Acute symptomatic seizures in the tropics—The need to improve outcomes

Regarding¹ acute symptomatic seizure associated with tropical conditions such as cerebral malaria² and Japanese encephalitis virus³ as being well-recognized to frequently result in neurologic sequelae including epilepsy, neurodevelopmental abnormalities and behavioral disorders, in the June issue of Seizure, Soni et al¹ working in Chandigarh, India detail neurologic outcomes in a cohort of 604 children with acute symptomatic seizures due to a number of conditions.

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Looking at risk factors for peripheral neuropathy in Uganda

In this week’s Neurology, Saylor et al. report findings from Uganda looking at risk factors for peripheral neuropathy (PN) among 800 adults in the Rakai Community Cohort Study. Based upon the requirement for at least one symptom AND least one sign on physical examination, 13% of adults assessed had evidence of neuropathy. HIV was certainly a risk factor for PN, but 7% of HIV negative participants also had PN. Risk factors included age, neurotoxic medications and tobacco use. As the authors point out, these rates of PN warrant further investigations into possible causes, especially environmental exposures and nutritional vulnerabilities especially since the presence of PN was associated with impaired function.

Diabetic peripheral neuropathy pain and pharmacotherapy

Waldfogel et al performed a systematic review of pharmacotherapy for diabetic peripheral neuropathy pain. Similar to four previous systematic reviews, they conclude that serotonin reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and pregabalin are effective medications for this highly prevalent condition. In contrast to previous studies, they conclude that gabapentin is not effective while oxcarbazepine is effective.

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Social Media and the RFS

Want to connect with residents and fellows training in neurology throughout the world? Stay up to date on articles being published by your peers? Challenge yourself with mystery cases and read the e-pearl of the week? You’ve come to the right place! To stay up to date on the latest from the Resident and Fellow Section (RFS), you have options:

  1. Go to our Facebook page by searching for @AANResidentsAndFellows, and be sure to click the “Like” button.
  2. Follow us on the twitter, #NeurologyRF. You can also follow RFS section editor @JohnMillichapMD.
  3. Subscribe to the R&F Section RSS feed using your web browser or an RSS Feed app such as Feedly.
  4. Bookmark our webpage, and read our latest posts!

Standard operating procedures improve neurological emergency management in a resource-poor sub-Saharan African setting

In this innovative intervention study in Gambia, Jaiteh et al. developed standard operative procedures (SOPs) for the care of common neurologic emergencies based upon syndromic diagnoses for stroke, fever with headache and seizure and found that in both rural and urban settings the availability of SOPs led to more appropriate evaluations and care. Larger studies with longitudinal assessments are likely needed to evaluate the impact on outcomes, but these findings suggest that a key role for the neurologist working in resource limited settings should be developing SOPs of this nature and assisting with implementation nationally.

Stroke risk factors in China

China now has the dubious honor of having a stroke incidence rate on par with high-income Western countries but a stroke mortality rate that remains typical of a lower middle income country. Risk factors are the usual suspects—hypertension, a family history of stroke, dyslipidemia, atrial fibrillation, diabetes, physical inactivity, tobacco use and an elevated body mass index. Read more about this in the Neurology® article Rapid transitions in the epidemiology of stroke and its risk factors in China from 2002 to 2013.

Stevens-Johnson Syndrome in southern Han population

In this case-control study in a southern Han Chinese population, HLA-A* 24:02 was identified as a risk factor for Stevens-Johnson Syndrome (SJS) from exposure to antiepileptic drugs including carbamazepine, lamotrigine, and phenytoin. HLA-B* 15:02 polymorphisms in this population were an already recognized risk factor for SJS after similar exposures. The prevalence of the HLA-A* 24:02 polymorphism in this population remains unknown making it difficult to determine if routine screening is indicated.

E-Pearls

In training, it’s not an uncommon occurrence for an attending or senior resident to point out a physical exam sign or unusual presentation of a common disease. E-pearls is the subsection of the Residents and Fellows Section (RFS) dedicated to these kinds of shorter, easily digested bits of knowledge or “pearls.” The goal of the e-pearls section is to provide one or more clinically relevant facts—generally about less common disease entities or clinical signs—that trainees will be able to recall six months later. E-pearls are posted on the RFS website and Facebook, and are also featured on the Neurology podcast. Continue Reading “E-Pearls”