Contingent negative variation in epilepsy

The contingent negative variation (CNV) is a long-latency event-related potential elicited by paired or associated stimuli. We recorded contingent negative variation in 50 patients with complex partial and secondarily generalized seizures and in 20 neurologically and psychiatrically normal unmedicated controls.CNV was recorded from Fz, Cz, and Pz. A 2000 Hz tone was followed after 1.5 s by 1000 microsecond light flash, at which a button press was to be executed. Filter band pass was 0.1–20 Hz, analysis time was 10s and 10 responses were replicated.Patients with complex partial seizures with and without secondary generalization had lower measurements of area under the CNV curve (AUC) than did controls, and CNV amplitude was significantly reduced. Patients with interictal behavioural symptoms had significantly smaller AUC and lower amplitude. No significant difference was found between depressed and non-depressed seizure patients with respect to AUC, but amplitude was significantly lower in depressed patients. Seizure patients with psychosis had significantly lower AUC but did not differ from non-psychotic patients in CNV amplitude. No differences were found between seizure patients with and without personality disorder with respect to CNV AUC or amplitude. Post-imperative negative variation was significantly more common in seizure patients than in controls and among patients with epilepsy, was significantly increased in those with inter-ictal behaviour disturbance generally and psychosis particularly. No specific effect of anticonvulsant monotherapy on AUC or amplitude was identified.These findings suggest that CNV may differ between partial epilepsy patients and controls, and that inter-ictal behaviour disturbance may particularly affect CNV measures. They also agree with previous evidence for a frontal lobe generator for the CNV, and a possible role for central dopaminergic pathways in the production of PINV

Towards collaborative management of nonalcoholic fatty liver disease (TCM-NAFLD): a ‘real-world’ pathway for fibrosis risk assessment in primary care

Background: The optimal strategy to support primary care practitioners (PCPs) to assess fibrosis severity in nonalcoholic fatty liver disease (NAFLD) and thereby make appropriate management decisions remains unclear.Aims: We aimed to examine the feasibility of using a 2-step pathway that combined simple scores (NAFLD Fibrosis Score and Fibrosis-4 Index) with transient elastography (FibroScan®) to streamline NAFLD referrals from a ‘routine’ primary care population to specialist hepatology management clinics (HMC).Methods: The 2-step “Towards Collaborative Management of NAFLD” (TCM-NAFLD) fibrosis risk assessment pathway was implemented at two outer metropolitan primary healthcare practices in Brisbane. Patients aged ≥18 years with a new or established PCP-diagnosis of NAFLD were eligible for assessment. The pathway triaged patients at “high risk” of clinically significant fibrosis to HMC for specialist review, and “low risk” patients to receive ongoing management and longitudinal follow-up in primary care.Results: A total of 162 patient assessments between Jun-2019 and Dec-2020 were included. Mean age was 58.7 ± 11.7 years, 30.9% were male, 54.3% had type 2 diabetes or impaired fasting glucose, and mean body mass index was 34.2 ± 6.9 kg/m2. 122 patients were considered “low risk” for clinically significant fibrosis, two patients had incomplete assessments, and 38 (23.5%) were triaged to HMC. Among 31 completed HMC assessments to date, 45.2% were considered to have clinically significant (or more advanced) fibrosis, representing 9.2% of 153 completed assessments.Conclusion: Implementation of the 2-step TCM-NAFLD pathway streamlined hepatology referrals for NAFLD and may facilitate a more cost-effective and targeted use of specialist hepatology resources