Biomarker Report from the Phase II Lamotrigine Trial in Secondary Progressive MS - Neurofilament as a Surrogate of Disease Progression

This work was supported by National MS Society (USA) under the Promise 2010 initiative and the MS Society of Great Britain and Northern Ireland as part of exploratory analysis for the UK MS Clinical Trial Network. VL is supported by Italian Minister of Health grant for young researcher 2008

Primary medical care in Irish prisons

BACKGROUND: An industrial dispute between prison doctors and the Irish Prison Service (IPS) took place in 2004. Part of the resolution of that dispute was that an independent review of prison medical and support services be carried out by a University Department of Primary Care. The review took place in 2008 and we report here on the principal findings of that review. METHODS: This study utilised a mixed methods approach. An independent expert medical evaluator (one of the authors, DT) inspected the medical facilities, equipment and relevant custodial areas in eleven of the fourteen prisons within the IPS. Semistructured interviews took place with personnel who had operational responsibility for delivery of prison medical care. Prison doctors completed a questionnaire to elicit issues such as allocation of clinician's time, nurse and administrative support and resources available. RESULTS: There was wide variation in the standard of medical facilities and infrastructure provided across the IPS. The range of medical equipment available was generally below that of the equivalent general practice scheme in the community. There is inequality within the system with regard to the ratio of doctor-contracted time relative to the size of the prison population. There is limited administrative support, with the majority of prisons not having a medical secretary. There are few psychiatric or counselling sessions available. CONCLUSIONS: People in prison have a wide range of medical care needs and there is evidence to suggest that these needs are being met inconsistently in Irish prisons

Myth or Memory? Recollections of Penal Times in Irish Folklore

Stories of priests being hunted down and murdered at Mass Rocks by priest catchers and soldiers during the Penal era in Ireland persist to the present day. Using Ó Ciosáin’s (2004) tripartite taxonomy of memory this paper explores the reasons why these images continue to dominate and reflect persecuted nature of Catholicism

‘The great imitator’: Neurosyphilis and new-onset refractory status epilepticus (NORSE) syndrome

New-onset refractory status epilepticus (NORSE) is a syndrome of new-onset drug resistant status epilepticus that often has a catastrophic outcome. A 30-year-old man of Somali origin presented with refractory status to a district general hospital. A clinical diagnosis of NORSE syndrome was made, and he was transferred to the regional epilepsy center for immunomodulatory treatment and consideration for cyclophosphamide treatment. After transfer to the regional epilepsy center, his repeat cerebrospinal fluid tested strongly positive for syphilis, indicating a diagnosis of neurosyphilis, and the patient was treated with high-dose intravenous (IV) benzylpenicillin. His status epilepticus abated 24 h later. New-onset refractory status epilepticus syndrome is a diagnosis of exclusion. Before instigation of potentially harmful neuromodulatory therapies, treatable causes such as neurosyphilis should be considered. We advocate the early transfer of refractory status patients to a specialist epilepsy center for both seizure management and cause determination

Gee...What's Causing that Pap? - Abstract

A 36 year old woman presented with history of Myasthenia Gravis (MG) since the age of 18. She was known to have dry eyes and hypothyroidism. Past surgical history included a thymectomy (age 23 years). The MG had been difficult to control with past medications including corticosteroids, azathioprine, methotrexate and mycophenolate. Eighteen months prior to this presentation she was enrolled in a double blind placebo controlled trial with Eculizumab, a terminal complement inhibitor. She had required intravenous immunoglobin (IV IG) as rescue therapy initially and went on to open label Eculizumab 9 months prior to this admission. She had subsequently developed Alopecia areata (no family history), followed by nummular dermatitis, and then Alopecia totalis. The decision was made to have a drug holiday. This precipitated a worsening of the MG requiring IV IG. She restarted Eculizumab and 3 weeks later developed swinging fevers, nausea and vomiting and generalised polyarthralgia. On admission her vision (6/5 OU) and colour vision were normal. She had longstanding symptomatic left limitation of abduction, with normal saccades. She had no relative afferent pupillary defect and enlarged blind spots on Humphrey visual field testing. Dilated examination showed bilateral papilloedema. There was no other cranial neuropathy. Blood tests on admission were normal, including inflammatory markers and three sets of blood cultures with no growth. Inflammatory antibody tests were normal, as was HIV and testing for Tuberculosis. Lumbar puncture opening pressure was 23 cm CSF, with raised protein (0.93g/dl), low CSF glucose compared to serum, a mononuclear pattern, oligoclonal bands in the CSF only and PCR for viral and bacterial factors were negative. Initial MRI imaging was normal. CT thorax, abdomen and pelvis was normal. FDG-PET imaging showed increased uptake along the spinal cord. Bone marrow biopsy was normal. A brain biopsy and one further diagnostic test was performed.KBDautoimmuneopticneuropath

Gee...What's Causing that Pap? - Slides

A 36 year old woman presented with history of Myasthenia Gravis (MG) since the age of 18. She was known to have dry eyes and hypothyroidism. Past surgical history included a thymectomy (age 23 years). The MG had been difficult to control with past medications including corticosteroids, azathioprine, methotrexate and mycophenolate. Eighteen months prior to this presentation she was enrolled in a double blind placebo controlled trial with Eculizumab, a terminal complement inhibitor. She had required intravenous immunoglobin (IV IG) as rescue therapy initially and went on to open label Eculizumab 9 months prior to this admission. She had subsequently developed Alopecia areata (no family history), followed by nummular dermatitis, and then Alopecia totalis. The decision was made to have a drug holiday. This precipitated a worsening of the MG requiring IV IG. She restarted Eculizumab and 3 weeks later developed swinging fevers, nausea and vomiting and generalised polyarthralgia. On admission her vision (6/5 OU) and colour vision were normal. She had longstanding symptomatic left limitation of abduction, with normal saccades. She had no relative afferent pupillary defect and enlarged blind spots on Humphrey visual field testing. Dilated examination showed bilateral papilloedema. There was no other cranial neuropathy. Blood tests on admission were normal, including inflammatory markers and three sets of blood cultures with no growth. Inflammatory antibody tests were normal, as was HIV and testing for Tuberculosis. Lumbar puncture opening pressure was 23 cm CSF, with raised protein (0.93g/dl), low CSF glucose compared to serum, a mononuclear pattern, oligoclonal bands in the CSF only and PCR for viral and bacterial factors were negative. Initial MRI imaging was normal. CT thorax, abdomen and pelvis was normal. FDG-PET imaging showed increased uptake along the spinal cord. Bone marrow biopsy was normal. A brain biopsy and one further diagnostic test was performed.KBDautoimmuneopticneuropath

Gee...What's Causing that Pap? - Video

A 36 year old woman presented with history of Myasthenia Gravis (MG) since the age of 18. She was known to have dry eyes and hypothyroidism. Past surgical history included a thymectomy (age 23 years). The MG had been difficult to control with past medications including corticosteroids, azathioprine, methotrexate and mycophenolate. Eighteen months prior to this presentation she was enrolled in a double blind placebo controlled trial with Eculizumab, a terminal complement inhibitor. She had required intravenous immunoglobin (IV IG) as rescue therapy initially and went on to open label Eculizumab 9 months prior to this admission. She had subsequently developed Alopecia areata (no family history), followed by nummular dermatitis, and then Alopecia totalis. The decision was made to have a drug holiday. This precipitated a worsening of the MG requiring IV IG. She restarted Eculizumab and 3 weeks later developed swinging fevers, nausea and vomiting and generalised polyarthralgia. On admission her vision (6/5 OU) and colour vision were normal. She had longstanding symptomatic left limitation of abduction, with normal saccades. She had no relative afferent pupillary defect and enlarged blind spots on Humphrey visual field testing. Dilated examination showed bilateral papilloedema. There was no other cranial neuropathy. Blood tests on admission were normal, including inflammatory markers and three sets of blood cultures with no growth. Inflammatory antibody tests were normal, as was HIV and testing for Tuberculosis. Lumbar puncture opening pressure was 23 cm CSF, with raised protein (0.93g/dl), low CSF glucose compared to serum, a mononuclear pattern, oligoclonal bands in the CSF only and PCR for viral and bacterial factors were negative. Initial MRI imaging was normal. CT thorax, abdomen and pelvis was normal. FDG-PET imaging showed increased uptake along the spinal cord. Bone marrow biopsy was normal. A brain biopsy and one further diagnostic test was performed.KBDautoimmuneopticneuropath