1
|
Wigglesworth S, Neligan A, Dickson JM, Pullen A, Yelland E, Anjuman T, Reuber M. The incidence and prevalence of epilepsy in the United Kingdom 2013-2018: A retrospective cohort study of UK primary care data. Seizure 2023; 105:37-42. [PMID: 36702018 DOI: 10.1016/j.seizure.2023.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/20/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023] Open
Abstract
PURPOSE The aim of this study was to update overall incidence and prevalence calculations for epilepsy of the United Kingdom (UK) and its constituent nations (England, Northern Ireland, Scotland, and Wales). METHODS We used data from primary care practices contributing to the Clinical Practice Research Datalink (CRPD), based on the electronic health records of 14 million patients, representing approximately 20% of the population. CPRD contains data from two different health record systems: the Vision clinical system (CPRD GOLD database) and the EMIS Web® clinical system (CPRD Aurum database). We calculated incidence and prevalence rates with 95% confidence intervals (CIs). Data were stratified by age, gender, deprivation, country (England, Scotland, Wales and Northern Ireland) and region (England only). RESULTS In the UK, the estimated overall point prevalence for epilepsy was 9.37 per 1000 persons / year (95% CI 9.34-9.40) and the overall estimated incidence rate was 42.68 per 100,000 person-years (95% 42.18-43.18) using the CPRD GOLD database. In England, the estimated incidence (37.41 (95% CI 36.96-37.83)) and prevalence (8.85 (95% CI 8.83-8.87)) was lower (combined databases) compared to figures for Scotland (incidence 47.76 (95% CI 46.15-49.42)); prevalence 10.13 (95% CI 10.06-10.20)) (CPRD GOLD only), Wales (incidence 54.84 (95% CI 52.79-56.95); prevalence 11.40 (95% CI 11.31-11.49)) (CPRD GOLD only) and Northern Ireland (incidence 46.18 (95% CI 43.13-49.90); prevalence 12.08 (95% CI 11.93-12.23))(combined databases). Prevalence and incidence were higher in more deprived regions. CONCLUSION The prevalence and incidence of epilepsy in the UK is broadly in line with other high income countries, showing the usual pattern of high incidence in the young and the old, with a nadir in middle age. The prevalence of epilepsy has fallen slightly since 2011. There is significant geographical variation (between countries and between regions), and a suggestion of a relationship between deprivation and epilepsy which needs further investigation.
Collapse
Affiliation(s)
- S Wigglesworth
- Former employee of Epilepsy Action, Yeadon, Leeds, United Kingdom.
| | - A Neligan
- Homerton University Hospital Foundation Trust, Homerton Row, London E9 6SR, United Kingdom; DCEE, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, United Kingdom
| | - J M Dickson
- Academic Unit of Primary Medical Care, The University of Sheffield, Sheffield, United Kingdom
| | - A Pullen
- Epilepsy Research UK, London, United Kingdom
| | - E Yelland
- Medicines and Healthcare products Regulatory Agency, London, United Kingdom
| | - T Anjuman
- Medicines and Healthcare products Regulatory Agency, London, United Kingdom
| | - M Reuber
- Academic Neurology Unit, University of Sheffield, Sheffield, United Kingdom
| |
Collapse
|
2
|
Noble AJ, Mason SM, Bonnett LJ, Reuber M, Wright J, Pilbery R, Jacques RM, Simpson RM, Campbell R, Fuller A, Marson AG, Dickson JM. Supporting the ambulance service to safely convey fewer patients to hospital by developing a risk prediction tool: Risk of Adverse Outcomes after a Suspected Seizure (RADOSS)-protocol for the mixed-methods observational RADOSS project. BMJ Open 2022; 12:e069156. [PMID: 36375988 PMCID: PMC9668054 DOI: 10.1136/bmjopen-2022-069156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Ambulances services are asked to further reduce avoidable conveyances to emergency departments (EDs). Risk of Adverse Outcomes after a Suspected Seizure seeks to support this by: (1) clarifying the risks of conveyance and non-conveyance, and (2) developing a risk prediction tool for clinicians to use 'on scene' to estimate the benefits an individual would receive if conveyed to ED and risks if not. METHODS AND ANALYSIS Mixed-methods, multi-work package (WP) project. For WP1 and WP2 we shall use an existing linked data set that tracks urgent and emergency care (UEC) use of persons served by one English regional ambulance service. Risk tools are specific to clinical scenarios. We shall use suspected seizures in adults as an exemplar.WP1: Form a cohort of patients cared for a seizure by the service during 2019/2020. It, and nested Knowledge Exchange workshops with clinicians and service users, will allow us to: determine the proportions following conveyance and non-conveyance that die and/or recontact UEC system within 3 (/30) days; quantify the proportion of conveyed incidents resulting in 'avoidable ED attendances' (AA); optimise risk tool development; and develop statistical models that, using information available 'on scene', predict the risk of death/recontact with the UEC system within 3 (/30) days and the likelihood of an attendance at ED resulting in an AA.WP2: Form a cohort of patients cared for a seizure during 2021/2022 to 'temporally' validate the WP1 predictive models.WP3: Complete the 'next steps' workshops with stakeholders. Using nominal group techniques, finalise plans to develop the risk tool for clinical use and its evaluation. ETHICS AND DISSEMINATION WP1a and WP2 will be conducted under database ethical approval (IRAS 307353) and Confidentiality Advisory Group (22/CAG/0019) approval. WP1b and WP3 have approval from the University of Liverpool Central Research Ethics Committee (11450). We shall engage in proactive dissemination and knowledge mobilisation to share findings with stakeholders and maximise evidence usage.
Collapse
Affiliation(s)
- Adam J Noble
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Suzanne M Mason
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Laura J Bonnett
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Markus Reuber
- Academic Neurology Unit, The University of Sheffield, Sheffield, UK
| | | | - Richard Pilbery
- Research and Development Department, Yorkshire Ambulance Service NHS Trust, Wakefield, UK
| | - Richard M Jacques
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Rebecca M Simpson
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Richard Campbell
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | | | - Anthony Guy Marson
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Jon Mark Dickson
- Academic Unit of Primary Medical Care, The University of Sheffield, Sheffield, UK
| |
Collapse
|
3
|
Clark J, Copsey B, Wright-Hughes A, McNaught E, Bijsterveld P, McCormack T, Foy R, Wilkes S, Dickson JM, Meads D, Farrin A, Johnson M. Cancer patients' needs assessment in primary care: study protocol for a cluster randomised controlled trial (cRCT), economic evaluation and normalisation process theory evaluation of the needs assessment tool cancer (CANAssess). BMJ Open 2022; 12:e051394. [PMID: 35508352 PMCID: PMC9073401 DOI: 10.1136/bmjopen-2021-051394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Unmet needs in patients with cancer and their carers are common but poorly identified and addressed. The Needs Assessment Tool-Cancer (NAT-C) is a structured consultation guide to identify and triage patient and carer unmet needs. The NAT-C is validated, but its effectiveness in reducing unmet patient and carer needs in primary care is unknown. METHODS AND ANALYSIS Cluster randomised controlled trial with internal pilot and embedded process evaluation to test the clinical and cost effectiveness of the NAT-C in primary care for people with active cancer in reducing unmet patient and carer need, compared with usual care. We will recruit 1080 patients with active cancer (and carers if relevant) from 54 general practices in England.Participating practices will be randomised 1:1 to either deliver an NAT-guided clinical consultation plus usual care or to usual care alone. Consenting participants with active cancer and their carers (if nominated) will be asked to complete study questionnaires at baseline, 1 and 3 months for all, 6 months except for those recruited outside of the last 3 months of recruitment, and attend an NAT-C appointment if allocated to an intervention practice. An internal pilot will assess: site and participant recruitment, intervention uptake and follow-up rates. The primary outcome, the proportion of patients with an unmet need on the Supportive Care Needs Survey Short Form 34 at 3 months postregistration, will be analysed using a multilevel logistic regression. Mixed-methods process evaluation informed by Normalisation Process Theory will use quantitative survey and interview data from clinicians and key stakeholders in cancer care to develop an implementation strategy for nationwide rollout of the NAT-C if the intervention is cost-effective. ETHICS AND DISSEMINATION Ethical approval from London-Surrey REC (20/LO/0312). Results will be peer-reviewed, published and made available to research participants. TRIAL REGISTRATION NUMBER ISRCTN15497400.
Collapse
Affiliation(s)
- Joseph Clark
- Wolfson Palliative Care Research Centre, University of Hull, Hull, UK
| | - Bethan Copsey
- Leeds Institute of Clinical Trials Research, University of Leeds Clinical Trials Research Unit, Leeds, UK
| | | | - Emma McNaught
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | | | | | - Robbie Foy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Scott Wilkes
- School of Pharmacy, University of Sunderland, Sunderland, UK
| | - Jon Mark Dickson
- Academic Unit of Primary Medical Care, The University of Sheffield, Sheffield, UK
| | - David Meads
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Miriam Johnson
- Wolfson Palliative Care Research Centre, University of Hull, Hull, UK
| |
Collapse
|
4
|
Noble AJ, Mathieson A, Ridsdale L, Holmes EA, Morgan M, McKinlay A, Dickson JM, Jackson M, Hughes DA, Goodacre S, Marson AG. Developing patient-centred, feasible alternative care for adult emergency department users with epilepsy: protocol for the mixed-methods observational 'Collaborate' project. BMJ Open 2019; 9:e031696. [PMID: 31678950 PMCID: PMC6830638 DOI: 10.1136/bmjopen-2019-031696] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Emergency department (ED) visits for epilepsy are common, costly, often clinically unnecessary and typically lead to little benefit for epilepsy management. An 'Alternative Care Pathway' (ACP) for epilepsy, which diverts people with epilepsy (PWE) away from ED when '999' is called and leads to care elsewhere, might generate savings and facilitate improved ambulatory care. It is unknown though what features it should incorporate to make it acceptable to persons from this particularly vulnerable target population. It also needs to be National Health Service (NHS) feasible. This project seeks to identify the optimal ACP configuration. METHODS AND ANALYSIS Mixed-methods project comprising three-linked stages. In Stage 1, NHS bodies will be surveyed on ACPs they are considering and semi-structured interviews with PWE and their carers will explore attributes of care important to them and their concerns and expectations regarding ACPs. In Stage 2, Discrete Choice Experiments (DCE) will be completed with PWE and carers to identify the relative importance placed on different care attributes under common seizure scenarios and the trade-offs people are willing to make. The uptake of different ACP configurations will be estimated. In Stage 3, two Knowledge Exchange workshops using a nominal group technique will be run. NHS managers, health professionals, commissioners and patient and carer representatives will discuss DCE results and form a consensus on which ACP configuration best meets users' needs and is NHS feasible. ETHICS AND DISSEMINATION Ethical approval: NRES Committee (19/WM/0012) and King's College London ethics Committee (LRS-18/19-10353). Primary output will be identification of optimal ACP configuration which should be prioritised for implementation and evaluation. A pro-active dissemination strategy will make those considering developing or supporting an epilepsy ACP aware of the project and opportunities to take part in it. It will also ensure they are informed of its findings. PROJECT REGISTRATION NUMBER Researchregistry4723.
Collapse
Affiliation(s)
- Adam J Noble
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Amy Mathieson
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Leone Ridsdale
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - E A Holmes
- Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Alison McKinlay
- Basic & Clinical Neuroscience, King's College London, London, UK
| | - Jon Mark Dickson
- Academic Unit of Primary Medical Care, The University of Sheffield, Sheffield, UK
| | - Mike Jackson
- North West Ambulance Service NHS Trust, Bolton, UK
| | - Dyfrig A Hughes
- Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Steve Goodacre
- Medical Care Research Unit, University of Sheffield, Sheffield, UK
| | - Anthony G Marson
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| |
Collapse
|
5
|
Cherry MG, Ablett JR, Dickson JM, Powell D, Sikdar S, Salmon P. A qualitative study of the processes by which carers of people with dementia derive meaning from caring. Aging Ment Health 2019; 23:69-76. [PMID: 29105501 DOI: 10.1080/13607863.2017.1393792] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Most individuals with dementia live in the community, receiving care from family or lay carers. Carers' wellbeing, and the quality of the care they provide, partly depends on their ability to derive meaning from caring for someone with dementia. Both carers' previous relationship with their relative and the caregiving process itself contribute to this sense of meaning. However, it remains unclear why some carers derive meaning from these sources, whereas others do not. OBJECTIVE To further explore the processes by which carers derive a sense of meaning from caring. METHODS Representative case sampling was used to recruit a purposive sample of 20 carers for individuals living with dementia. In-depth semi-structured interviews were audio-recorded and transcribed, and analysed using pluralist qualitative methodology. RESULTS A framework of three sources from which carers derived meaning from caring was identified, encompassing: carers' perceptions of how 'right' or 'symmetrical' caring felt in light of their current and previous relationship with the person with dementia; maintenance of a 'protected' sense of self within the care relationship; and carers' perceptions of their 'social connectedness' outside the relationships. CONCLUSION Holistic assessment based on this framework could help to tailor individualised provision of support, foster resilience and safeguard carers' well-being.
Collapse
Affiliation(s)
- M G Cherry
- a Department of Psychological Sciences , University of Liverpool , Liverpool , United Kingdom of Great Britain and Northern Ireland.,b Liverpool Cancer Psychology Service, Linda Mccartney Centre , Royal Liverpool University Hospital , Liverpool , United Kingdom of Great Britain and Northern Ireland
| | - J R Ablett
- b Liverpool Cancer Psychology Service, Linda Mccartney Centre , Royal Liverpool University Hospital , Liverpool , United Kingdom of Great Britain and Northern Ireland.,c Division of Clinical Psychology , University of Liverpool , Liverpool , United Kingdom of Great Britain and Northern Ireland
| | - J M Dickson
- a Department of Psychological Sciences , University of Liverpool , Liverpool , United Kingdom of Great Britain and Northern Ireland.,d Psychology Department (Building 30) , Edith Cowan University , Joondalup , Australia
| | - D Powell
- e Arise Clinical Psychology Liverpool , Liverpool , United Kingdom of Great Britain and Northern Ireland
| | - S Sikdar
- f Older Adults' Mental Health Team , South Sefton Community Resource Centre , Liverpool , United Kingdom of Great Britain and Northern Ireland
| | - P Salmon
- c Division of Clinical Psychology , University of Liverpool , Liverpool , United Kingdom of Great Britain and Northern Ireland
| |
Collapse
|
6
|
Dickson JM, Jacques R, Reuber M, Hick J, Campbell MJ, Morley R, Grünewald RA. Emergency hospital care for adults with suspected seizures in the NHS in England 2007-2013: a cross-sectional study. BMJ Open 2018; 8:e023352. [PMID: 30344177 PMCID: PMC6196871 DOI: 10.1136/bmjopen-2018-023352] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
AIMS To quantify the frequency, characteristics, geographical variation and costs of emergency hospital care for suspected seizures. DESIGN Cross-sectional study using routinely collected data (Hospital Episode Statistics). SETTING The National Health Service in England 2007-2013. PARTICIPANTS Adults who attended an emergency department (ED) or were admitted to hospital. RESULTS In England (population 2011: 53.11 million, 41.77 million adults), suspected seizures gave rise to 50 111 unscheduled admissions per year among adults (≥18 years). This is 47.1% of unscheduled admissions for neurological conditions and 0.71% of all unscheduled admissions. Only a small proportion of admissions for suspected seizures were coded as status epilepticus (3.5%) and there were a very small number of dissociative (non-epileptic) seizures. The median length of stay for each admission was 1 day, the median cost for each admission was £1651 ($2175) and the total cost of all admissions for suspected seizures in England was £88.2 million ($116.2 million) per year. 16.8% of patients had more than one admission per year. There was significant geographical variability in the rate of admissions corrected for population age and gender differences and some areas had rates of admission which were consistently higher than the average. CONCLUSIONS Our data show that suspected seizures are the most common neurological cause of admissions to hospital in England, that readmissions are common and that there is significant geographical variability in admission rates. This variability has not previously been reported in the published literature. The cause of the geographical variation is unknown; important factors are likely to include prevalence, deprivation and clinical practice and these require further investigation. Dissociative seizures are not adequately diagnosed during ED attendances and hospital admissions.
Collapse
Affiliation(s)
- Jon Mark Dickson
- The Academic Unit of Primary Medical Care, The University of Sheffield, Sheffield, UK
| | | | - Markus Reuber
- Academic Neurology Unit, The University of Sheffield, Sheffield, UK
| | | | | | | | - Richard A Grünewald
- Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| |
Collapse
|
7
|
Dickson JM, Rawlings GH, Grünewald RA, Miles K, Mack C, Heywood T, Reuber M. An alternative care pathway for suspected seizures in pre-hospital care: a service evaluation. Br Paramed J 2017. [DOI: 10.29045/14784726.2017.2.2.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
8
|
Abstract
OBJECTIVE To determine the clinical characteristics, management and outcomes of patients taken to hospital by emergency ambulance after a suspected seizure. DESIGN Quantitative cross-sectional retrospective study of a consecutive series of patients. SETTING An acute hospital trust in a large city in England. PARTICIPANTS In 2012-2013, the regions' ambulance service managed 605 481 emergency incidents, 74 141/605 481 originated from Sheffield (a large city in the region), 2121/74 141 (2.9%) were suspected seizures and 178/2121 occurred in May 2012. We undertook detailed analysis of the medical records of the 91/178 patients who were transported to the city's acute hospital. After undertaking a retrospective review of the medical records, the best available aetiological explanation for the seizures was determined. RESULTS The best available aetiological explanation for 74.7% (68/91) of the incidents was an epileptic seizure, 11.0% (10/91) were psychogenic non-epileptic seizures and 9.9% (9/91) were cardiogenic events. The epileptic seizures fall into the following four categories: first epileptic seizure (13.2%, 12/91), epileptic seizure with a historical diagnosis of epilepsy (30.8%, 28/91), recurrent epileptic seizures without a historical diagnosis of epilepsy (20.9%, 19/91) and acute symptomatic seizures (9.9%, 9/91). Of those with seizures (excluding cardiogenic events), 2.4% (2/82) of patients were seizing on arrival in the Emergency Department (ED), 19.5% (16/82) were postictal and 69.5% (57/82) were alert. 63.4% (52/82) were discharged at the end of their ED attendance and 36.5% (19/52) of these had no referral or follow-up. CONCLUSIONS Most suspected seizures are epileptic seizures but this is a diagnostically heterogeneous group. Only a small minority of patients require emergency medical care but most are transported to hospital. Few patients receive expert review and many are discharged home without referral to a specialist leaving them at risk of further seizures and the associated morbidity, mortality and health services costs of poorly controlled epilepsy.
Collapse
Affiliation(s)
- Jon Mark Dickson
- The Academic Unit of Primary Medical Care, The Medical School, Sheffield, England
| | - Hannah Dudhill
- Sheffield Medical School, The University of Sheffield, Sheffield, South Yorkshire, UK
| | - Jane Shewan
- Research and Development, Yorkshire Ambulance Service NHS Trust, Wakefield, UK
| | - Sue Mason
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Richard A Grünewald
- Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Markus Reuber
- Academic Neurology Unit, The University of Sheffield, Sheffield, UK
| |
Collapse
|
9
|
Dickson JM, Peacock M, Grünewald RA, Howlett S, Bissell P, Reuber M. Non-epileptic attack disorder: the importance of diagnosis and treatment. BMJ Case Rep 2017; 2017:bcr-2016-218278. [PMID: 28249881 DOI: 10.1136/bcr-2016-218278] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 50-year-old woman was taken to hospital by emergency ambulance during her first seizure. She was admitted to hospital, treated with intravenous diazepam, diagnosed with epilepsy and started on antiepileptic drug (AED) therapy. This was ineffective so she was referred to a tertiary centre where she underwent video EEG and was diagnosed with non-epileptic attack disorder. Her experience of the diagnosis was positive; it allowed her to understand what was happening to her and to understand the link between her seizures, adverse childhood experiences and the death of her mother. She stopped taking AEDs and she was referred to a psychologist which led to a significant improvement in her functioning and quality of life. We present this case as a good example of the benefits of accurate diagnosis, clear explanation and access to specialist care.
Collapse
Affiliation(s)
- Jon Mark Dickson
- Academic Unit of Primary Medical Care, The University of Sheffield, Sheffield, UK
| | | | | | - Stephanie Howlett
- Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Paul Bissell
- Section of Public Health, ScHARR, The University of Sheffield, UK
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, UK
| |
Collapse
|
10
|
Affiliation(s)
- Simon Bell
- Sheffield Teaching Hospital NHS Trust, Sheffield, UK
| | | | | | - Daniel Blackburn
- Sheffield Teaching Hospital NHS Trust, Sheffield, UK University of Sheffield, Sheffield, UK
| |
Collapse
|
11
|
Dickson JM, Naylor G, Colver G, Powers HJ, Masters P. Multiple vitamin deficiencies in a patient with a history of chronic alcohol excess and self-neglect in the UK. BMJ Case Rep 2014; 2014:bcr-2014-204523. [PMID: 25246460 DOI: 10.1136/bcr-2014-204523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report a case of inadequate diet (caused by extreme self-neglect and alcohol excess) which led to chronic severe deficiencies of vitamins A, D and E. At presentation the patient had widespread follicular hyperkeratosis of the skin, keratomalacia of both eyes and a severe cognitive impairment. He responded well to treatment including high dose parenteral vitamins, but lasting impairments in his vision and cognition have caused permanent disability.
Collapse
Affiliation(s)
- Jon Mark Dickson
- Academic Unit of Primary Medical Care, The University of Sheffield, Sheffield, UK
| | - Greg Naylor
- Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield, UK
| | - Graham Colver
- Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield, UK
| | - Hilary J Powers
- Human Nutrition Unit, The University of Sheffield, Sheffield, UK
| | - Paul Masters
- Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield, UK
| |
Collapse
|
12
|
Dickson JM, Wilkinson ID, Howell SJL, Griffiths PD, Grünewald RA. Idiopathic generalised epilepsy: a pilot study of memory and neuronal dysfunction in the temporal lobes, assessed by magnetic resonance spectroscopy. J Neurol Neurosurg Psychiatry 2006; 77:834-40. [PMID: 16574726 PMCID: PMC2117498 DOI: 10.1136/jnnp.2005.086918] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The memory deficits in patients with temporal lobe epilepsy (TLE) are associated with epileptogenic lesions of the temporal lobes, especially hippocampal sclerosis. Memory deficits have been extensively studied in TLE, but the presence of pre-existing temporal lobe abnormality has confounded studies on the relationship between memory dysfunction and seizure activity. Idiopathic generalised epilepsy (IGE) is characterised by primary generalised seizures and is found to occur in the absence of any macroscopic brain abnormalities. IGE is therefore ideal for investigations on the effects of seizure activity on memory and cognition. AIM AND METHODS Magnetic resonance spectroscopy (MRS) and neuropsychological testing were used to investigate the relationship between epileptic seizures, memory performance and neuronal dysfunction in the temporal lobes of a group of patients with IGE. 30 patients and 15 healthy controls participated in the study. RESULTS Patients with IGE were found to perform worse than controls on tests of speed of information processing, general cognitive performance and a range of memory tests, including face recognition, word recognition, verbal recall and complex figure recall. The performance of the patient group on the visual recognition and verbal recall sections of the Doors and People Test was found to correlate with MRS ratios of N-acetyl aspartate:choline and N-acetyl aspartate:creatine in the temporal lobes. CONCLUSION This result supports the hypothesis that memory deficits in epilepsy may be due to neuronal dysfunction secondary to epileptic activity itself in the absence of any macroscopic lesions in the temporal lobes.
Collapse
Affiliation(s)
- J M Dickson
- Department of Biomedical Science, University of Sheffield, Sheffield, UK.
| | | | | | | | | |
Collapse
|
13
|
Dickson JM, Weavers HM, Mitchell N, Winter EM, Wilkinson ID, Van Beek EJR, Wild JM, Griffiths PD. The effects of dehydration on brain volume -- preliminary results. Int J Sports Med 2005; 26:481-5. [PMID: 16037892 DOI: 10.1055/s-2004-821318] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In adults the cranium is a rigid bony vault of fixed size and therefore the intra-cranial volume is a constant which equals the sum of the volume of the brain, the intra-cranial volume of CSF and the intra-cranial volume of blood. There can be marked changes in the volumes of these three intra-cranial compartments which may influence susceptibility to brain damage after head injury. This is the first study to investigate the relationship between dehydration and changes in the volume of the brain and the cerebral ventricles. Six healthy control subjects underwent magnetic resonance imaging of the brain before and after a period of exercise in an environmental chamber. The subjects lost between 2.1 % and 2.6 % of their body mass due to water loss through sweating. We found a correlation between the degree of dehydration and the change in ventricular volume (r=0.932, p=0.007). The changes in ventricular volume caused by dehydration were much larger than those seen in day-to-day fluctuations in a normally hydrated healthy control subject.
Collapse
Affiliation(s)
- J M Dickson
- Department of Biomedical Science, The University of Sheffield, Sheffield, UK.
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Wilkinson ID, Hadjivassiliou M, Dickson JM, Wallis L, Grünewald RA, Coley SC, Widjaja E, Griffiths PD. Cerebellar abnormalities on proton MR spectroscopy in gluten ataxia. J Neurol Neurosurg Psychiatry 2005; 76:1011-3. [PMID: 15965215 PMCID: PMC1739706 DOI: 10.1136/jnnp.2004.049809] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Gluten sensitivity can manifest with ataxia. The metabolic status of the cerebellum was investigated in 15 patients with gluten ataxia and 10 controls using proton MR spectroscopy. Significant differences were present in mean N-acetyl aspartate levels at short echo time and N-acetyl aspartate/choline ratios at long echo time between the patient and control groups. These data support the hypothesis that cerebellar neuronal physiology differs between patients with gluten ataxia and healthy controls.
Collapse
Affiliation(s)
- I D Wilkinson
- Academic Unit of Radiology, University of Sheffield, Sheffield, England.
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Dickson JM, Weavers HM, Mitchell N, Winter EM, Wilkinson ID, VanBeek EJR, Griffiths PD. Choice of cross size in stereology--a cautionary note. Neuroradiology 2003; 45:896-9. [PMID: 13680031 DOI: 10.1007/s00234-003-1091-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2003] [Accepted: 07/23/2003] [Indexed: 11/29/2022]
Abstract
The stereological method of cross-counting based on the Cavalieri principle is widely used in neuroimaging to estimate the volume of cerebral structures. Although superficially simple, the stereological technique is validated by arcane mathematical proofs, so the cross size is determined by most investigators on a pragmatic basis with the assumption that the volume calculated is independent of the cross size used. We used three cross sizes (8x8, 5x5 and 3x3 voxels) to estimate the brain volume of six healthy control subjects. The volume estimate using a cross size of 3x3 was 9% larger than with a cross size of 5x5 and the latter was 15% larger than with a cross size of 8x8. We conclude that cross size significantly affects whole brain volume estimates and this result is presumably applicable to other structures whose cross-sectional areas form complex shapes. Investigators should be aware of this fact, especially when trying to make direct comparisons between volume estimates derived from the stereological method using different cross sizes.
Collapse
Affiliation(s)
- J M Dickson
- Department of Biomedical Science, Alfred Denny Building, University of Sheffield, Western Bank, Sheffield, S10 2TN, UK.
| | | | | | | | | | | | | |
Collapse
|
16
|
|
17
|
|
18
|
Griffiths A, Dickson JM, Griffiths CH. Determination of the Coefficient of Diffusion of Potassium Chloride by an Analytical Method. ACTA ACUST UNITED AC 2002. [DOI: 10.1088/1478-7814/28/1/308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
19
|
|
20
|
Dickson JM, Vincze E, Grant MR, Smith LA, Rodber KA, Farnden KJ, Reynolds PH. Molecular cloning of the gene encoding developing seed L-asparaginase from Lupinus angustifolius. Plant Mol Biol 1992; 20:333-6. [PMID: 1391778 DOI: 10.1007/bf00014503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
A genomic sequence encoding Lupinus angustifolius L-asparaginase has been obtained, and is the first report of this gene from a plant source. The 3.2 kb of DNA sequenced contains a 1136 bp 5' flanking sequence, four exons and three introns. Intron-exon borders were mapped by comparing the genomic sequence with that of a L. arboreus cDNA. Primer extension analysis revealed transcription start sites 16 bp and 13 bp 5' of the initiating ATG for L. angustifolius and L. arboreus, respectively. The 5' flanking region contained sequences associated with seed-specific expression.
Collapse
Affiliation(s)
- J M Dickson
- Immunology and Plant Molecular Biology Unit, Department of Scientific and Industrial Research-Fruit and Trees, Palmerston North, New Zealand
| | | | | | | | | | | | | |
Collapse
|
21
|
Abstract
One hundred seventy-four youthful psychiatric inpatients were given the Draw-A-Person Test (DAP) as part of an assessment battery. Sex of person drawn was compared to subject's sex, Achenbach aggression and delinquency scores, and scores on Children's Inventory of Anger and Nowicki-Strickland Locus of Control Scale. The sex of the person drawn was also compared to family composition, specifically whether or not the child came from an intact family with both a male and female parent or role model. Results support drawing of a same-sexed individual as normative, regardless of age or sex. Adolescent girls and young boys were the only groups that differed significantly from this norm. Personality measures and family composition were not significantly related to the tendency to draw same versus opposite sex.
Collapse
|
22
|
Abstract
The importance of the physical therapist in the ICU nursery is in early detection and intervention, which is often critical to the success of treatment in any field of medicine or remedial education. Based on information about neurological development, movement is often the first and possibly only external indicator that development of an infant is abnormal. Movement is an area of special interest for which the physical therapist has the potential of having much expertise for providing early identification and intervention. Research is needed to validate this role. Neonatology is a young, rapidly growing medical specialty that deserves input from an allied health profession that can provide valuable knowledge and services to complement and expand the complex treatment of the high-risk newborn.
Collapse
|
23
|
Holliday R, Pukkila PJ, Dickson JM, Spanos A, Murray V. Relationships between the correction of mismatched bases in DNA and mutability. Cold Spring Harb Symp Quant Biol 1979; 43 Pt 2:1317-23. [PMID: 290445 DOI: 10.1101/sqb.1979.043.01.151] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
24
|
Brown GA, Kuelling BL, Dickson JM. Objective measurement of motor skill acquisition. Phys Ther 1973; 53:864-6. [PMID: 4719854 DOI: 10.1093/ptj/53.8.864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
25
|
Abstract
A system for care and maintenance of the common vampire bat in captivity is reported, which results in easy handling and a thriving breeding colony. A method for anaesthetising bats and collecting saliva is described.
Collapse
|
26
|
Hamerton JL, Dickson JM, Pollard CE, Grieves SA, Short RV. Genetic intersexuality in goats. J Reprod Fertil Suppl 1969; 7:Suppl 7:25-51. [PMID: 5272213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|