32 e-Letters

published between 2014 and 2017

  • Romberg's test has stood up to the test of time and should remain standing
    Angus Nisbet

    Title: Romberg's test has stood up to the test of time and should remain standing (Neuromythology: Letter to the Editor)

    I was Interested to read Professor Martin Turner's article entitled Romberg's test no longer stands up. In the article Professor Turner describes the test as "the process of standing unsupported with the eyes closed and feet together for 30 s" and asserts that "the positive result is the p...

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    Fabio Bandini

    Sir, I read with much interest the review by Weerasinghe and Lueck on the diagnosis of optic neuritis. The authors provide an extensive and detailed analysis on the differential diagnoses and the management of the disease. The importance of retinal electrophysiology is also acknowledged when differentiating retinal disorders that can mimic optic neuritis. Surprisingly, however, the diagnostic role of pattern-reversal Visua...

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  • Reply from Pennington et al.
    C Pennington

    We welcome debate around this emerging condition. We all recognise a situation when as clinicians we have had a strong feeling that a patient has a functional complaint from early on in the consultation. However, the differential diagnosis for Functional Cognitive Disorder is neurodegenerative dementia which itself affects behaviour and personality and could, therefore, influence many of the cues clinicians pick up on wh...

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  • Re: Pennington et al. Functional cognitive disorder: what is it and what to do about it?
    Jan A Coebergh

    Pennington and colleagues review of Functional Cognitive Disorder (FCD) [1] is very welcome to guide practice in a complex condition that is presenting increasingly to general and cognitive neurology clinics. However, in our view Pennington's presumption towards specialist assessment, investigation and surveillance is unnecessary and misses an opportunity to provide patients with a prompt diagnosis, explanation and reas...

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  • A case of functional cognitive disorder with acute onset?
    Rachel A Cichosz

    While reading Pennington et al's (2015) article on Functional Cognitive Disorder, I was struck by the similarity between their descriptions and a patient seen in clinic (patient X), with the exception that X's symptoms appeared over the course of a few days with no identifiable precipitating event. Extensive physical tests and brain imaging investigations were carried out and no organic disease was found yet symptoms we...

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  • Re:Comment on Death in pregnancy: a call for neurological action (JP Leach. Practical Neurology 2015)
    Dr John Paul Leach

    The outlined model of cooperative and integrative services for pregnant women with neurological conditions is warmly welcomed (and not a little envied!). While such services are provided the English centres mentioned, it is sad that such high quality provision remains patchy and incomplete. This nettle-grasping should no longer be quiet, but should be loudly heralded and made the norm. The recently updated SIGN guideline...

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  • Comment on Death in pregnancy: a call for neurological action (JP Leach. Practical Neurology 2015)
    Dr. Dominic Paviour

    Dear Sirs, We welcome Dr Leach's comments and a call for action from Neurologists, regarding service provision for women of childbearing age with neurological disorders1. We would also like to highlight that quietly, a number of us are grasping the nettle. Risk is inherent in clinical practice. Managing risk effectively and pro- actively in preference to reactively minimises the likelihood of a poor outcome. This can be...

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  • Are the new ABN guidlines for MS of any use in clinical practice?
    Julian N Furby

    As a jobbing MS neurologist in Southampton I am really not sure how these guidelines are going to assist in my clinical practice.

    Perhaps first and foremost, if I was to follow these guidelines I would find myself frequently in breach of NHS commissioning criteria with perhaps severe implications for both myself and my hospital trust given the cost of these therapies. As such I feel the authors should have give...

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  • Re:Letter to Practical Neurology: comment on MG: ABN's management guidelines (Sussman et al. Practical Neurology 2015 )
    Dr. Jon Sussman

    I am grateful to Drs Wong and Plant for their invaluable comments, based on their enormous experience of patients presenting with suspected ocular myasthenia. The Guidelines are intended to offer non-specialists an approach to management that will work, safely, in the majority of patients. Within them, we stressed repeatedly the need to seek specialist opinion when in any doubt, and their letter emphasises the benefit of...

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  • Letter to Practical Neurology: comment on MG: ABN's management guidelines (Sussman et al. Practical Neurology 2015 )
    Sui Hsien Wong

    Dear Sirs, Myasthenia gravis: Association of British Neurologists' management guidelines We read with interest the ABN's management guidelines on Myasthenia Gravis[1] and commend the authors for putting toget her guidelines for this condition where the evidence base is limited. The comments here reflect our experience of managing a large number of patients with ocular myasthenia gravis (OMG). Moor fields Eye Hospital is th...

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