98 e-Letters

  • Pre-protocol experience from Belfast.
    Michael O. Kinney

    We welcome the article by Jones et al, and in particular the chance to compare the protocol used in their institution with the one we hope to implement (1).

    In Northern Ireland, we are in the process of drawing up a regional protocol for the management of status epilepticus, due to wide variation in current practice. We carried out preliminary work to see where the gaps in knowledge are, so that we can create a...

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  • Re:What is the risk of PCP in patients with neurological disease?
    Simon Cronin

    We thank Dr Lilleker for his comments. We agree that use of PCP prophylaxis must provide benefit that would outweigh any attendant risk. As suggested in our article, this risk is likely to vary depending on the dose and duration of steroid therapy, the co-administration of other biologicals and the systemic health of the patient. A patient with e.g., systemic vasculitis-associated mononeuritis multiplex who has also b...

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  • What is the risk of PCP in patients with neurological disease?
    James B Lilleker

    I thank the authors for highlighting this difficult topic with a very thought provoking article.

    In immunosuppressing a patient with neurological disease, as with anything a physician does to a patient, there are potential risks to take into account and to be weighed up against the proposed benefits. Indeed, this sort of "cost-benefit" analysis is a central tenant of decision making in much of life outside of me...

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  • Superb Book
    Roger L. Albin

    This is a superb book that deserves to be better known, at least on my side of the Atlantic. In addition to Barker's outstanding depiction of WW1 Britain, the sympathetic and revealing exploration of the physician- patient relationship is peerless. Interested readers should know that Regeneration is the first book in a trilogy, though neither is quite as good as Regeneration. The second book, The Eye in the Door, is qui...

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  • Chocolate Consumption, Nobel Prizes and -Scientific Integrity
    Bradford D. Pendley

    In a paper published last year in the New England Journal of Medicine (NEJM), Messerli noted "a surprisingly powerful correlation between chocolate intake per capita and the number of Nobel laureates in various countries," which he postulated as "most likely" related to the cognitive enhancing benefits of chocolate.1 This article in one of the premier journals in the world received extraordinary press reports around the t...

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  • Spontaneously resolving cerebellar syndrome as a sequelae of dengue viral infection
    Viroj Wiwanitkit

    Sir, the report on "spontaneously resolving cerebellar syndrome as a sequelae of dengue viral infection" is very interesting [1]. In fact, neurological complication of dengue is not common but it can be detectable [2]. The spontaneously resolving cerebellar syndrome in this report is questionable for the relationship to dengue. Based on the previous study from Thailand, the spontaneously resolving pathology of cerebellum...

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  • Neurophilia! Not.
    Rory Roopnarine

    I really enjoyed Dr. Fuller's wonderful article on a likely emerging public and professional fascination with neurology. The bad news, however, is humankind's perpetual fascination with phobias; a fascination with 'death' being but one example. I'd perhaps say that neurology has joined some rather elite company.

    I would postulate that neurophobia, rather than neurophilia, drives the impetus to produce copious ar...

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  • The use of stimulation single fibre EMG in investigation of congenital myasthenia
    Matthew C Pitt

    We enjoyed the review by our colleagues Finlayson et al 1 from the United Kingdom, Congenital Myasthenic service, covering all aspects of the congenital myasthenic syndromes. We would, however, suggest that the section on neurophysiology could have been expanded and elaborated more. To state that the neurophysiological findings in congenital myasthenic syndromes are similar to those in autoimmune myasthenia gravis is corr...

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  • Functional symptoms in neurology-making the right diagnosis
    Nitin K. Sethi

    The borderland between functional diseases and neurological diseases gets blurred especially when the patient presents with a myriad of symptoms which do not localize to any one level of the neural axis.1 If in addition the neurological examination is normal (especially the lack of 'hard' neurological signs such as upgoing plantars, cranial nerve signs, definite asymmetry of the deep tendon reflexes, cerebellar signs and...

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  • Shying away from making a clinical diagnosis
    Nitin K. Sethi

    Turner and Talbot rightly emphasize that in spite of advances in EMG techniques and emergence of novel neuroimaging and CSF biomarkers the diagnosis of motor neuron disease (MND) still remains a clinical one.1 Find upper motor neuron (UMN) and lower motor neuron (LMN) signs in the same limb and MND should be high up in the differential I recall was taught to me in medical school. EMG was to be used in atypical cases wher...

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