ISSN 1473-9348 VOLUME 10 ISSUE 4 SEPTEMBER/OCTOBER 2010 ACNRwww.acnr.co.uk ADVANCES IN CLINICAL NEUROSCIENCE & REHABILITATION In this issue Gérard Said – Vasculitic Neuropathy Famous Neurologists J van Gijn – Joseph Babinski 1857-1932 Hugh Rickards – How Helpful is it to Global Outcome to Treat Abnormal Movements in Tourette’s Syndrome? Personal Perspectives Parkinson’s Disease: personal experience NEWS REVIEW > CONFERENCE REPORTS > BOOK REVIEWS > JOURNAL REVIEWS > EVENTS DIARY Make a lasting impression By initiating early Azilect monotherapy, you can maintain your patients’ overall motor performance.1,2 So make a lasting impression – initiate Azilect monotherapy early in the course of Parkinson’s disease.3 Simple and effective when it matters Azilect ® 1mg tablets in patients treated concomitantly with antidepressants/SNRIs and POM Marketing Authorisation Number: 1mg tablets (28 pack size) Prescribing information (Please refer to the Summary of Product rasagiline. Avoid concomitant use with fluoxetine or fluvoxamine. EU/1/04/304/003 Marketing Authorisation Holder: Teva Pharma Characteristics (SmPC) before prescribing) Presentation: Tablets Leave at least five weeks between discontinuation of fluoxetine and GmbH, Kandelstr 10, D-79199 Kirchzarten Germany Date last revised: containing 1mg rasagiline (as the mesilate). Indication: Treatment initiation of treatment with rasagiline. Leave at least 14 days between December 2009. Further information available from: Lundbeck of idiopathic Parkinson’s disease as monotherapy or as adjunct to discontinuation of rasagiline and initiation of treatment with fluoxetine Limited, Lundbeck House, Caldecotte Lake Business Park, Caldecotte, levodopa in patients with end of dose fluctuations. Dosage and or fluvoxamine. Administer potent CYP1A2 inhibitors with caution. Milton Keynes, MK7 8LG administration: Oral, 1mg once daily taken with or without food Co-administration with dextromethorphan or sympathomimetics and with or without levodopa. Elderly: No change in dosage required. not recommended. Avoid use in patients with moderate hepatic Children and adolescents (<18 years): Not recommended. Patients impairment. Use caution in patients with mild hepatic impairment. Use Adverse events should be reported. Reporting with renal impairment: No change in dosage required. Patients with with caution in pregnancy or lactation. There is an increased risk of skin forms and information can be found at hepatic impairment: Predominant hepatic metabolism. Do not use in cancer in Parkinson’s disease, not associated with any particular drug. www.yellowcard.gov.uk. Adverse events should patients with severe impairment. Avoid use in patients with moderate Suspicious skin lesions require specialist evaluation. Cases of elevated also be reported to Teva Pharmaceuticals Ltd on impairment. Use with caution in patients with mild impairment and blood pressure have been reported in the post-marketing period, telephone number: 01296 719768. stop if progresses to moderate. Overdose: Symptoms reported following including one report of hypertensive crisis associated with the ingestion rasagiline overdose (3-100mg) included dysphoria, hypomania, of unknown amounts of tyramine. Undesirable effects in clinical trials: hypertensive crisis and serotonin syndrome. Contraindications: Monotherapy: >1%: headache, influenza, skin carcinoma, leucopenia, References: Hypersensitivity to the active substance or to any of the excipients. Do allergy, depression, hallucinations, conjunctivitis, vertigo, angina 1. Olanow CW et al. N Engl J Med 2009;361:1268-78. not use in patients with severe hepatic impairment. Co-administration pectoris, rhinitis, flatulence, dermatitis, musculoskeletal pain, neck 2. Parkinson Study Group. Arch Neurol 2002;59:1937-1943. of other monoamine oxidase (MAO) inhibitors is contraindicated pain, arthritis, urinary urgency, fever, malaise. <1%: decreased appetite, 3. Horstink M et al. Eur J Neurol 2006;13:1170-1185. due to risk of hypertensive crises. Concomitant pethidine treatment cerebrovascular accident, myocardial infarction, vesiculobullous rash. is contraindicated. Allow at least 14 days off rasagiline before using Adjunct therapy: >1%: dyskinesia, decreased appetite, hallucinations, other MAO inhibitors or pethidine. Special warnings and precautions: abnormal dreams, dystonia, carpal tunnel syndrome, balance disorder, Administer antidepressants with caution as serious adverse reactions orthostatic hypotension, abdominal pain, constipation, nausea and have been reported with concomitant use of selective serotonin vomiting, dry mouth, rash, arthralgia, neck pain, decreased weight, reuptake inhibitors (SSRIs), serotonin noradrenaline reuptake inhibitors fall. <1%: skin melanoma, confusion, cerebrovascular accident, angina (SNRIs), tricyclic and tetracyclic antidepressants, and MAO inhibitors. pectoris. Please refer to the SmPC for the rates of adverse events. Cases of serotonin syndrome have been reported post-marketing Basic NHS Price: Azilect® (tablets) 1mg x 28 £70.72 Legal category: Job No. 0210/AZL/501/053 Date of preparation: April 2010 AWARDS AND APPOINTMENTS Editorial board and contributors Roger Barker is co-editor of ACNR, and is Honorary Consultant in ABN Case Report Winner Neurology at The Cambridge Centre for Brain Repair. His main area of research is into neurodegenerative and movement disorders, in particular Congratulations to Dr Charles Marshall who has parkinson's and Huntington's disease. He is also the university lecturer in received £100 from ACNR, for winning the ABN case Neurology at Cambridge where he continues to develop his clinical research report competition. Dr Marshall studied Medicine at into these diseases along with his basic research into brain repair using neu- Oxford and UCL, and is currently a Neurology ral transplants. Registrar in London. Alasdair Coles is co-editor of ACNR. He is a University Lecturer in Neuroimmuniology at Cambridge University. He works on experimental immunological therapies in multiple sclerosis. Queen's Birthday Honours Congratulations to Professor Linda Luxon, who has been awarded a CBE in the Queen's Birthday Honours for services to medicine. Mike Zandi is co-editor of ACNR. He is an Honorary Specialist Registrar in Professor Luxon is a Consultant in Neuro-otology at the Neurology at Addenbrooke's Hospital, Cambridge and a Research Fellow at National Hospital for Neurology and Neurosurgery and Professor Cambridge University. His research interests are in neuroimmunology, bio- of Audiovestibular Medicine at the UCL Ear Institute. markers and therapeutics in particular. She is the Director of the UCL MSc programme in Audiovestibular Medicine and supervisor to a number of PhD, MD and post-doctoral students across a range of topics including genetic, autoimmune and noise induced hearing loss, paediatric vestibular disorders, Stephen Kirker is the editor of the Rehabilitation Section of ACNR and novel vestibular rehabilitation, auditory electrophysiology, efferent auditory Consultant in Rehabilitation Medicine in Addenbrooke's NHS Trust, Cambridge. He trained in neurology in Dublin, London and Edinburgh dysfunction and auditory processing. before moving to rehabilitation in Cambridge and Norwich. His main research has been into postural responses after stroke. His particular inter- ests are in prosthetics, orthotics, gait training and neurorehabilitation. New Awards for Innovation in Acquired David J Burn is the editor of our Conference News Section and is Professor in Movement Disorder Neurology & Honorary Consultant, Brain Injury Newcastle General Hospital. He runs Movement Disorders clinics in Newcastle-upon-Tyne. Research interests include progressive supranuclear The United Kingdom Acquired Brain Injury Forum has announced an award palsy and dementia with Lewy bodies. He is also involved in several drugs scheme for innovation in the field of acquired brain injury. The aim of the awards studies for Parkinson's Disease. is to acknowledge the good work which is being done in the sector and reward those who excel in their practice. Due to the variety of professions in the sector Andrew Larner is the editor of our Book Review Section. He is a the awards have been divided into a number of cate- Consultant Neurologist at the Walton Centre for Neurology and gories: Neurosurgery in Liverpool, with a particular interest in dementia and cogni- • Innovation by a law firm in the field of ABI tive disorders. He is also an Honorary Apothecaries' Lecturer in the History • Innovation by a clinician in the field of ABI of Medicine at the University of Liverpool. • Innovation by a care provider in the field of ABI • Innovation by a social care worker in the field of ABI • Innovation by a voluntary sector provider or registered Alastair Wilkins is our Case Report Co-ordinator. He is Senior Lecturer in charity in the field of ABI Neurology and Consultant Neurologist, University of Bristol. He trained in ‘We know that there are many people who go the extra mile or come up with a Neurology in Cambridge, Norwich and London. His research interests are clever idea which goes unrecognised. We are not necessarily looking for big proj- the basic science of axon degeneration and developing treatments for pro- ects – these might be very small things which help to make life easier for those gressive multiple sclerosis. people suffering from an acquired brain injury,’ said Professor Mike Barnes, Chair of UKABIF. Nominations may be made by those involved in or benefiting from a project