{"title":"Carphology","authors":"A Fo Ben","doi":"10.1136/pn-2024-004217","DOIUrl":"https://doi.org/10.1136/pn-2024-004217","url":null,"abstract":"In the lexicon of ‘things that rarely occur’ we have been over-using the ‘hen’s teeth’ simile, when there was an evolutionary biology exemplar available to us. In the 3.5 billion years since life first evolved on Earth, bacteria had merged with other organisms on just three occasions: this is the origin of organelles. Now, a fourth example has been found, a once-independent bacterium has evolved into an organelle providing nitrogen to algal cells (figure). They call this the nitroplast. Optimists out there can let their imaginations run wild with the potential for new and exotic life forms, whereas the PN-reading pessimists can predict a pantheon of pathogens. Science . 2024; 3846692: 217-222. Topiramate was first licenced by the FDA in 1996, without sufficient scrutiny to know …","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141169934","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":"ABN news","authors":"Biba Stanton, Maya McCourt","doi":"10.1136/pn-2024-004229","DOIUrl":"https://doi.org/10.1136/pn-2024-004229","url":null,"abstract":"Thanks to so many of our members for joining us in Edinburgh for our annual meeting where we enjoyed a varied programme of cutting edge neuroscience (including Irene Tracey on the pain matrix, Tara Spires-Jones on Alzheimer’s disease) and practical clinical updates, as well as re-connecting with colleagues from around the country. The ABN recognises that the climate emergency is a major threat to global health and well-being and also that the health service is a major contributor to carbon emissions. We are a member of UK Health Action on Climate Change, and are beginning to develop a new sustainability strategy. We are interested in members’ views on how the ABN reacts to these challenges. The sustainability Special Interest Group hold a breakfast session at the Edinburgh meeting …","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141169935","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":"Correction: Neurological gait assessment","authors":"BMJ Publishing Group Ltd","doi":"10.1136/pn-2023-003917corr1","DOIUrl":"https://doi.org/10.1136/pn-2023-003917corr1","url":null,"abstract":"Mermelstein S, Barbosa P, Kaski D. Neurological gait assessment. Pract Neurol 2024;24:11-21. doi: 10.1136/pn-2023-003917. The authors are grateful to a reader who highlighted a typo in the …","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141169936","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":"Editors’ commentary","authors":"Phil E M Smith, Geraint N Fuller","doi":"10.1136/pn-2024-004198","DOIUrl":"https://doi.org/10.1136/pn-2024-004198","url":null,"abstract":"Every intervention in medicine is built on a benefit–risk analysis. Clinical trials can formally assess this balance, estimating the number needed to treat vs the number needed to harm. But deciding the acceptability of this balance is not straightforward, because the nature, magnitude and frequency of the benefits and risks differ. Regulatory bodies in different countries make such decisions when licensing drugs. For example, they might decide that the trade-off is acceptable for chemotherapy agents, which reduce mortality significantly but frequently cause toxic neuropathies, but unacceptable when an antiseizure medication causes rare but potentially fatal liver failure or aplastic anaemia. The regulators must make complicated decisions, balancing the size of the benefit against the frequency and consequence of the adverse effects in the context of the alternative agents available. Once they are licensed, clinicians subsequently will discuss with their patients how best to use these agents and their individual benefit–risk ratio. The benefit–risk trade off becomes more complicated when the benefit comes to one patient but the potential risk …","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141170020","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}
Daniel Whittam, Rachael Matthews, Randa Nimeri, Saifuddin Shaik
{"title":"Antibiomania: clarithromycin-induced neurotoxicity mimicking autoimmune limbic encephalitis.","authors":"Daniel Whittam, Rachael Matthews, Randa Nimeri, Saifuddin Shaik","doi":"10.1136/pn-2023-004035","DOIUrl":"10.1136/pn-2023-004035","url":null,"abstract":"<p><p>We describe a 64-year-old woman with relapsing encephalopathy. She initially presented with 5 days of psychomotor agitation, progressing to mania, psychosis and seizures that mimicked autoimmune limbic encephalitis. During her first hospital admission, extensive investigation failed to establish the underlying cause, and she improved with antiseizure medication alone. After a month at home, she relapsed with identical symptoms, and only then did we recognise that both episodes had been provoked by clarithromycin, prescribed for <i>Helicobacter pylori</i> eradication. Clarithromycin-induced neurotoxicity is rarely reported but likely to be under-recognised. It usually manifests within days of starting treatment, with delirium, mania, psychosis or visual hallucinations, sometimes termed 'antibiomania'. Seizures and status epilepticus appear to be less frequent. A full recovery is expected on stopping the medication.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139643093","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":"Rituximab leading to an atypical presentation of neuroborreliosis and false negative serology.","authors":"Åslaug Rudjord Lorentzen, Kristine Karlsrud Berg, Unn Ljøstad","doi":"10.1136/pn-2023-003976","DOIUrl":"10.1136/pn-2023-003976","url":null,"abstract":"<p><p>Two patients, recently treated with the B-cell-depleting monoclonal antibody, rituximab, had 2-3 months of progressive systemic symptoms; comprehensive investigations did not clarify the diagnosis. Transient radicular pain at disease onset had suggested neuroborreliosis, but seronegativity and an atypical clinical course made this unlikely. However, PCR identified <i>Borrelia burgdorferi</i> DNA in cerebrospinal fluid, establishing the diagnosis of neuroborreliosis. Both the clinical picture and the laboratory findings can be atypical in people with neuroborreliosis who have recently been treated with rituximab. In B-cell depleted patients living in endemic areas, one should suspect neuroborreliosis even when the typical symptoms are drowned out by more atypical symptoms; PCR should be used as a diagnostic supplement when the serological response is uncertain or absent.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138886208","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":"Congenital myasthenic syndrome from a <i>MUSK</i> gene mutation.","authors":"Antonia McLean, Ian Wilson","doi":"10.1136/pn-2023-003945","DOIUrl":"10.1136/pn-2023-003945","url":null,"abstract":"<p><p>Slowly progressive neuromuscular symptoms often have a genetic basis. We present the case of a woman in her 40s with gradually progressive symmetrical weakness and respiratory muscle involvement. Extensive investigation found no specific cause. After a novel neuromuscular gene panel became available, we identified a mutation in the <i>MUSK</i> gene (muscle-specific kinase), confirming a diagnosis of congenital myasthenic syndrome. This group of rare disorders are caused by mutations in genes encoding the neuromuscular junction.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138177539","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}
Maya Behn, Jane Kielhofner, Jalesh N Panicker, Tamara B Kaplan
{"title":"Sexual dysfunction and commonly used drugs in neurology.","authors":"Maya Behn, Jane Kielhofner, Jalesh N Panicker, Tamara B Kaplan","doi":"10.1136/pn-2023-003760","DOIUrl":"10.1136/pn-2023-003760","url":null,"abstract":"<p><p>Sexual dysfunction is common in men and women with neurological diseases. Medications used in neurology can cause sexual dysfunction independently of the disease process and this may adversely affect patients' quality of life. This review focuses on medications commonly prescribed to neurological patients that may contribute to altered sexual function, and discusses how they may differ in men and women.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139425664","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":"Rippling muscles as a diagnostic clue to thymoma.","authors":"Arne Hostens, Wietse Wiels, Gert Cypers","doi":"10.1136/pn-2023-004018","DOIUrl":"10.1136/pn-2023-004018","url":null,"abstract":"","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404662","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}