{"title":"Nocturnal behaviours, stridor and recurrent respiratory failure in anti-IgLON5 disease.","authors":"Thanakrit Tanrattanakorn, Athiwat Tripipitsiriwat, Jindapa Srikajon, Apinya Kroeksattayaporn, Jiraporn Jitprapaikulsan","doi":"10.1136/pn-2026-005340","DOIUrl":"https://doi.org/10.1136/pn-2026-005340","url":null,"abstract":"<p><p>Anti-IgLON5 disease is a rare autoimmune encephalopathy with concurrent tauopathy, characterised by sleep dysfunction and brainstem involvement. A 77-year-old woman developed obstructive sleep apnoea and recurrent hypercapnic respiratory failure requiring repeated intubation, initially misdiagnosed as epilepsy. Video recordings captured elaborate nocturnal behaviours, including praying and offering alms during sleep, alongside inspiratory stridor and sleep attacks during eating. Serial polysomnography documented progressive loss of sleep spindles and undifferentiated non-rapid eye movement sleep. Brain imaging showed only mild cortical, cerebellar and brainstem atrophy. She had anti-IgLON5 antibodies in serum and cerebrospinal fluid. Her condition partially improved after intravenous methylprednisolone and then rituximab, and she remains under follow-up. Patients with treatment-resistant sleep-disordered breathing, laryngeal dysfunction and nocturnal motor behaviours should be tested for anti-IgLON5 disease.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082238","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}
Gareth Llewelyn, Dafydd Llewelyn, Muhammed Ameen Noushad, Haider A Katifi
{"title":"Focal neuropathies: a neuroanatomical approach to diagnosis and management.","authors":"Gareth Llewelyn, Dafydd Llewelyn, Muhammed Ameen Noushad, Haider A Katifi","doi":"10.1136/pn-2026-005108","DOIUrl":"https://doi.org/10.1136/pn-2026-005108","url":null,"abstract":"<p><p>We provide a framework for clinically evaluating and managing focal neuropathies, emphasising the value of functional neuroanatomy in their diagnosis. Rather than relying solely on electrophysiology, we advocate an approach that aligns specific symptoms with known anatomical pathways to improve clinical diagnostic accuracy. We structure the paper around common clinical presentations of various mononeuropathies involving the upper and lower limbs. By categorising disorders based on their typical motor and sensory manifestations, we offer a practical approach to identifying nerve entrapments and injuries. We also explore how traditional bedside assessment can be used alongside advanced imaging to inform diagnosis and management.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149065092","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}
Janisha Ratnayake, Hmmtb Herath, Adam Handel, Kask Karunanayaka, Sunil Wimalaratna
{"title":"The diagnosis was captured at home: home surveillance in LGI1 encephalitis.","authors":"Janisha Ratnayake, Hmmtb Herath, Adam Handel, Kask Karunanayaka, Sunil Wimalaratna","doi":"10.1136/pn-2026-005372","DOIUrl":"https://doi.org/10.1136/pn-2026-005372","url":null,"abstract":"","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149065109","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":"Bilateral lingual epilepsy following traumatic brain injury.","authors":"Glenn Calvert, Peter Flynn, Mark Owen McCarron","doi":"10.1136/pn-2026-005336","DOIUrl":"https://doi.org/10.1136/pn-2026-005336","url":null,"abstract":"<p><p>Lingual seizures are an uncommon form of focal motor epilepsy. Although classically associated with infective, neoplastic or vascular causes, it may follow traumatic brain injury. A 37-year-old man had sustained a severe brain injury when aged 2 years. Following a generalised tonic-clonic seizure at the age of 9 years, he subsequently had brief and recurrent episodes of bilateral lingual twitching that persisted into adulthood. These events were refractory to carbamazepine, lacosamide and valproate. MR brain imaging showed cystic encephalomalacia of the left frontal operculum. Electroencephalography showed irregular and sharpened left-sided slow waves but no epileptiform activity, even during episodes of lingual twitching. Bilateral lingual seizures in this patient implied that the left operculum cortex innervated both hypoglossal nuclei.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026510","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":"Drug-induced Pisa syndrome from long-term trimipramine.","authors":"Tsun Ming Lau, Heidi Elizabeth Cox, Jan Coebergh","doi":"10.1136/pn-2026-005294","DOIUrl":"https://doi.org/10.1136/pn-2026-005294","url":null,"abstract":"","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026577","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}
Julian Leto, Belinda Errington, Katharine Kline, Heidi Beadnall, Michael Barnett, Judith M Spies, Nicolás Urriola
{"title":"Severe gastrointestinal dysmotility in autoimmune autonomic ganglionopathy: recognition, reclassification and reversal.","authors":"Julian Leto, Belinda Errington, Katharine Kline, Heidi Beadnall, Michael Barnett, Judith M Spies, Nicolás Urriola","doi":"10.1136/pn-2026-005287","DOIUrl":"https://doi.org/10.1136/pn-2026-005287","url":null,"abstract":"<p><p>A 30-year-old woman presented with sepsis. She had chronic severe gastrointestinal dysmotility and depended on parenteral nutrition. Further history identified orthostatic intolerance, hypohidrosis and recurrent opioid-induced respiratory depression. She was noted incidentally to have tonic pupils; applying topical apraclonidine and dilute pilocarpine eye drops demonstrated both sympathetic and parasympathetic pupil denervation. Serum testing identified antibodies against the ganglionic nicotinic acetylcholine receptor, consistent with autoimmune autonomic ganglionopathy. After treatment with plasma exchange and pulsed intravenous cyclophosphamide, all features of autonomic dysfunction had improved by 3 months. Parenteral nutrition was soon stopped completely, and at 12 months, she had sustained remission of all symptoms of autonomic dysfunction while taking maintenance immunosuppression with mycophenolic acid. Accurate diagnosis of autoimmune autonomic ganglionopathy can allow functional cure of chronic severe gastrointestinal dysmotility with appropriate immunosuppression. Neurologists and non-neurologists should be aware of this condition.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026484","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":"Encephalitic rabies following cat bites: two cases in northern Uganda.","authors":"Dan Langoya Oriba, Annet Adongpiny, Neil Scolding","doi":"10.1136/pn-2026-005099","DOIUrl":"10.1136/pn-2026-005099","url":null,"abstract":"<p><p>Although rabies continues to exert a major global health impact, only a very small minority of UK neurologists will ever have encountered cases, and many remain unfamiliar with its diagnosis and management. The recent death of a UK national, in Yorkshire, emphasises the importance of general neurologists having familiarity with the manifestations of rabies. Here, we describe two cases of Ugandan males who developed rapidly fatal encephalitic rabies following cat bites. We outline their clinical features and summarise current diagnostic and management approaches.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":"487-490"},"PeriodicalIF":2.5,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147663441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Omar Bokhari, Sarah Alqhtani, Laila Alqahtani, Benjamin Whatley
{"title":"Aphasic status epilepticus complicating hyperosmolar hyperglycaemic state.","authors":"Omar Bokhari, Sarah Alqhtani, Laila Alqahtani, Benjamin Whatley","doi":"10.1136/pn-2025-004936","DOIUrl":"10.1136/pn-2025-004936","url":null,"abstract":"<p><p>Aphasic status epilepticus is a rare neurological complication of the hyperosmolar hyperglycaemic state, a severe metabolic emergency in diabetes mellitus. Symptoms include language disturbance without significantly impaired consciousness. The diagnosis is complex, and management of the aphasic status epilepticus involves metabolic correction and antiseizure medications. We describe a 66-year-old man with type 2 diabetes who presented with progressive speech decline and impaired coordination following a fall. EEG confirmed non-convulsive status epilepticus, and MR brain scan showed transient left temporal changes with later hippocampal atrophy. Initial treatment with insulin and levetiracetam led to significant recovery. This case underscores hyperosmolar hyperglycaemic states as a reversible cause of aphasic status epilepticus and highlights the varied neurological presentations of uncontrolled diabetes. We include a review of the literature to contextualise this under-recognised clinical entity.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":"479-483"},"PeriodicalIF":2.5,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145678964","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}