R.J. Galvin

Clinical characteristics and outcome of patients diagnosed with psychogenic nonepileptic seizures: a 5-year review.

OBJECTIVE The goal of this article was to describe the clinical characteristics and outcomes of patients diagnosed with psychogenic nonepileptic seizures (PNES). METHODS We conducted a retrospective review of patients diagnosed with PNES in a 5-year period. RESULTS Fifty patients with PNES were identified, giving an estimated incidence of 0.91/100,000 per annum. Thirty-eight were included for review, 15 of whom were male (39%). Eighteen patients had been diagnosed with epilepsy as well as PNES (47%). We demonstrated a gender difference in our patients, with males having higher seizure frequencies, more antiepileptic drug use, and a longer interval before diagnosis of PNES. Females were diagnosed with other conversion disorders more often than males. Impaired social function was observed in PNES, as was resistance to psychological interventions with a subsequent poor response to treatments. CONCLUSIONS PNES remains a difficult condition to treat, and may affect males in proportions higher than those described in previous studies.

A study of idiopathic generalised epilepsy in an Irish population.

UNLABELLED Idiopathic generalised epilepsy (IGE) is subdivided into syndromes based on clinical and EEG features. PURPOSE The aim of this study was to characterise all cases of IGE with supportive EEG abnormalities in terms of gender differences, seizure types reported, IGE syndromes, family history of epilepsy and EEG findings. We also calculated the limited duration prevalence of IGE in our cohort. METHODS Data on abnormal EEGs were collected retrospectively from two EEG databases at two tertiary referral centres for neurology. Clinical information was obtained from EEG request forms, standardised EEG questionnaires and medical notes of patients. RESULTS two hundred twenty-three patients met our inclusion criteria, 89 (39.9%) male and 134 (60.1%) females. Tonic clonic seizures were the most common seizure type reported, 162 (72.65%) having a generalised tonic clonic seizure (GTCS) at some time. IGE with GTCS only (EGTCSA) was the most common syndrome in our cohort being present in 94 patients (34 male, 60 female), with 42 (15 male, 27 female) patients diagnosed with Juvenile myoclonic epilepsy (JME), 23 (9 male, 14 female) with Juvenile absence epilepsy (JAE) and 20 (9 male, 11 female) with childhood absence epilepsy (CAE). EEG studies in all patients showed generalised epileptiform activity. CONCLUSIONS More women than men were diagnosed with generalised epilepsy. Tonic clonic seizures were the most common seizure type reported. EGTCSA was the most frequent syndrome seen. Gender differences were evident for JAE and JME as previously reported and for EGTCSA, which was not reported to date, and reached statistical significance for EGTCA and JME.

Acquired generalised neuromyotonia, cutaneous lupus erythematosus and alopecia areata in a patient with myasthenia gravis.

We describe a patient with the diagnoses of acquired neuromyotonia, cutaneous lupus erythematosus and alopecia areata, occurring many years after a thymectomy for myasthenia gravis associated with a thymoma. We review the current literature on autoimmune conditions associated with myasthenia gravis and thymectomy. To our knowledge, this combination of multiple autoimmune conditions has not been reported previously.

Late-onset ophthalmoplegic migraine in a patient with previous childhood abdominal migraine

Ophthalmoplegic migraine (OM) has been classified by the Headache Classification Committee of the International Headache Society (IHS) in 2004 under the heading of ‘Cranial neuralgias and central causes of facial pain’ (13.17) (1). OM is defined as consisting of at least two episodes of headache accompanied or followed within 4 days of its onset by paresis of one or more of the third, fourth and/or sixth cranial nerves, with investigations having ruled out parasellar, orbital fissure and posterior fossa lesions. This is a rare condition, of which the vast majority of cases present in childhood. We describe a case of late-onset OM in a 35-year-old female with a previous history of childhood abdominal migraine. We discuss the differential diagnosis and investigations of this condition and review the current literature regarding this disorder.

Clinical neurophysiology referral patterns to a tertiary hospital : a prospective audit

AbstractBackground Cork University Hospital (CUH) provides a tertiary service for all neurophysiology referrals in the Southern Health Board region. Aim To ascertain the number, source, symptoms and diagnosis of neurophysiology referrals at CUH. Methods We did a prospective audit of the referral patterns to the neurophysiology department over a 12-week period. Results Of 635 referrals, 254 had electromyograms (EMG), 359 had electro-encephalograms (EEG), 18 had visual evoked potentials (VEP), three had somato-sensory evoked potentials (SSEP) and one had multiple sleep latency tests (MSLT). We analysed the demographic pattern, reason for referrals, the average waiting time for neurophysiology tests and the patterns of diagnosis in this audit. Conclusions Patients from County Cork are making more use of the neurophysiology services than patients from other counties within the Southern Health Board. The average waiting time for an EEG was 32 days and for an EMG was 74 days. However, more than 35% of those patients waiting for an EEG or an EMG had their tests done within four weeks of referral. The appointments of EEG and EMG were assigned on the basis of clinical need.

A study of idiopathic generalised epilepsy in an Irish population

tion studies (NCS). We wished to ascertain the correlation with clinical diagnosis as well as severity, especially in those being considered for decompression surgery. Methods: We carried out a retrospective study using the neurophysiology database. All patients referred for a compression neuropathy were included during the course of 1 year. All those referred with another possible diagnosis such as polyneuropathy were excluded. Result: In total, there were 581 referrals for NCS of whom 60% were female with a median age of 52.05 years. Bilateral CTS was the most common reason for referral (29.9%) Neurology (27.2%) and Orthopaedics (28.1%) were the main sources of referral. Overall 5.2% had L CTS, 13.6% had R CTS, 31.3% bilateral CTS, 9.1% L UN, 5.4% R UN and 4.6% bilateral UN. 7.6% had another diagnosis and 23.2% had normal studies. Cumulatively neurology had 48.7% and orthopaedics had 52.8% correlation with clinical diagnosis. Conclusion: This study raises important questions about referral for surgery on the basis of clinical diagnosis alone.