Advances in Clinical Neuroscience & Rehabilitation

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Advances in Clinical Neuroscience & Rehabilitation ISSN 1473-9348 VOLUME 19 ISSUE 1 AUGUST-OCTOBER 2019 ACNRwww.acnr.co.uk ADVANCES IN CLINICAL NEUROSCIENCE & REHABILITATION In this issue Thanuja Dharmadasa and Neil G Simon – Clinical and research applications of peripheral nerve MRI David Wong and Mike Boggild – Therapeutic plasma exchange in CNS inflammatory demyelinating disorders: time is brain and spine? Rachel Farrell and David Baker – An expert opinion: Optimisation of pharmacological management of multiple sclerosis related spasticity David Veale, A Felix de Carvalho and Jessica Coffin – Safety versus sleep – is a lack of protected sleep time on psychiatry wards bad for mental health? Emma C Argaet, Andrew P Bradshaw and Miriam S Welgampola – Benign Positional Vertigo and its mimics SPECIAL FEATURE JMS Pearce – History of Neurology – Choked disc, optic neuritis, and papilloedema BOOK REVIEWS > CONFERENCE PREVIEWS AND REPORTS > EVENTS DIARY t an irs d F O e n l h y SALIVARY GLANDS T UK * B approved a o t e u h l r in r u lo m ia S neu in r otoxin type A XEOMIN® (botulinum neurotoxin type A) is indicated for the treatment of chronic sialorrhea due to neurological disorders in adults.1 I HAVE GOALS I HAVE ASPIRATIONS HELP ME ACHIEVE THEM XEOMIN® IS INJECTED DIRECTLY INTO THE SALIVARY GLANDS1 PROVIDING TARGETED TREATMENT OF SIALORRHEA2,3 RECOMMENDED TOTAL DOSE 2* GLAND(S) UNITS PER SIDE TOTAL Parotid gland(s) 30 Units 60 Units Submandibular 20 Units 40 Units gland(s) Total 50 Units 100 Units * The timing for repeat treatment should be determined based on the actual clinical need of the individual patient, and no sooner than every 16 weeks, as per the UK marketing authorisation of XEOMIN®. References: 1. XEOMIN® Summary of Product Characteristics (SmPC). 2. Jost WH. et al. Neurology. 2019 Apr 23;92(17):e1982-e1991. doi: 10.1212/WNL.0000000000007368. Epub 2019 Mar 27. 3. Restivo D. et al. Toxins (Basel) 2018; 10(2):55. * As of May 2019 Prescribing information can be found on the facing page. Date of preparation: August 2019 M-XEO-UKI-0499 J000222 A4 Sialorrhea ACNR AD_v3.indd 1 12/08/2019 11:03 CONTENTSAUGUST-OCTOBER 2019 REVIEW ARTICLES 05 Clinical and research applications of BNPA Annual peripheral nerve MRI – Thanuja Dharmadasa and Neil G Simon Meeting 10 Therapeutic plasma exchange in CNS inflammatory demyelinating disorders: time 5th-6th March, 2020 is brain and spine? Kings Place, York Way, London – David Wong and Mike Boggild 20 Benign Positional Vertigo and its mimics Psychedelic drugs in neuropsychiatry – Emma C Argaet, Andrew P Bradshaw and Miriam S Neuropsychiatry of PD Welgampola Psychotic phenomena – hallucinations and beyond REHABILITATION ARTICLE State of the art neuromodulation 13 An expert opinion: Optimisation of *NEW* Interdisciplinary clinical sessions & discussion of pharmacological management of multiple complex cases through psychiatry & neurology lenses sclerosis related spasticity – Rachel Farrell and David Baker Registration: www.bnpa.org.uk ESSAY For all other enquiries including sponsors contact 16 Safety versus sleep – is a lack of protected Jackie Ashmenall sleep time on psychiatry wards bad for Telephone: +44 (0)20 898 76111 mental health? Email: hello@bnpa.org.uk – David Veale, A Felix de Carvalho and Jessica Coffin SPECIAL FEATURE 18 History of Neurology – Choked disc, optic neuritis, and papilloedema – JMS Pearce REGULARS 09 and 17 Book reviews 24 Events diary Advanced Stroke Imaging 25 Conference previews and reports One Day course Cover image shows papilloedema. See article on page 18. 13th November 2019 This one-day course for healthcare professionals provides an overview of using neuroimaging and mechanical thrombectomy to treat people who have had a stroke. This course is run by the UCL Institute of ACNR Neurology in Queen Square. Published by Whitehouse Publishing, 1 The Lynch, Mere, Wiltshire, BA12 6DQ. Publisher. Rachael Hansford E. rachael@acnr.co.uk Course content PUBLISHER AND ADVERTISING • methods for quantifying the impact of a stroke using advanced imaging Rachael Hansford, T. 01747 860168, M. 07989 470278, techniques – from penumbral and core infarct size to methods of E. rachael@acnr.co.uk imaging recovery from stroke • using CT and MRI scans to evaluate infarcts and haemorrhages COURSE ADVERTISING Rachael Hansford, E. Rachael@acnr.co.uk • the benefits nda applications of mechanical thrombectomy EDITORIAL Anna Phelps E. anna@acnr.co.uk Lecture topics will include: Printed by Stephens & George • Evidence basis for thrombectomy Copyright: All rights reserved; no part of this publication may be reproduced, stored in a retrieval • Endovascular services system or transmitted in any form or by any means, electronic, mechanical, photocopying, • Machine learning recording or otherwise without either the prior written permission of the publisher or a license • Foundations of neuroimaging permitting restricted photocopying issued in the UK by the Copyright Licensing Authority. Disclaimer: The publisher, the authors and editors accept no responsibility for loss incurred by any Who this course is for? person acting or refraining from action as a result of material in or omitted from this magazine. Doctors in training / stroke consultants / allied health professionals working Any new methods and techniques described involving drug usage should be followed only in in stroke medicine, You’ll receive a certificate of attendance. There is the conjunction with drug manufacturers’ own published literature. This is an independent publication opportunity for the delegates to submit a case for presentation and panel - none of those contributing are in any way supported or remunerated by any of the companies discussion. The course attracts 8 CPD points by the Federation of the Royal advertising in it, unless otherwise clearly stated. Comments expressed in editorial are those of the Colleges of Physicians of the United Kingdom. The fee for this course is: author(s) and are not necessarily endorsed by the editor, editorial board or publisher. The editor’s decision is final and no correspondence will be entered into. £200 for bookings made from 1 September 2019. ACNR's paper copy is published quarterly, For more information see https://www.ucl.ac.uk/short-courses/ with Online First content and additional email updates. search-courses/advanced-stroke-neuroimaging Sign up at www.acnr.co.uk/subscribe-to-acnrs-e-newsletter For all queries please contact: s.gill@ucl.ac.uk or ion.educationunit@ucl.ac.uk @ACNRJournal /ACNRjournal/ 4 > ACNR > VOLUME 19 NUMBER 1 > AUGUST-OCTOBER 2019 r e v i e w a r t i c l e Clinical and research applications of peripheral nerve MRI Thanuja Dharmadasa Abstract MBBS, PhD, FRACP, is a Neurologist and Postdoctoral The non-invasive exploration of the periph- Research Fellow at the Nuffield eral nervous system using magnetic resonance Department of Clinical Neurosciences, imaging (MRI) has recently gained momentum. University of Oxford. Her clinical The use of basic and advanced MRI protocols and research interests are in neuromuscular and neurodegenerative has allowed for both qualitative and quantita- disorders, with particular focus on tive assessment of the peripheral nerves (PN), motor neuron disease (MND). Dr enabling the structural and functional changes Dharmadasa recently completed her of peripheral pathology to be increasingly inves- PhD investigating MND (University of Sydney) and was awarded the tigated. From a clinical perspective, this has Jim Lance Young Investigator's impacted diagnosis, treatment and monitoring Award in 2017. Her post-doctoral across a variety of conditions. This review will research continues in this area, provide an overview of the current MRI protocols Figure 1: Peripheral nerve anatomy. exploring the development of novel Schematic drawing of a large peripheral nerve. The epineurium neurophysiological and neuroimaging used for PN evaluation, the application of this in insheathes a collection of fascicles interspersed with adipose biomarkers for this disorder. the clinical setting, and the expanding techniques tissue. Each fascicle (enlarged) is surrounded by a perineurium within the research field. and contains axons (myelinated and unmyelinated) that are each enclosed by endoneurial connective tissue. Adapted from [4]. Introduction Peripheral nerves (PN) are involved in a myriad of by endoneurial fluid. This fluid is a main deter- pathologies and represent a significant burden of minant of signal characteristics on non-contrast disease. Gold standard evaluation currently relies T2 scans, appearing moderately hyperintense in on both clinical and electrodiagnostic testing, but the absence of pathology. The nerve fascicle is this bestows certain challenges, particularly in the smallest unit that can be visualised on MRI, early stages of disease when signs and symptoms insheathed by the perineurium. This layer acts may be insidious.1 As such, neuromuscular medi- as a blood-nerve-barrier, and thus no gadolinium Neil G Simon MBBS, PhD, cine is not uncommonly marred by diagnostic contrast enhancement should be seen in healthy FRACP, uncertainty, complicating management and treat- nerves.1,3 is an academic Neurologist with ment decisions. MR neurography (MRN) is a specifically clinical and research interests in nerve Although magnetic resonance imaging (MRI) designed PN protocol that delivers a higher level and muscle imaging, neuromuscular disease and clinical neurophysiology. commands a pivotal role in the clinical assess- of anatomic detail. This usually incorporates a Dr Simon is Head
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