and structural and functional brain imaging with observations of behaviour in normal and brain-damaged adults, as well as those affected by certain brain diseases. This has allowed Karalyn to directly link particular structures in the brain with specific cognitive issues. Karalyn’s research has important consequences for our understanding of brain conditions that affect memory; for example, Alzheimer’s disease and other forms of dementia. She has also revealed the impact of the same brain disorder on the speakers of two diverse languages, English and Japanese. Semantic dementia (SD) is a neurodegenerative condition in the spectrum of frontotemporal dementia, and considered to be one of the main varieties of primary progressive aphasia. The question in the title of this talk will be addressed from two different perspectives. The first asks whether the pattern of language features observed in SD varies in any principled and significant way across different languages. English and Japanese, for example, differ in almost every component of language – phonology, syntax, written form, etc; yet the profiles of language deficit in SD patients from these two language communities are virtually identical. From this perspective, therefore, the answer is no, it does not matter which language you speak. The second question asks whether the severity of the language disorder in SD varies in a principled and significant way across the two languages spoken by bilingual cases of SD. A high proportion of people living in India speak two or more languages. When bilingual Indian SD patients are given the same tests in their L1 and L2 languages, of course they are impaired in both, but they show a striking advantage for L1. Furthermore, and of substantial theoretical interest, the patients’ correct responses to test items in L2 are a virtually perfect subset of correct responses to the same test items in L1. From this perspective, therefore, the answer is yes, it does matter which language you are speaking. These contrasting answers to the two forms of the question follow from the following pair of hypotheses: (a) the language disorder in SD is a fairly pure reflection of a disintegrating semantic system, and (b) the semantic system is fundamentally language-independent. References Fushimi, T, Komori, K, Ikeda, M, Lambon Ralph, MA & Patterson, K. (2009). The association between semantic dementia and surface dyslexia in Japanese. Neuropsychologia. 2009;47:1061–1068. Patterson, K & Fushimi, T. Organisation of language in the brain: Does it matter which language you spe","PeriodicalId":171927,"journal":{"name":"Day 2 – 8th March 2019","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":"115185878","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}

{"title":"12 Feigned or functional?","authors":"M. Edwards","doi":"10.1136/JNNP-2019-BNPA.12","DOIUrl":"https://doi.org/10.1136/JNNP-2019-BNPA.12","url":null,"abstract":"Mark Edwards is Professor of Neurology at St George’s University of London and Consultant Neurologist at the Atkinson Morley Regional Neuroscience Centre at St Georges University Hospital. He has a specialist clinical and research interest in Movement Disorders and in neurophysiological and psychophysical methods for exploring their pathophysiology. He did his PhD at the UCL Institute of Neurology with Professor John Rothwell and Professor Kailash Bhatia and was then a Senior Lecturer and Honorary Consultant Neurologist at UCL and the National Hospital for Neurology and Neurosurgery. Here he built up a specific interest in functional neurological symptoms and developed an NIHR funded research program and specialist clinical diagnostic and treatment service for patients with functional movement disorders. At St George’s he is part of an integrated diagnostic and treatment service for functional neurological disorder, and continues also with research and clinical work in movement disorders in general. Abstract ‘Poor Hysterics…first they were treated as victims of sexual trouble…then of moral perversity and mediocrity…then of imagination’. Over a century since William James wrote these words, the status of people with functional neurological disorder remains uncertain and ambiguous. The language of everyday medical discourse betrays this ambiguity: ‘Are they real seizures? ... Does he have genuine weakness?...The good news is that there’s nothing serious wrong…’ In this talk I will explore to what extent clinical and experimental work can help address this issue. While we may not be able to resolve the question of ‘feigned or functional?’ – perhaps because it is unanswerable in this form – exploring it may make us more aware of our own biases, hidden or not, and the way they affect our interaction and care for people with functional neurological disorder.","PeriodicalId":171927,"journal":{"name":"Day 2 – 8th March 2019","volume":"12 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":"116177358","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}

{"title":"13 Hypermobility and autonomic dysfunction: insights from bench to bedside","authors":"J. Eccles","doi":"10.1136/JNNP-2019-BNPA.13","DOIUrl":"https://doi.org/10.1136/JNNP-2019-BNPA.13","url":null,"abstract":"Dr Jessica Eccles trained in medicine at University of Cambridge and University of Oxford, completing a BA in The History and Philosophy of Science, sparking a keen interest in philosophy of mind and brain-body interactions. Since graduation from medical school has pursued a combined academic clinical path at Brighton and Sussex Medical School. As an MRC Clinical Research Training Fellow she recently completed her PhD in the relationship between joint hypermobility, autonomic dysfunction and psychiatric symptoms and is now an NIHR Clinical Lecturer. She is currently working on an Academy of Medical Sciences grant to explore neural connectivity in hypermobility using leading edge Human Connectome Project techniques and has recently been awarded a MQ Arthritis Research UK Fellows Award to conduct a randomised clinical trial of a new targeted treatment for anxiety in hypermobility. Dr Eccles has also been awarded a grant from Dysautonomia International and will be working with Profs Critchley, Cercignani, Rowe, Murphy and Drs Nagai, Asslanni, Iodice and Giovanni to explore multi-modal correlates of ‘brain fog’ in Postural Tachycardia Syndrome. Dr Eccles is working with Profs Davies, Harrison, Cercignani, Critchley and Dr Tarzi to explore brain- body interactions in Fibromyalgia and ME/CFS. This involves autonomics, inflammatory and cytokine markers, brain imaging and genomics. This work is funded by Versus Arthritis and Action for ME Alongside clinical academic colleagues at BSMS, Prof Harrison and Dr Colasanti. Joint hypermobility is a common, yet poorly recognised variant of connective tissue affecting up to 20% of the population. Hypermobility is a cardinal feature of Hyermobility Spectrum Disorder (HSD) and hypermobile Ehlers Danlos Syndrome (hEDS), inherited disorders of connective tissue. Individuals with joint hypermobility are over represented in panic, anxiety and neurodevelopmental populations and are prone to dysautonomia, typically postural tachycardia syndrome (PoTS), in which there is a phenomenological overlap with anxiety disorder. Interestingly differences in brain structure and function have been described in hypermobility in regions associated with emotional processing, including amygdala and insula. Individuals with joint hypermobility are more likely to experience severe chronic widespread pain, and many have co-morbid rheumatic conditions. A data-driven theoretical model linking joint hypermobility to psychiatric disorder is proposed, characterised by aberrant autonomic control and central representation, grounded in current theoretical models that seek to frame emotion as interoceptive inference, using leading-edge predictive coding approaches. Ultimately this approach has considerable relevance to personalised psychiatric medicine in this disorder and greater understanding of brain-body mechanisms underpinning neuropsychiatric states.","PeriodicalId":171927,"journal":{"name":"Day 2 – 8th March 2019","volume":"9 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":"126424938","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}