128 e-Letters

  • The Babinski sign: Key Facts
    Mark Baker

    Dear Editor,

    In his recent Neuromythology article1 on the Babinski sign, Professor Kiernan repeats the oft quoted recommendation regarding the best method for testing the plantar response, which is to:

    'Run a car key (figure 1; or as some have suggested, a most expensive motor car key...) along the lateral border of the sole.'

    It will not surprise many readers of Practical Neurology to learn th...

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  • The biography of functional disorders
    Jonathon P Tomlinson

    This sensitive review is very welcome, as in our experience, most patients with functional disorders are told by specialists what they do not have. I would be much more inclined to refer patients if this kind of approach was more common. It is one reason why relatively few of the patients we see in primary care are referred for specialist attention. Specialists are seeing only the tip of the primary care functional iceb...

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  • 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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