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Cabreira V, Alty J, Antic S, Araújo R, Aybek S, Ball HA, Baslet G, Bhome R, Coebergh J, Dubois B, Edwards M, Filipović SR, Frederiksen KS, Harbo T, Hayhow B, Howard R, Huntley J, Isaacs J, LaFrance WC, Larner AJ, Di Lorenzo F, Main J, Mallam E, Marra C, Massano J, McGrath ER, McWhirter L, Moreira IP, Nobili F, Pennington C, Tábuas-Pereira M, Perez DL, Popkirov S, Rayment D, Rossor M, Russo M, Santana I, Schott J, Scott EP, Taipa R, Tinazzi M, Tomic S, Toniolo S, Tørring CW, Wilkinson T, Frostholm L, Stone J, Carson A. Perspectives on the diagnosis and management of functional cognitive disorder: An international Delphi study. Eur J Neurol 2024:e16318. [PMID: 38700361 DOI: 10.1111/ene.16318] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/18/2024] [Accepted: 04/11/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Current proposed criteria for functional cognitive disorder (FCD) have not been externally validated. We sought to analyse the current perspectives of cognitive specialists in the diagnosis and management of FCD in comparison with neurodegenerative conditions. METHODS International experts in cognitive disorders were invited to assess seven illustrative clinical vignettes containing history and bedside characteristics alone. Participants assigned a probable diagnosis and selected the appropriate investigation and treatment. Qualitative, quantitative and inter-rater agreement analyses were undertaken. RESULTS Eighteen diagnostic terminologies were assigned by 45 cognitive experts from 12 countries with a median of 13 years of experience, across the seven scenarios. Accurate discrimination between FCD and neurodegeneration was observed, independently of background and years of experience: 100% of the neurodegenerative vignettes were correctly classified and 75%-88% of the FCD diagnoses were attributed to non-neurodegenerative causes. There was <50% agreement in the terminology used for FCD, in comparison with 87%-92% agreement for neurodegenerative syndromes. Blood tests and neuropsychological evaluation were the leading diagnostic modalities for FCD. Diagnostic communication, psychotherapy and psychiatry referral were the main suggested management strategies in FCD. CONCLUSIONS Our study demonstrates the feasibility of distinguishing between FCD and neurodegeneration based on relevant patient characteristics and history details. These characteristics need further validation and operationalisation. Heterogeneous labelling and framing pose clinical and research challenges reflecting a lack of agreement in the field. Careful consideration of FCD diagnosis is advised, particularly in the presence of comorbidities. This study informs future research on diagnostic tools and evidence-based interventions.
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Affiliation(s)
- Verónica Cabreira
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Jane Alty
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - Sonja Antic
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Rui Araújo
- Department of Neurology, Centro Hospitalar Universitário São João, Porto, Portugal
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine University of Porto, Porto, Portugal
| | - Selma Aybek
- Neurology, Faculty of Sciences and Medicine, Fribourg University, Fribourg, Switzerland
| | - Harriet A Ball
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Gaston Baslet
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rohan Bhome
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
- Centre for Medical Image Computing, University College London, London, UK
| | - Jan Coebergh
- Department of Neurology, St George's University of London, London, UK
| | - Bruno Dubois
- Department of Neurology, Institut de la mémoire et de la maladie d'Alzheimer (IM2A), AP-HP, Brain Institute, Sorbonne University, Paris, France
| | - Mark Edwards
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry Psychology and Neurosciences, Kings College London, London, UK
| | - Saša R Filipović
- University of Belgrade Institute for Medical Research, Belgrade, Serbia
| | - Kristian Steen Frederiksen
- Clinical Trial Unit, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Harbo
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Bradleigh Hayhow
- Department of Neurology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- School of Medicine, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK
| | - Jonathan Huntley
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Jeremy Isaacs
- Department of Neurology, St George's University of London, London, UK
| | - William Curt LaFrance
- Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Neuropsychiatry and Behavioral Neurology, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Andrew J Larner
- Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - Francesco Di Lorenzo
- Department of Clinical and Behavioural Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - James Main
- Bristol Dementia Wellbeing Service, Devon Partnership NHS Trust, Bristol, UK
| | | | - Camillo Marra
- Department of Neuroscience, Catholic University of the Sacred Heart, Memory Clinic - Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - João Massano
- Department of Neurology, Centro Hospitalar Universitário São João, Porto, Portugal
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine University of Porto, Porto, Portugal
| | - Emer R McGrath
- School of Medicine, University of Galway, Galway, Ireland
| | - Laura McWhirter
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Isabel Portela Moreira
- Neurology Department, Private Hospital of Gaia of the Trofa Saúde Group, Vila Nova de Gaia, Portugal
| | - Flavio Nobili
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Catherine Pennington
- Clinical Lecturer, University of Edinburgh, Edinburgh, UK
- Neurology Department, NHS Forth Valley, Larbert, UK
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - Miguel Tábuas-Pereira
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
| | - David L Perez
- Department of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Stoyan Popkirov
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Dane Rayment
- Rosa Burden Centre for Neuropsychiatry, Southmead Hospital, Bristol, UK
| | - Martin Rossor
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Mirella Russo
- Department of Neuroscience, Imaging and Clinical Sciences G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Isabel Santana
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
| | - Jonathan Schott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Emmi P Scott
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ricardo Taipa
- Neuropathology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Svetlana Tomic
- Department of Neurology, University Hospital Center Osijek, Medical School on University of Osijek, Osijek, Croatia
| | - Sofia Toniolo
- Cognitive Disorder Clinic, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Tim Wilkinson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Lisbeth Frostholm
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Binks SNM, Veldsman M, Handel AE, Jacob S, Maddison P, Coebergh J, Michael S, Ramanathan S, Easton A, Nissen MS, Leite MI, Okai D, Blaabjerg M, Husain M, Irani SR. Fatigue predicts quality of life after leucine-rich glioma-inactivated 1-antibody encephalitis. Ann Clin Transl Neurol 2024; 11:1053-1058. [PMID: 38303486 PMCID: PMC11021603 DOI: 10.1002/acn3.52006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/20/2023] [Accepted: 01/15/2024] [Indexed: 02/03/2024] Open
Abstract
Patient-reported quality-of-life (QoL) and carer impacts are not reported after leucine-rich glioma-inactivated 1-antibody encephalitis (LGI1-Ab-E). From 60 patients, 85% (51 out of 60) showed one abnormal score across QoL assessments and 11 multimodal validated questionnaires. Compared to the premorbid state, QoL significantly deteriorated (p < 0.001) and, at a median of 41 months, fatigue was its most important predictor (p = 0.025). In total, 51% (26 out of 51) of carers reported significant burden. An abbreviated five-item battery explained most variance in QoL. Wide-ranging impacts post-LGI1-Ab-E include decreased QoL and high caregiver strain. We identify a rapid method to capture QoL in routine clinic or clinical trial settings.
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Affiliation(s)
- Sophie N. M. Binks
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical NeurosciencesOxfordUK
- Department of NeurologyOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Michele Veldsman
- Department of Experimental PsychologyUniversity of OxfordOxfordUK
| | - Adam E. Handel
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical NeurosciencesOxfordUK
- Department of NeurologyOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Saiju Jacob
- Department of Neurology, Queen Elizabeth HospitalUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Paul Maddison
- Department of Neurology, Queen's Medical CentreNottingham University Hospitals NHS TrustNottinghamUK
| | - Jan Coebergh
- St Peter's HospitalAshford and St Peter's NHS Hospitals Foundation TrustChertseyUK
| | - Sophia Michael
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical NeurosciencesOxfordUK
- Department of Neurology, Queen Elizabeth HospitalUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Sudarshini Ramanathan
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical NeurosciencesOxfordUK
- Translational Neuroimmunology Group, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
- Department of NeurologyConcord HospitalSydneyNew South WalesAustralia
| | - Ava Easton
- The Encephalitis Society32 Castlegate, MaltonNorth YorkshireYO17 7DTUK
- Department of Clinical Infection, Microbiology and ImmunologyUniversity of LiverpoolLiverpoolUK
| | - Mette Scheller Nissen
- Department of NeurologyOdense University HospitalOdenseDenmark
- Department of Clinical ResearchUniversity of Southern DenmarkOdenseDK‐5000Denmark
| | - Maria Isabel Leite
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical NeurosciencesOxfordUK
- Department of NeurologyOxford University Hospitals NHS Foundation TrustOxfordUK
| | - David Okai
- Neuropsychiatry DepartmentMaudsley Outpatients, Maudsley HospitalDenmark HillLondonSE5 8AZUK
| | - Morten Blaabjerg
- Department of NeurologyOdense University HospitalOdenseDenmark
- Department of Clinical ResearchUniversity of Southern DenmarkOdenseDK‐5000Denmark
| | - Masud Husain
- Department of Experimental PsychologyUniversity of OxfordOxfordUK
- Nuffield Department of Clinical NeurosciencesOxfordUK
| | - Sarosh R. Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical NeurosciencesOxfordUK
- Department of NeurologyOxford University Hospitals NHS Foundation TrustOxfordUK
- Departments of Neurology and NeurosciencesMayo ClinicJacksonvilleFloridaUSA
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3
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Collett J, Lawrie S, Bromley S, Harling P, Reed A, Brusco N, Coe S, Coebergh J, Carroll C, Roberts HC, Hu MT, Dawes H. A programme evaluation of 'First Steps': A peer-conceived, developed and led self-management intervention for people after a Parkinson's diagnosis. Clin Rehabil 2024; 38:403-413. [PMID: 37941369 PMCID: PMC10829422 DOI: 10.1177/02692155231210969] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/13/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE A diagnosis of Parkinson's often leads to uncertainty about the future and loss of perceived control. Peer support may offer a means to address these concerns and promote self-management. DESIGN A programme evaluation of the feasibility and potential effects of 'First Steps', utilising a pragmatic step wedge approach. Comparing First Steps (intervention) to (control) conditions.Setting: In the community at four sites in southern England.Participants: Newly diagnosed (≤ 12months) people with Parkinson's.Intervention: First Steps was a 2-day peer-conceived, developed and led intervention to support self-management.Main measures: At 0, 12 and 24 weeks anxiety and depression (Hospital, Anxiety and Depression Scale, HADS), daily functioning (World Health Organisation Disability Assessment Schedule, WHODAS), physical activity, quality of life (EQ5D), carer strain and service utilisation were assessed. RESULTS Between February 2018 and July 2019, 36 participants were enrolled into intervention and 21 to control conditions, all were included in statistical analysis. Lost to follow up was n = 1 (intervention) and n = 1 adverse event was reported (control, unrelated). Of the 36 allocated to the intervention n = 22 participants completed both days of First Steps during the study period. Completion of outcome measures was >95% at 24 weeks. Small effects favouring the intervention were found for HADS (odds ratio (OR) = 2.06, 95% confidence interval (CI) 0.24:17.84), Carer Strain Index (OR = 2.22, 95% CI 0.5:9.76) and vigorous (d = 0.42, 95% CI -0.12:0.97) and total physical activity (d = 0.41, 95% CI -0.13:0.95). EQ5D, WHOSDAS and service utilisation, was similar between groups. CONCLUSIONS First Steps was feasible and safe and we found potential to benefit physical activity, mental health and carer strain. Further research with longer-term follow up is warranted.
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Affiliation(s)
- Johnny Collett
- Centre for Movement, Occupational and Rehabilitation Sciences, OxINMAHR Oxford Brookes University, Oxfordshire, UK
| | - Sophie Lawrie
- Centre for Movement, Occupational and Rehabilitation Sciences, OxINMAHR Oxford Brookes University, Oxfordshire, UK
| | | | | | - Alex Reed
- European Parkinson's Therapy Centre, Brescia, Italy
| | - Natasha Brusco
- School of Primary and Allied Health Care, Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Australia
| | - Shelly Coe
- Centre for Movement, Occupational and Rehabilitation Sciences, OxINMAHR Oxford Brookes University, Oxfordshire, UK
- Centre for Nutrition and Health, OxINMAHR Oxford Brookes University, Oxfordshire, UK
| | - Jan Coebergh
- Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
- Department of Neurology, Ashford St Peter's NHS Foundation Trust, Chertsey, UK
| | - Camille Carroll
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Helen C Roberts
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Hampshire, UK
| | - Michele T Hu
- Oxford Parkinson's Disease Centre, Division of Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxfordshire, UK
| | - Helen Dawes
- NIHR Exeter BRC, Medical School, University of Exeter, Devon, UK
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4
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White P, Abbey S, Angus B, Ball HA, Buchwald DS, Burness C, Carson AJ, Chalder T, Clauw DJ, Coebergh J, David AS, Dworetzky BA, Edwards MJ, Espay AJ, Etherington J, Fink P, Flottorp S, Garcin B, Garner P, Glasziou P, Hamilton W, Henningsen P, Hoeritzauer I, Husain M, Huys ACML, Knoop H, Kroenke K, Lehn A, Levenson JL, Little P, Lloyd A, Madan I, van der Meer JWM, Miller A, Murphy M, Nazareth I, Perez DL, Phillips W, Reuber M, Rief W, Santhouse A, Serranova T, Sharpe M, Stanton B, Stewart DE, Stone J, Tinazzi M, Wade DT, Wessely SC, Wyller V, Zeman A. Anomalies in the review process and interpretation of the evidence in the NICE guideline for chronic fatigue syndrome and myalgic encephalomyelitis. J Neurol Neurosurg Psychiatry 2023; 94:1056-1063. [PMID: 37434321 DOI: 10.1136/jnnp-2022-330463] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 05/03/2023] [Indexed: 07/13/2023]
Abstract
Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a disabling long-term condition of unknown cause. The National Institute for Health and Care Excellence (NICE) published a guideline in 2021 that highlighted the seriousness of the condition, but also recommended that graded exercise therapy (GET) should not be used and cognitive-behavioural therapy should only be used to manage symptoms and reduce distress, not to aid recovery. This U-turn in recommendations from the previous 2007 guideline is controversial.We suggest that the controversy stems from anomalies in both processing and interpretation of the evidence by the NICE committee. The committee: (1) created a new definition of CFS/ME, which 'downgraded' the certainty of trial evidence; (2) omitted data from standard trial end points used to assess efficacy; (3) discounted trial data when assessing treatment harm in favour of lower quality surveys and qualitative studies; (4) minimised the importance of fatigue as an outcome; (5) did not use accepted practices to synthesise trial evidence adequately using GRADE (Grading of Recommendations, Assessment, Development and Evaluations trial evidence); (6) interpreted GET as mandating fixed increments of change when trials defined it as collaborative, negotiated and symptom dependent; (7) deviated from NICE recommendations of rehabilitation for related conditions, such as chronic primary pain and (8) recommended an energy management approach in the absence of supportive research evidence.We conclude that the dissonance between this and the previous guideline was the result of deviating from usual scientific standards of the NICE process. The consequences of this are that patients may be denied helpful treatments and therefore risk persistent ill health and disability.
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Affiliation(s)
- Peter White
- Wolfson Institute for Population Health, Queen Mary University Barts and The London School of Medicine and Dentistry, London, UK
| | - Susan Abbey
- Toronto General Hospital Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Brian Angus
- Nuffield Department of Medicine, Oxford University, Oxford, UK
| | - Harriet A Ball
- Bristol Medical School, University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Dedra S Buchwald
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, Washington, USA
| | | | - Alan J Carson
- Centre for Clinical Brain Sciences, Royal Infirmary, Edinburgh, UK
| | - Trudie Chalder
- Department of Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Daniel J Clauw
- Departments of Anesthesiology, Medicine and Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Jan Coebergh
- Ashford St Peter's NHS Foundation Trust, Chertsey, St George's University Hospitals, London, UK
| | - Anthony S David
- Institute of Mental Health, University College London, London, UK
| | - Barbara A Dworetzky
- Department of Neurology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mark J Edwards
- Neuroscience Research Centre, St George's University, London, UK
| | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | | | - Per Fink
- Research Clinic for Functional Disorders, Aarhus University, Aarhus, Denmark
| | - Signe Flottorp
- Centre for Epidemic Interventions Research, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Béatrice Garcin
- Hopital Avicenne, Universite Sorbonne Paris Nord - Campus de Bobigny, Bobigny, France
| | - Paul Garner
- Centre for Evidence Synthesis in Global Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Robina, Queensland, Australia
| | - Willie Hamilton
- Institute of Health Research, University of Exeter, Exeter, UK
| | - Peter Henningsen
- Psychosomatic Medicine, University Hospital, Technical University Munich, Munich, Germany
| | - Ingrid Hoeritzauer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Mujtaba Husain
- Persistent Physical Symptom Service, South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Hans Knoop
- Department of Medical Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Kurt Kroenke
- Regenstrief Institute, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Alexander Lehn
- Brisbane Clinical Neuroscience Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - James L Levenson
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Paul Little
- Primary Care Research Centre, Primary Care Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Andrew Lloyd
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Ira Madan
- Faculty of Occupational Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jos W M van der Meer
- Department of Internal Medicine, Radboud University Medical College, Nijmegen, Netherlands
| | - Alastair Miller
- Department of Medicine, Cumberland Infirmary Carlisle, Carlisle, UK
| | - Maurice Murphy
- Department of Infection and Immunity, Barts Health NHS Trust, London, UK
| | - Irwin Nazareth
- Primary Care & Population Science, University College London, London, UK
| | - David L Perez
- Neurology and Psychiatry, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Wendy Phillips
- Department of Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Markus Reuber
- Department of Neuroscience, The Medical School, University of Sheffield, Sheffield, UK
| | - Winfried Rief
- Division of Clinical Psychology and Psychotherapy Clinic, University of Marburg, Marburg, Germany
| | - Alastair Santhouse
- Persistent Physical Symptom Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Tereza Serranova
- Dept. of Neurology and Center of Clinical Neuroscience, Charles University in Prague, Prague, Czech Republic
| | - Michael Sharpe
- Psychological Medicine Research, University of Oxford, Oxford, UK
| | - Biba Stanton
- Department of Neurology, King's College Hospital, London, UK
| | - Donna E Stewart
- Centre for Mental Health, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Jon Stone
- Centre for Clinical Brain Sciences, Royal Infirmary, University of Edinburgh, Edinburgh, UK
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Derick T Wade
- Centre for Movement, Occupational and Rehabilitation Sciences, Oxford Brookes University, Oxford, UK
| | - Simon C Wessely
- Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Vegard Wyller
- Division of Medicine and Laboratory Sciences, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Adam Zeman
- Cognitve Neurology Research Group, University of Exeter Medical School, Exeter, UK
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5
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Moughal S, Christou A, Edwards M, Coebergh J. Looking for inconsistency: Combining distraction with spirography for diagnosis of functional tremor. J Neurol Sci 2023; 453:120785. [PMID: 37703705 DOI: 10.1016/j.jns.2023.120785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/30/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023]
Affiliation(s)
- Saad Moughal
- St George's Hospitals NHS Foundation Trust, London, UK
| | | | - Mark Edwards
- St George's Hospitals NHS Foundation Trust, London, UK; University of St George's, London, UK
| | - Jan Coebergh
- St George's Hospitals NHS Foundation Trust, London, UK; University of St George's, London, UK; Ashford St Peter's NHS Foundation Trust, Chertsey, UK.
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6
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Cope TE, Sohoglu E, Peterson KA, Jones PS, Rua C, Passamonti L, Sedley W, Post B, Coebergh J, Butler CR, Garrard P, Abdel-Aziz K, Husain M, Griffiths TD, Patterson K, Davis MH, Rowe JB. Temporal lobe perceptual predictions for speech are instantiated in motor cortex and reconciled by inferior frontal cortex. Cell Rep 2023; 42:112422. [PMID: 37099422 DOI: 10.1016/j.celrep.2023.112422] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/23/2022] [Accepted: 04/05/2023] [Indexed: 04/27/2023] Open
Abstract
Humans use predictions to improve speech perception, especially in noisy environments. Here we use 7-T functional MRI (fMRI) to decode brain representations of written phonological predictions and degraded speech signals in healthy humans and people with selective frontal neurodegeneration (non-fluent variant primary progressive aphasia [nfvPPA]). Multivariate analyses of item-specific patterns of neural activation indicate dissimilar representations of verified and violated predictions in left inferior frontal gyrus, suggestive of processing by distinct neural populations. In contrast, precentral gyrus represents a combination of phonological information and weighted prediction error. In the presence of intact temporal cortex, frontal neurodegeneration results in inflexible predictions. This manifests neurally as a failure to suppress incorrect predictions in anterior superior temporal gyrus and reduced stability of phonological representations in precentral gyrus. We propose a tripartite speech perception network in which inferior frontal gyrus supports prediction reconciliation in echoic memory, and precentral gyrus invokes a motor model to instantiate and refine perceptual predictions for speech.
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Affiliation(s)
- Thomas E Cope
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK; Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK; Cambridge University Hospitals NHS Trust, Cambridge CB2 0QQ, UK.
| | - Ediz Sohoglu
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK; School of Psychology, University of Sussex, Brighton BN1 9RH, UK
| | - Katie A Peterson
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK; Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK
| | - P Simon Jones
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Catarina Rua
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Luca Passamonti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK
| | - William Sedley
- Biosciences Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Brechtje Post
- Theoretical and Applied Linguistics, Faculty of Modern & Medieval Languages & Linguistics, University of Cambridge, Cambridge CB3 9DA, UK
| | - Jan Coebergh
- Ashford and St Peter's Hospital, Ashford TW15 3AA, UK; St George's Hospital, London SW17 0QT, UK
| | - Christopher R Butler
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK; Faculty of Medicine, Department of Brain Sciences, Imperial College London, London W12 0NN, UK
| | - Peter Garrard
- St George's Hospital, London SW17 0QT, UK; Molecular and Clinical Sciences Research Institute, St. George's, University of London, London SW17 0RE, UK
| | - Khaled Abdel-Aziz
- Ashford and St Peter's Hospital, Ashford TW15 3AA, UK; St George's Hospital, London SW17 0QT, UK
| | - Masud Husain
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Timothy D Griffiths
- Biosciences Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Karalyn Patterson
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK; Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
| | - Matthew H Davis
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK; Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK; Cambridge University Hospitals NHS Trust, Cambridge CB2 0QQ, UK
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7
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Ducroizet A, Zimianti I, Golder D, Hearne K, Edwards M, Nielsen G, Coebergh J. Functional neurological disorder: Clinical manifestations and comorbidities; an online survey. J Clin Neurosci 2023; 110:116-125. [PMID: 36871491 DOI: 10.1016/j.jocn.2023.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 11/01/2022] [Revised: 02/02/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023]
Abstract
Functional Neurological Disorder (FND) is common and is often accompanied by multiple comorbid symptoms and conditions. There have been no large-scale studies exploring the change of its clinical manifestations and comorbidities. We used an online survey to assess FND patient characteristics, changes to fatigue, sleep and pain and comorbid symptoms and diagnoses, as well as treatment strategies. The survey was shared via the charities FND Action and FND Hope. 527 participants were included in the analysis. Most (97.3%) reported experiencing more than one core FND symptom. Many respondents reported associated pain (78.1%), fatigue (78.0%) and sleep disturbances (46.7%) before FND diagnosis which often increased thereafter. Rates of obesity were higher (36.9%) than in the general population. Obesity was associated with increased pain, fatigue and sleep difficulties. There was frequent weight gain after diagnosis. 50.0% of participants reported having other diagnoses prior to FND, while in 43.3% new comorbidities arise after FND diagnosis. Many respondents reported being dissatisfied with their care, expressing a wish for further follow-up from mental health (32.7%) and/or neurological services (44.3%). This large online survey further supports the phenotypic complexity of FND. High rates of pain, fatigue and sleep disturbance exist before diagnosis but monitoring for change is worthwhile. Our study identified major gaps in service provision; we highlight the importance of an open mind regarding change in symptoms; this could aid the early identification and management of co-morbidities, including obesity and migraine, which possibly have a negative impact on FND.
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Affiliation(s)
- Alexandra Ducroizet
- Department of Neurology, Ashford St. Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | | | | | | | - Mark Edwards
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, UK
| | - Glenn Nielsen
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK; Department of Neurology, St. George's Hospital NHS Foundation Trust, London, UK
| | - Jan Coebergh
- Department of Neurology, Ashford St. Peter's Hospitals NHS Foundation Trust, Chertsey, UK; Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK; Department of Neurology, St. George's Hospital NHS Foundation Trust, London, UK.
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8
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Stevens KN, Creanor S, Jeffery A, Whone A, Zajicek J, Foggo A, Jones B, Chapman R, Cocking L, Wilks J, Webb D, Carroll C, Inches J, Underwood D, Frost J, James A, Schofield C, James R, O’Reilly C, Sheridan R, Statton S, Goff A, Russell T, Whitcher A, Craw S, Lewis A, Sophia R, Amar K, Hernandez R, Pitcher A, Carvey S, Hamlin R, Lyell V, Aubry L, Carey G, Coebergh J, Mojela I, Molloy S, Berceruelo Bergaz Y, Camera B, Campbell P, Morris H, Samakomva T, Schrag A, Fuller S, Misbahuddin A, Parker L, Visentin E, Gallehawk S, Rudd J, Singh S, Wilson S, Creven J, Croucher Y, Tluk S, Watts P, Hargreaves S, Johnson D, Worboys L, Worth P, Brooke J, Kobylecki C, Parker V, Johnson L, Joseph R, Melville J, Raw J, Birt J, Hare M, Shaik S, Alty J, Cosgrove J, Burn D, Green A, McNichol A, Pavese N, Pilkington H, Price M, Walker K, Chaudhuri R, Podlewska A, Reddy P, Trivedi D, Bandmann O, Clegg R, Cole G, Emery A, Dostal V, Graham J, Keshet-Price J, Mamutse G, Miller-Fik A, Wiltshire A, Wright C, Dixon K, Abdelhafiz A, Rose J. Evaluation of Simvastatin as a Disease-Modifying Treatment for Patients With Parkinson Disease: A Randomized Clinical Trial. JAMA Neurol 2022; 79:1232-1241. [PMID: 36315128 PMCID: PMC9623477 DOI: 10.1001/jamaneurol.2022.3718] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Importance Current treatments manage symptoms of Parkinson disease (PD), but no known treatment slows disease progression. Preclinical and epidemiological studies support the potential use of statins as disease-modifying therapy. Objective To determine whether simvastatin has potential as a disease-modifying treatment for patients with moderate PD. Design, Setting, and Participants This randomized clinical trial, a double-blind, parallel-group, placebo-controlled futility trial, was conducted between March 2016 and May 2020 within 23 National Health Service Trusts in England. Participants aged 40 to 90 years with a diagnosis of idiopathic PD, with a modified Hoehn and Yahr stage of 3.0 or less while taking medication, and taking dopaminergic medication with wearing-off phenomenon were included. Data were analyzed from May 2020 to September 2020, with additional analysis in February 2021. Interventions Participants were allocated 1:1 to simvastatin or matched placebo via a computer-generated random sequence, stratified by site and Hoehn and Yahr stage. In the simvastatin arm, participants entered a 1-month phase of simvastatin, 40 mg daily, followed by 23 months of simvastatin, 80 mg daily, before a 2-month washout period. Main Outcomes and Measures The prespecified primary outcome was 24-month change in Movement Disorder Society Unified Parkinson Disease Rating Scale (MDS-UPDRS) part III score measured while not taking medication (high scores indicate worse outcome). The primary futility analysis included participants who commenced the 80-mg phase and had valid primary outcome data. The safety analysis included all participants who commenced trial treatment and is reported by dose at time of event. Results Of 332 patients assessed for eligibility, 32 declined and 65 were ineligible. Of 235 recruited participants, 97 (41%) were female, 233 (99%) were White, and the mean (SD) age was 65.4 (9.4) years. A total of 216 patients progressed to the 80-mg dose. Primary outcome analysis (n = 178) indicated the simvastatin group had an additional deterioration in MDS-UPDRS III score while not taking medication at 24 months compared with the placebo group (1.52 points; 2-sided 80% CI, -0.77 to 3.80; 1-sided futility test P = .006). A total of 37 serious adverse events (AEs), including 3 deaths, and 171 AEs were reported for participants receiving 0-mg simvastatin; 37 serious AEs and 150 AEs were reported for participants taking 40 mg or 80 mg of simvastatin. Four participants withdrew from the trial because of an AE. Conclusions and Relevance In this randomized clinical trial, simvastatin was futile as a disease-modifying therapy in patients with PD of moderate severity, providing no evidence to support proceeding to a phase 3 trial. Trial Registration ISRCTN Identifier: 16108482.
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Affiliation(s)
- Kara N. Stevens
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom,Exploristics Ltd, Belfast, United Kingdom
| | - Siobhan Creanor
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Alison Jeffery
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Alan Whone
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - John Zajicek
- School of Medicine, Medical and Biological Sciences, University of St Andrews, St Andrews, United Kingdom
| | - Andy Foggo
- School of Biological and Marine Sciences, Faculty of Science and Engineering, University of Plymouth, Plymouth, United Kingdom
| | - Ben Jones
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Rebecca Chapman
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Laura Cocking
- NIHR BioResource, University of Cambridge, Cambridge, United Kingdom
| | - Jonny Wilks
- MAC Clinical Research, Blackpool, United Kingdom
| | - Doug Webb
- Bristol Trials Centre, University of Bristol, Bristol, United Kingdom
| | - Camille Carroll
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
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9
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Teodoro T, Koreki A, Chen J, Coebergh J, Poole N, Ferreira JJ, Edwards MJ, Isaacs JD. Functional cognitive disorder affects reaction time, subjective mental effort and global metacognition. Brain 2022; 146:1615-1623. [PMID: 36200349 DOI: 10.1093/brain/awac363] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 06/20/2022] [Revised: 09/05/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
We previously hypothesised that Functional Cognitive Disorder is characterised by heightened subjective mental effort, exhausted attentional reserve and metacognitive failure. To test this hypothesis, we administered a colour-word Stroop task in which attentional demand was varied by task difficulty (congruent versus incongruent cues) and the presence of a secondary auditory stimulus (passive or active listening to an oddball-type paradigm). We measured subjective mental effort, objective performance (reaction times and accuracy), metacognition and EEG-based biomarkers of mental workload. We tested 19 Functional Cognitive Disorder patients and 23 healthy controls. Patients reported higher levels of depression, anxiety, fatigue, pain, sleep disruption, dissociation and obsessiveness. They rated their memory as significantly poorer than healthy controls; however, accuracy did not differ between groups in any condition. In contrast to healthy controls, patients rated their performance as poorer on the congruent Stroop task with background noise compared to silent conditions. Functional Cognitive Disorder was consistently associated with slower reaction times but this was not exacerbated by increased attentional demand. Patients but not healthy controls reported greater mental workload in noisy conditions but EEG biomarkers were similar between groups, regardless of task difficulty. Functional Cognitive Disorder has significant syndromic overlap with mood disorders and chronic fatigue and pain. It is associated with global metacognitive failure whereas local (task-specific) metacognition is only selectively impaired. Patients were slower than healthy controls, which might contribute to the "brain fog" reported in this condition. Although subjective mental effort was increased in noisy conditions, we found no evidence of attentional exhaustion in Functional Cognitive Disorder. Our results suggest that Functional Cognitive Disorder is a multisystem condition affecting reaction time, subjective mental effort and global metacognition.
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Affiliation(s)
- Tiago Teodoro
- Neurosciences Research Centre, Institute of Molecular and Clinical Sciences, St George's, University of London, London, UK.,Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa & Serviço de Neurologia, Hospital de Santa Maria, Lisboa, Portugal.,Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Akihiro Koreki
- Department of Psychiatry, National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan
| | - Jiaying Chen
- Neurosciences Research Centre, Institute of Molecular and Clinical Sciences, St George's, University of London, London, UK
| | - Jan Coebergh
- Neurosciences Research Centre, Institute of Molecular and Clinical Sciences, St George's, University of London, London, UK.,Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Norman Poole
- South West London and St George's Mental Health NHS Trust, London, UK
| | - Joaquim J Ferreira
- Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa & Serviço de Neurologia, Hospital de Santa Maria, Lisboa, Portugal
| | - Mark J Edwards
- Neurosciences Research Centre, Institute of Molecular and Clinical Sciences, St George's, University of London, London, UK.,Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Jeremy D Isaacs
- Neurosciences Research Centre, Institute of Molecular and Clinical Sciences, St George's, University of London, London, UK.,Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
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10
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Coebergh J, Zimianiti I, Elmers TJ, Kaski D. Response to Geroin et al. Tapping into the mechanisms of abnormal functional postural control. Eur J Neurol 2022; 29:3748-3749. [PMID: 36165986 DOI: 10.1111/ene.15578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 09/20/2022] [Indexed: 11/29/2022]
Affiliation(s)
- J Coebergh
- Ashford and St Peter's Hospitals NHS Trust, Chertsey, UK.,St George's University Hospitals NHS Foundation Trust, London, UK
| | - I Zimianiti
- University College London, Department of Clinical and Movement Neurosciences, London, UK
| | - T J Elmers
- Imperial College London, Department of Brain Sciences, UK
| | - D Kaski
- University College London, Department of Clinical and Movement Neurosciences, London, UK
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11
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Coebergh J, Zimianiti I, Kaski D. Shoulder-Tap Test for Functional Gait Disorders: A Sign of Abnormal Anticipatory Behavior. Neurology 2021; 97:1070-1071. [PMID: 34607927 DOI: 10.1212/wnl.0000000000012886] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/24/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jan Coebergh
- From the Ashford St Peter's NHS Foundation Trust (J.C.), London; St George's NHS Foundation Trust (J.C.), London; Imperial College London (I.Z.), School of Medicine; and Centre for Vestibular and Behavioural Neurosciences (D.K.), Institute of Neurology, University College London, UK.
| | - Ioanna Zimianiti
- From the Ashford St Peter's NHS Foundation Trust (J.C.), London; St George's NHS Foundation Trust (J.C.), London; Imperial College London (I.Z.), School of Medicine; and Centre for Vestibular and Behavioural Neurosciences (D.K.), Institute of Neurology, University College London, UK
| | - Diego Kaski
- From the Ashford St Peter's NHS Foundation Trust (J.C.), London; St George's NHS Foundation Trust (J.C.), London; Imperial College London (I.Z.), School of Medicine; and Centre for Vestibular and Behavioural Neurosciences (D.K.), Institute of Neurology, University College London, UK
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12
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Zamfir G, Chattun H, Alam Z, Coebergh J, Saifuddin A. A 38-year-old man presenting with a >1-month history of increased sensitivity to touch in the right index finger, thumb and middle finger with a positive Tinel's sign over the median nerve. Skeletal Radiol 2021; 50:2289-2291. [PMID: 33860846 DOI: 10.1007/s00256-021-03785-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/01/2021] [Accepted: 04/08/2021] [Indexed: 02/02/2023]
Affiliation(s)
- Georgiana Zamfir
- ST6 Radiology Registrar, Department of Radiology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, Surrey, KT16 0PZ, UK.
| | - Halimah Chattun
- ST4 Radiology Registrar, Department of Radiology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, Surrey, KT16 0PZ, UK
| | - Zaina Alam
- University College London Medical School, 74 Huntley Street, London, WC1E 6BT, UK
| | - Jan Coebergh
- Department of Neurology, St George's Hospital, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
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13
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Coebergh J, Morgante F, Edwards MJ. Heat, Hormones, and Functional Movement Disorders: Further Sources of Symptom Variability. Mov Disord 2021; 36:2213-2214. [PMID: 34543464 DOI: 10.1002/mds.28739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Jan Coebergh
- Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom.,Department of Neurology, Ashford St. Peter's Hospital NHS Foundation Trust, Chertsey, United Kingdom
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, United Kingdom.,Department of Experimental and Clinical Medicine, University of Messina, Messina, Italy
| | - Mark J Edwards
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, United Kingdom
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14
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Butler M, Coebergh J, Safavi F, Carson A, Hallett M, Michael B, Pollak TA, Solomon T, Stone J, Nicholson TR. Functional Neurological Disorder After SARS-CoV-2 Vaccines: Two Case Reports and Discussion of Potential Public Health Implications. J Neuropsychiatry Clin Neurosci 2021; 33:345-348. [PMID: 34261345 PMCID: PMC8556318 DOI: 10.1176/appi.neuropsych.21050116] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Matthew Butler
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Butler, Pollak, Nicholson); Ashford St. Peter's National Health Service (NHS) Foundation Trust and St. George's NHS Foundation Trust, London (Coebergh);Division of Intramural Research, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Md. (Safavi, Hallett);Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (Carson, Stone); and Department of Neurology, the Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (Michael, Solomon)
| | - Jan Coebergh
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Butler, Pollak, Nicholson); Ashford St. Peter's National Health Service (NHS) Foundation Trust and St. George's NHS Foundation Trust, London (Coebergh);Division of Intramural Research, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Md. (Safavi, Hallett);Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (Carson, Stone); and Department of Neurology, the Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (Michael, Solomon)
| | - Farinaz Safavi
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Butler, Pollak, Nicholson); Ashford St. Peter's National Health Service (NHS) Foundation Trust and St. George's NHS Foundation Trust, London (Coebergh);Division of Intramural Research, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Md. (Safavi, Hallett);Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (Carson, Stone); and Department of Neurology, the Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (Michael, Solomon)
| | - Alan Carson
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Butler, Pollak, Nicholson); Ashford St. Peter's National Health Service (NHS) Foundation Trust and St. George's NHS Foundation Trust, London (Coebergh);Division of Intramural Research, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Md. (Safavi, Hallett);Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (Carson, Stone); and Department of Neurology, the Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (Michael, Solomon)
| | - Mark Hallett
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Butler, Pollak, Nicholson); Ashford St. Peter's National Health Service (NHS) Foundation Trust and St. George's NHS Foundation Trust, London (Coebergh);Division of Intramural Research, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Md. (Safavi, Hallett);Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (Carson, Stone); and Department of Neurology, the Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (Michael, Solomon)
| | - Benedict Michael
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Butler, Pollak, Nicholson); Ashford St. Peter's National Health Service (NHS) Foundation Trust and St. George's NHS Foundation Trust, London (Coebergh);Division of Intramural Research, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Md. (Safavi, Hallett);Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (Carson, Stone); and Department of Neurology, the Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (Michael, Solomon)
| | - Thomas A Pollak
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Butler, Pollak, Nicholson); Ashford St. Peter's National Health Service (NHS) Foundation Trust and St. George's NHS Foundation Trust, London (Coebergh);Division of Intramural Research, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Md. (Safavi, Hallett);Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (Carson, Stone); and Department of Neurology, the Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (Michael, Solomon)
| | - Tom Solomon
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Butler, Pollak, Nicholson); Ashford St. Peter's National Health Service (NHS) Foundation Trust and St. George's NHS Foundation Trust, London (Coebergh);Division of Intramural Research, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Md. (Safavi, Hallett);Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (Carson, Stone); and Department of Neurology, the Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (Michael, Solomon)
| | - Jon Stone
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Butler, Pollak, Nicholson); Ashford St. Peter's National Health Service (NHS) Foundation Trust and St. George's NHS Foundation Trust, London (Coebergh);Division of Intramural Research, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Md. (Safavi, Hallett);Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (Carson, Stone); and Department of Neurology, the Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (Michael, Solomon)
| | - Timothy R Nicholson
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Butler, Pollak, Nicholson); Ashford St. Peter's National Health Service (NHS) Foundation Trust and St. George's NHS Foundation Trust, London (Coebergh);Division of Intramural Research, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Md. (Safavi, Hallett);Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (Carson, Stone); and Department of Neurology, the Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (Michael, Solomon)
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15
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Lin D, Castro P, Edwards A, Sekar A, Edwards MJ, Coebergh J, Bronstein AM, Kaski D. Dissociated motor learning and de-adaptation in patients with functional gait disorders. Brain 2020; 143:2594-2606. [DOI: 10.1093/brain/awaa190] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/14/2020] [Accepted: 04/20/2020] [Indexed: 12/20/2022] Open
Abstract
Abstract
Walking onto a stationary platform that had been previously experienced as moving generates a locomotor after-effect—the so-called ‘broken escalator’ phenomenon. The motor responses that occur during locomotor after-effects have been mapped theoretically using a hierarchal Bayesian model of brain function that takes into account current sensory information that is weighted according to prior contextually-relevant experiences; these in turn inform automatic motor responses. Here, we use the broken escalator phenomenon to explore motor learning in patients with functional gait disorders and probe whether abnormal postural mechanisms override ascending sensory information and conscious intention, leading to maladaptive and disabling gait abnormalities. Fourteen patients with functional gait disorders and 17 healthy control subjects walked onto a stationary sled (‘Before’ condition, five trials), then onto a moving sled (‘Moving’ condition, 10 trials) and then again onto the stationary sled (‘After’ condition, five trials). Subjects were warned of the change in conditions. Kinematic gait measures (trunk displacement, step timing, gait velocity), EMG responses, and subjective measures of state anxiety/instability were recorded per trial. Patients had slower gait velocities in the Before trials (P < 0.05) but were able to increase this to accommodate the moving sled, with similar learning curves to control subjects (P = 0.87). Although trunk and gait velocity locomotor after-effects were present in both groups, there was a persistence of the locomotor after-effect only in patients (P < 0.05). We observed an increase in gait velocity during After trials towards normal values in the patient group. Instability and state anxiety were greater in patients than controls (P < 0.05) only during explicit phases (Before/After) of the task. Mean ‘final’ gait termination EMG activity (right gastrocnemius) was greater in the patient group than controls. Despite a dysfunctional locomotor system, patients show normal adaptive learning. The process of de-adaptation, however, is prolonged in patients indicating a tendency to perpetuate learned motor programmes. The trend to normalization of gait velocity following a period of implicit motor learning has implications for gait rehabilitation potential in patients with functional gait disorders and related disorders (e.g. fear of falling).
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Affiliation(s)
- Denise Lin
- Department of Brain Sciences, Neuro-otology Unit, Imperial College London, London, UK
| | - Patricia Castro
- Department of Brain Sciences, Neuro-otology Unit, Imperial College London, London, UK
- Universidad del Desarrollo, Escuela de Fonoaudiología, Facultad de Medicina Clínica Alemana, Santiago, Chile
| | - Amy Edwards
- Department of Brain Sciences, Neuro-otology Unit, Imperial College London, London, UK
| | - Akila Sekar
- Department of Brain Sciences, Neuro-otology Unit, Imperial College London, London, UK
| | - Mark J Edwards
- Department of Neurology, St George’s Hospital, London, UK
| | - Jan Coebergh
- Department of Neurology, St George’s Hospital, London, UK
| | - Adolfo M Bronstein
- Department of Brain Sciences, Neuro-otology Unit, Imperial College London, London, UK
| | - Diego Kaski
- Department of Brain Sciences, Neuro-otology Unit, Imperial College London, London, UK
- Department of Clinical and Motor Neurosciences, Centre for Vestibular and Behavioural Neurosciences, University College London, London, UK
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16
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Khoja LA, Coebergh J, Nicholson TR. 28 The link between functional neurological disorder (FND) & migraine: a systematic review. J Neurol Neurosurg Psychiatry 2020. [DOI: 10.1136/jnnp-2020-bnpa.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundFND and migraine are both common disorders that occur in the absence of structural brain damage. Clinically, it is suspected that they might co- occur more often than would be expected by chance. It is important to distinguish them in some clinical situations, especially hemiplegic migraine from migraine that triggers FND with weakness but there are no systematic, and limited narrative reviews of the topic.ObjectivesTo study the association of FND and migraine with a systematic review of the literature.MethodsSearches for relevant literature were performed in July 2018 in MEDLINE and PsycINFO electronic databases without time limitation and augmented by hand searching the reference lists within these papers and the knowledge of literature from selected experts in the fieldResultsFive studies were identified; two from electronic, one from hand searches and two from experts. The total number of the sample size from the included studies was 2385. Findings generally indicated a positive association between migraine and FND. A prospective epidemiological study found that number of FND symptoms reported by migraineurs was 2.2 and 1.1 on controls. In a retrospective review of medical report study functional movement disorders occurred within 6 months or concomitantly with migraine onset in 71% of chronic migraine (CM) & 87.5% episodic migraine (EM) cases and the outcome effect of treating migraine on FND symptoms was a decrease or remission in 91% in CM and by 67% in EM. In a retrospective chart review study in the epilepsy monitoring unit, migraine diagnosis had a predictive value for diagnosing PNES & epilepsy OR=1.83, p<0.037 (95% CI: 1.04–3.32) compared to other biological factors. 40% of people diagnosed with FND reported having headache compared to 9% of controls in patients with other neurological disorders (P<0.0001). Unpublished data from a case-control study by Stone et al, revealed that 36% of 107 FND patients with limb weakness experienced migraine. Additionally, a clinical-based observational study from India of 1000 patients highlighted the common occurrence of psychogenic non-epileptic seizures (PNES) during acute migraine attacks.ConclusionsDespite a limited evidence base, migraine and FND appear to co-occur at elevated rates. It is imperative to explore how treating either migraine or FND impacts on the other. More studies are needed to confirm these findings and to investigate any potential mechanistic overlap.
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Coebergh J, Hearne K, Nicholson T. Telling me you don't know is ok, but not explaining functional neurological disorder is not. BMJ 2020; 368:m1158. [PMID: 32209547 DOI: 10.1136/bmj.m1158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jan Coebergh
- Ashford and St Peter's Hospitals NHS Foundation Trust, St Peter's Hospital, Chertsey KT19 0PZ, UK
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Furness A, Coebergh J, Wood M, Irvine-Sellars M, Saikia S, Sharma S, McBride B, Johnson C, Teoh M, Cockroft F, Wing S, Murray P, Hewish M. Pembrolizumab-induced subacute sensory ataxia. Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30045-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Binks SNM, Jacob S, Maddison P, Coebergh J, Isabel Leite M, Irani SR. 1712 ‘Less contented as a person’: preliminary data from the lgi1-qol study. J Neurol Neurosurg Psychiatry 2017. [DOI: 10.1136/jnnp-2017-abn.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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20
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Han E, Coebergh J. PO013 Management of suspected herpes simplex virus encephalitis in a district general hospital – putting guidelines into practice? J Neurol Neurosurg Psychiatry 2017. [DOI: 10.1136/jnnp-2017-abn.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bucknall T, Fung R, Coebergh J. 23 Audit of functional neurology inpatient care on kent ward in 2014/15. J Neurol Psychiatry 2017. [DOI: 10.1136/jnnp-2017-bnpa.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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22
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Gough J, Coebergh J, Chandra B, Tabet N, Nilforooshan R. 4 A new era in psychiatry: ect and/or plasmapheresis? a new case of anti-nmda antibodies with isolated psychiatric. J Neurol Neurosurg Psychiatry 2017. [DOI: 10.1136/jnnp-2017-bnpa.64] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Rajwani H, Coebergh J. PROGRESSIVE SUPRANUCLEAR PALSY IN THE ELDERLY IN A DISTRICT GENERAL HOSPITAL. J Neurol Neurosurg Psychiatry 2016. [DOI: 10.1136/jnnp-2016-315106.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Weston P, Coebergh J, White I. SEVERELY ELEVATED CREATINE KINASE IN A CASE OF GIULLAIN-BARRÉ SYNDROME. J Neurol Neurosurg Psychiatry 2016. [DOI: 10.1136/jnnp-2016-315106.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Robinson R, Coebergh J, Abdel-Aziz K. PARANEOPLASTIC ANTI-GQ1B SYNDROME ASSOCIATED WITH DIFFUSE LARGE B-CELL LYMPHOMA. J Neurol Neurosurg Psychiatry 2016. [DOI: 10.1136/jnnp-2016-315106.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Gough JL, Coebergh J, Chandra B, Nilforooshan R. Electroconvulsive therapy and/or plasmapheresis in autoimmune encephalitis? World J Clin Cases 2016; 4:223-228. [PMID: 27574610 PMCID: PMC4983693 DOI: 10.12998/wjcc.v4.i8.223] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 04/01/2016] [Accepted: 06/16/2016] [Indexed: 02/05/2023] Open
Abstract
Autoimmune encephalitis is a poorly understood condition that can present with a combination of neurological and psychiatric symptoms, either of which may predominate. There are many autoantibodies associated with a variety of clinical syndromes - anti-N-Methyl-D-Aspartate receptor (NMDAR) is the commonest. Currently, the most widely used therapy is prompt plasmapheresis and steroid treatment (and tumour resection if indicated), followed by second line immunosuppression if this fails. Given the growing awareness of autoimmune encephalitis as an entity, it is increasingly important that we consider it as a potential diagnosis in order to provide timely, effective treatment. We discuss several previously published case reports and one new case. These reports examined the effects of electroconvulsive therapy (ECT) on patients with autoimmune encephalitis, particularly those in whom psychiatric symptoms are especially debilitating and refractory to standard treatment. We also discuss factors predicting good outcome and possible mechanisms by which ECT may be effective. Numerous cases, such as those presented by Wingfield, Tsutsui, Florance, Sansing, Braakman and Matsumoto, demonstrate effective use of ECT in anti-NMDAR encephalitis patients with severe psychiatric symptoms such as catatonia, psychosis, narcolepsy and stupor who had failed to respond to standard treatments alone. We also present a new case of a 71-year-old female who presented to a psychiatric unit initially with depression, which escalated to catatonia, delusions, nihilism and auditory hallucinations. After anti-NMDAR antibodies were isolated, she was treated by the neurology team with plasmapheresis and steroids, with a partial response. She received multiple sessions of ECT and her psychiatric symptoms completely resolved and she returned to her premorbid state. For this reason, we suggest that ECT should be considered, particularly in those patients who are non-responders to standard therapies.
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Hayes L, Bawa R, Coebergh J. Atypical presentation of spinal cord infarction after a pulseless electrical activity arrest. Assoc Med J 2016. [DOI: 10.1136/bmj.i2936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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28
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Middelburg J, Rozema T, Maas H, Baartman E, Aarts M, Geijsen D, Leest A, Jobsen J, Coebergh J, Struikmans H. OC-0533: TGUGT and G8 tests predicting frailty and radiotherapy compliance and acute toxicity in the elderly. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31783-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Adjei M, Coebergh J. AN AUDIT OF THE DIAGNOSIS AND COSTS ASSOCIATED WITH INPATIENTS WITH FUNCTIONAL NEUROLOGICAL SYMPTOMS IN A DISTRICT GENERAL HOSPITAL. J Neurol Psychiatry 2014. [DOI: 10.1136/jnnp-2014-308883.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Coebergh J. Working at Heathrow airport may be a risk factor for cardiovascular disease. BMJ 2013; 347:f6794. [PMID: 24252820 DOI: 10.1136/bmj.f6794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jan Coebergh
- Ashford and St Peter's Hospitals NHS Trust, Chertsey KT16 0PZ, UK
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Coebergh J. Accurate diagnosis and long term management is problem in epilepsy, not cost of drugs. BMJ 2013; 346:f3920. [PMID: 23778279 DOI: 10.1136/bmj.f3920] [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: 11/04/2022]
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de Vries E, Arnold M, Altsitsiadis E, Trakatelli M, Hinrichs B, Stockfleth E, Coebergh J. Potential impact of interventions resulting in reduced exposure to ultraviolet (UV) radiation (UVA and UVB) on skin cancer incidence in four European countries, 2010-2050. Br J Dermatol 2012; 167 Suppl 2:53-62. [PMID: 22881588 DOI: 10.1111/j.1365-2133.2012.11087.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Behavioural interventions to reduce exposure to ultraviolet radiation (UVR) can reduce risk of skin cancer. OBJECTIVES To integrate the data and to evaluate the impact of interventions to limit exposure to UVR on skin cancer incidence in four selected countries. METHODS Using PREVENT, a dynamic simulation model, we modelled the potential for skin cancer prevention in four European countries under various scenarios to avoid damage by UVR. RESULTS In general, the most effective interventions were those aimed at protecting people during outdoor work and outdoor hobbies against the harmful effects of UVR, and combinations of several interventions. These could in theory lead to reductions of up to 45% in skin cancer cases projected for the year 2050. CONCLUSIONS The scope for prevention depends on the prevalence of the risk factors in the different countries, as well as the associated risk factors and time lags modelled.
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Affiliation(s)
- E de Vries
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
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Coebergh J, Karim-Kos H, De Vries E. 105 Recent trends in the burden of cancer in Europe: a combined approach of incidence, survival and mortality for 17 major cancer sites since the 1990 s. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)70097-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Coebergh J, deVries E, Soerjomataram I, Barendregt J, Oenema A, Lemmens V, Kunst A, Boniol M, Autier P, Klepp K. 269 Scenarios for Cancer prevention in Europe: the Eurocadet project. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)70226-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Coebergh J, van de Poll-Franse L. 118 The Netherlands cancer plan experience. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)70106-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Coebergh J. Dutch medical schools abandon selection for lottery system for places. Assoc Med J 2003. [DOI: 10.1136/sbmj.0305138a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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van der Sanden GA, Wesseling P, Schouten LJ, Teepen HL, Coebergh J. A uniform histological cluster scheme for ICD-O-coded primary central nervous system tumors. Neuroepidemiology 2000; 17:233-46. [PMID: 9705583 DOI: 10.1159/000026176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 11/19/2022] Open
Abstract
Comparability of population-based measures of risk and prognosis for primary central nervous system (CNS) tumors, which exhibit marked histological diversity, may be hampered by differences in detection and case ascertainment and by the lack of unequivocal and uniform histological criteria for pathological diagnoses. Furthermore, many cancer registries do not include benign tumors as defined by the International Classification of Diseases for Oncology (ICD-O), such as meningiomas, schwannomas and pituitary adenomas. We propose both a detailed and a rough uniform histological cluster scheme for data coded according to the first or second edition of the ICD-O, published in 1976 and 1990, respectively. Primary CNS tumors, typed and graded according to (modified) classification systems of Bailey and Cushing, Kernohan, Ringertz, the WHO and Daumas-Duport, are clustered as clinically relevant entities on the basis of the second edition of the WHO classification system, published in 1993. The proposed scheme identifies some of the (potential) pitfalls in the descriptive epidemiology of CNS tumors and may facilitate temporal and geographical comparability of population-based data.
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van der Sanden GA, Schouten LJ, van Dijck JA, van Andel JP, Coebergh J. Incidence of primary central nervous system cancers in South and East Netherlands in 1989-1994. Neuroepidemiology 2000; 17:247-57. [PMID: 9705584 DOI: 10.1159/000026177] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [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: 11/19/2022] Open
Abstract
About 2,000 patients with primary CNS cancers, as defined by the ICD-O, were registered in four adjacent cancer registries in South and East Netherlands in 1989-1994, covering a population of more than 5 million people. About 85% of the patients were registered through pathological laboratories, concentrated in four centers for neurosurgery. Patients with a clinical-radiological diagnosis only (about 50% in the age-group of 75 years and older) were mainly identified through medical records of hospitalized patients. World-standardized incidence rates of 6.5 and 4.4 per 100,000 person-years for males and females, respectively, were similar to those reported in other European cancer registries. Eighty-five percent of histologically verified primary CNS cancers were of glial origin, 6% were lymphomas and 4% embryonal tumors. Gliomas were mainly of astrocytic (about 85%) and oligodendroglial or mixed type (about 10%). Without additional review most astrocytic tumors could be classified into high-grade (70-75%) and low-grade astrocytomas (20-25%). Different grading systems were used for gliomas, but the dichotomy of astrocytomas according to differentiation grade seemed to correspond well with the definition of the WHO. Age-specific incidence rates for low-grade astrocytomas were remarkably constant. The incidence of high-grade astrocytomas increased sharply with age and declined after the age of 70, whereas the incidence of clinically diagnosed tumors continued to increase. Male/females-ratios were relatively high for these tumor types (1. 6-1.7). We conclude that the registration of primary CNS cancers in the Netherlands may be almost complete and valid for gliomas, embryonal tumors and lymphomas.
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