2 rows where subject = "["Surgery", "Psychiatry and Mental health", "Clinical Neurology"]"
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|42||42||["Hyper-reflexia in Guillain-Barr\u00e9 syndrome: systematic review"]||10.1136/jnnp-2019-321890||http://dx.doi.org/10.1136/jnnp-2019-321890||2020-01-14T22:33:50Z||["Surgery", "Psychiatry and Mental health", "Clinical Neurology"]||43||1||["0022-3050", "1468-330X"]||Journal of Neurology, Neurosurgery & Psychiatry||<jats:p>Areflexia or hyporeflexia is a mandatory clinical criterion for the diagnosis of Guillain-Barré syndrome (GBS). A systematic review of the literature from 1 January 1993 to 30 August 2019 revealed 44 sufficiently detailed patients with GBS and hyper-reflexia, along with one we describe. 73.3% of patients were from Japan, 6.7% from the USA, 6.7% from India, 4.4% from Italy, 4.4% from Turkey, 2.2% from Switzerland and 2.2% from Slovenia, suggesting a considerable geographical variation. Hyper-reflexia was more frequently associated with antecedent diarrhoea (56%) than upper respiratory tract infection (22.2%) and the electrodiagnosis of acute motor axonal neuropathy (56%) than acute inflammatory demyelinating polyneuropathy (4.4%). Antiganglioside antibodies were positive in 89.7% of patients. Hyper-reflexia was generalised in 90.7% of patients and associated with reflex spread in half; it was present from the early progressive phase in 86.7% and disappeared in a few weeks or persisted until 18 months. Ankle clonus or Babinski signs were rarely reported (6.7%); spasticity never developed. 53.3% of patients could walk unaided at nadir, none needed mechanical ventilation or died. 92.9% of patients with limb weakness were able to walk unaided within 6 months. Electrophysiological studies showed high soleus maximal H-reflex amplitude to maximal compound muscle action potential amplitude ratio, suggestive of spinal motoneuron hyperexcitability, and increased central conduction time, suggestive of corticospinal tract involvement, although a structural damage was never demonstrated by MRI. Hyper-reflexia is not inconsistent with the GBS diagnosis and should not delay treatment. All GBS variants and subtypes can present with hyper-reflexia, and this eventuality should be mentioned in future diagnostic criteria for GBS.</jats:p>||3||["http://orcid.org/0000-0002-8131-8912", "http://orcid.org/0000-0002-4716-8578"]||["Antonino Uncini", "Francesca Notturno", "Satoshi Kuwabara"]||[""]||[""]||[""]|
|63||63||["TM2-2\u2005Analysis of adverse events in the management of chronic headache by occipital nerve stimulation"]||10.1136/jnnp-2019-abn.41||http://dx.doi.org/10.1136/jnnp-2019-abn.41||2019-02-14T22:48:47Z||["Surgery", "Psychiatry and Mental health", "Clinical Neurology"]||0||0||["0022-3050", "1468-330X"]||Journal of Neurology, Neurosurgery & Psychiatry||<jats:sec><jats:title>Objectives</jats:title><jats:p>To analyse long-term adverse events of occipital nerve stimulation (ONS).</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Prospective open-label observational study.</jats:p></jats:sec><jats:sec><jats:title>Subjects</jats:title><jats:p>134 patients with refractory headaches implanted between 2007–2014 in a single specialised centre.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Information was collected on ONS device, implantable pulse generator (IPG) site and adverse event rates. The impact of implanter experience and the association between IPG site and adverse event rates was also explored.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Mean follow up was 46 months (6–108 months). A total of 139 adverse events were recorded in 75 patients (56%). A total of 59 additional surgeries were needed in 39 patients. A significant difference was seen in the rates of adverse events recorded between 2007–2010 and 2011–2014 (60.7% vs 42.6%, p=0.002). A significant reduction in ONS revision was seen over time (25.7% vs 5.9%, p=0.002). Analysis of adverse events with IPG site showed those with abdominal implants recorded higher adverse event rate that those with an IPG in the chest (65.8% vs 40.3%, p=0.004).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>In specialist centres, adverse event rates of ONS can be much lower than reported in the literature. Our results suggest implanter experience and IPG site both have an effect on adverse event rate.</jats:p></jats:sec>||3||||["S Miller", "L Watkins", "M Matharu"]||[""]||[""]||[""]|
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