Identifying young Aboriginal and Torres Strait Islander children in linked administrative data: A comparison of methods.

BACKGROUND: In the ongoing debate on optimum methods for identification of Indigenous people within linked administrative data, few studies have examined the impacts of method on population counts and outcomes in family-based linkage studies of Aboriginal children. OBJECTIVE: To quantify differences between three algorithms in ascertaining Aboriginal and Torres Strait Islander children in linked administrative data. METHODS: Linked administrative health data for children born in Western Australia (WA) from 2000-2013, were used to examine the cohorts identified by three methods: A) the Indigenous Status Flag (ISF, derived by the WA Data Linkage Branch using a multistage-median approach) for the children alone; B) the ISF of the children, their parents and grandparents; and C) Indigenous status of the child, mother or father on either of the child's perinatal records (Midwives or birth registration), to determine differing characteristics of each cohort. RESULTS: Method B established a larger cohort (33,489) than Method C (33,306) and Method A (27,279), with all methods identifying a core group of 26,790 children (80-98%). Compared with children identified by Method A, additional children identified by Methods B or C, were from less-disadvantaged and more urban areas, and had better perinatal outcomes (e.g. lower proportions of small-for-gestational age, 10% vs 16%). Differences in demographics and health outcomes between Methods C and B were minimal. CONCLUSIONS: Demographic and perinatal health characteristics differ by Aboriginal identification method. Using perinatal records or the ISF of parents and grandparents (in addition to the ISF of the child) appear to be more inclusive methods for identifying young Indigenous children in administrative datasets. KEYWORDS: Aboriginal health, identification, data linkage, Indigenous, child, methodology.

Diagnostic Yield of Routine EEG in Adults with Active Epilepsy

Routine electroencephalogram (rEEG) is an important investigation in suspected seizures but can be normal in people with epilepsy. The diagnostic yield of rEEG varies considerably according to the patient group studied. We aimed to estimate the diagnostic yield of rEEG in a real-world cohort of adults with active epilepsy­a population not previously reported. This single centre study evaluated neurophysiology findings for adults with prolonged inpatient video EEG (vEEG)-confirmed active epilepsy, who had at least one prior rEEG. Sixty-eight patients had a total of 171 rEEGs, of which 93 (54.4%) were normal, 42 (24.6%) found non-specific abnormalities and 36 (21.1%) captured interictal epileptiform abnormalities (IIEAs). Serial rEEGs revealed a 22.1% yield of IIEAs on the first test, with the cumulative yield peaking at 33.8% on the fourth rEEG. This study adds to existing evidence regarding the limited diagnostic usefulness of serial rEEG in patients with active epilepsy.

Investment in epilepsy monitoring units improves epilepsy care-experience in a regional neuroscience centre.

An evaluation of the clinical yield of inpatient long-term video-EEG (vEEG) in a new epilepsy monitoring unit (EMU) was undertaken, with findings compared to the centre's prior method of bedside vEEG recording in a standard neurology ward, as reported in 2004. A retrospective analysis of neurophysiology reports for all adults who underwent elective vEEG monitoring in the EMU at Cork University Hospital between January 2015 and July 2016 was conducted. Of 115 vEEG studies in the EMU, 100 (87.0%) were deemed diagnostically conclusive, 14 (12.2%) failed to catch any clinical events and showed normal EEG throughout, and one (0.9%) captured spells of unclear clinical significance - the corresponding figures reported in 2004 for bedside vEEGs were 21.3%, 77% and 1.6%, respectively. The EMU offers a more effective method of recording inpatient vEEG, which aids decision-making and improves clinical outcomes. Some evidence-based measures which could further enhance diagnostic yield are discussed.

Foot Drop: Looking Beyond Common Peroneal Nerve Palsy: A Neurophysiology Centre Experience.

Foot drop is a complex symptom with a considerable range in aetiology, severity and prognosis. We aim to characterise the aetiologies of foot drop and assess the diagnostic contribution of neurophysiologic testing (NCS/EMG). Retrospective review of consecutive referrals of foot drop to the Neurophysiology Department in Cork University Hospital was performed over a two year period (January 2012 to December 2013). Of a total of 59 referrals, common peroneal nerve (CPN) palsy comprised only slightly more than half of cases; 3(5%) have central origin; 3(5%) have motor neuron disease. Six (10%) have diabetes; 7(12%) have cancer; 5(8%) were bilateral. NCS/EMG altered initial working diagnosis in 14 out of 52 (27%) cases whereby initial diagnosis was provided. However one-third of all cases revealed additional coexistent pathology in an anatomic location remote to that of the primary diagnosis. Foot drop with central and proximal localisations are important and under recognised. NCS/EMG is valuable and also reveals additional pathology which warrants investigation.

Utilization and Yield of Nerve Conduction Studies and Electromyography in Older Adults.

Older adults are at increased risk of both central and peripheral neurological disorders. Impaired nerve and muscle deficits contribute to morbidity and reduced quality of life. Our aim was to define the utilization and yield of nerve conduction studies (NCS) and electromyography (EMG) in older adults. We reviewed NCS and EMG records for all patients older than age 65 in the year 2012. Of 1,530 NCS and EMGs performed, 352 (23%) were in patients older than 65 (mean age 73.7, 52% male). 288 (83.7%) of NCS were abnormal as were 102 (71.8%) of EMGs. The likelihood of having an abnormal test result increased with increasing age. The most common diagnosis was peripheral neuropathy 231 (65.4%). The incidence of peripheral neuropathy is particularly high in this age group and detection is vital to prevent morbidity and improve quality of life.

An unusual presentation of Guillain-Barré syndrome in a young man with bilateral upper extremity weakness.

A 30-year-old man attended the emergency department with a 4-day history of progressive, bilateral upper limb weakness. He had mild shortness of breath and occasional swallowing difficulties. One month prior to presentation, he had flu-like symptoms and diarrhoea. Examination revealed upper limb hypotonia, symmetrical distal arm weakness and hyporeflexia. Power and reflexes in the lower limbs were normal. Nerve conduction studies and lumbar puncture demonstrated features consistent with Guillain-Barré syndrome (GBS). The patient was treated with a 5-day course of intravenous immunoglobulins. He improved significantly over the next 2 weeks. Breathing and swallow function did not deteriorate and required no further intervention. He had a sustained improvement, and remained at baseline 1 year later. Work-up for underlying structural, infectious, inflammatory and paraneoplastic aetiologies were negative. Serum antiganglioside antibodies were positive for the anti-GT1a IgG isotype supporting the clinical diagnosis of the pharyngeal-cervical-brachial variant of GBS.

Your diagnosis? Congenital foot drop.

A term infant was noted to have right-sided foot drop. We discuss the role of neurophysiology and diagnostic imaging.

Maternal and neonatal outcomes associated with gestational diabetes in women from culturally and linguistically diverse backgrounds in Western Australia.

AIMS: To compare maternal and neonatal outcomes for Australian-born women with gestational diabetes mellitus with those of culturally and linguistically diverse and non-culturally and linguistically diverse foreign-born women with gestational diabetes. METHODS: A total of 205,616 singleton births in Western Australia between 1998 and 2006 were examined using multivariate logistic regression. Risks of ten maternal and neonatal outcomes associated with gestational diabetes were compared for pregnancies with gestational diabetes to foreign-born women from both culturally and linguistically diverse and non-culturally and linguistically diverse backgrounds vs. Australian-born women. The same outcomes were also compared for pregnancies without gestational diabetes. RESULTS: Foreign-born culturally and linguistically diverse women were more likely to undergo emergency Caesarean section, but less likely to have pre-eclampsia, an elective Caesarean section or induced labour than Australian-born women. Their infants were less likely to be large for gestational age, require resuscitation or be transferred to specialist care. These differences were also evident among pregnancies without gestational diabetes to culturally and linguistically diverse women, but did not exist between foreign-born non-culturally and linguistically diverse women and Australian-born women with gestational diabetes. CONCLUSIONS: While gestational diabetes places women and infants at increased risk of adverse perinatal outcomes, these outcomes differed for foreign-born women from culturally and linguistically diverse backgrounds when compared with Australian-born women. Further investigation is required to elucidate why being foreign-born and culturally and linguistically diverse reduces the risk of several of these outcomes.

Erratum: Profound and persistent painful paclitaxel peripheral neuropathy in a premenopausal patient.

[This corrects the article DOI: 10.1136/bcr.12.2010.3645.].

EEG use in a tertiary referral centre.

The aim of this study was to retrospectively audit all electroencephalograms (EEGs) done over a 2-month period in 2009 by the Neurophysiology Department at Cork University Hospital. There were 316 EEGs performed in total, of which 176/316 (56%) were done within 24 hours of request. Out of 316 EEGs, 208 (66%) were considered 'appropriate' by SIGN and NICE guidelines; 79/208 (38%) had abnormal EEGs and 28 of these abnormal EEGs had epileptiform features. There were 108/316 (34%) 'inappropriate' requests for EEG; of these 15/108 (14%) were abnormal. Of the 67/316 (21%) patients who had EEGs requested based on a history of syncope/funny turns: none of these patients had epileptiform abnormalities on their EEGs. Our audit demonstrates that EEGs are inappropriately over-requested in our institution in particular for cases with reported 'funny turns' and syncope. The yield from EEGs in this cohort of patients was low as would be expected.

Intra subject variation and correlation of motor potentials evoked by transcranial magnetic stimulation.

BACKGROUND: Characterising intra and inter-subject variability of motor-evoked potential (MEP) measurements from transcranial magnetic stimulation (TMS) is key to its development as a diagnostic tool. METHODS: We performed three experiments to elucidate MEP variability within subjects: (i) repeated measurements at different levels of stimulation and muscle activation, (ii) simultaneous measurements at pairs of ipsilateral and contralateral muscles, (iii) simultaneous measurements of contralateral muscles when one is activated. RESULTS: Cube root transformation of MEP data produces approximately constant coefficient of variation with Gaussian distribution and no significant autocorrelation between repeat measurements. After adjustment of intersubject variability, correlation between simultaneous muscle pairs was insignificant (p = 0.36). Highly significant effects were observed due to increase in intensity of stimulation: (0.07, 0.23) mV, p < 0.0001, muscle type: (p < 0.009) and activation of ipsilateral muscle: (0.10, 0.49) mV, p < 0.0001. CONCLUSION: Corticospinal effect is dominated by intersubject variability in simultaneous measurements on normal population.

Profound and persistent painful paclitaxel peripheral neuropathy in a premenopausal patient.

The authors herein report the case of a 35-year-old woman undergoing adjuvant therapy for node positive breast cancer, who presented with short and rapidly progressive history of bilateral lower limb symptoms of peripheral neuropathy following therapy with paclitaxel. MRI of her neural axis revealed no leptomeningeal enhancement or focal metastatic lesions. Neurophysiological tests favoured toxic sensory axonal polyneuropathy. She remains symptomatic following discontinuation of therapy 20 months ago, and is under review with pain management.

Parallel artefact rejection for epileptiform activity detection in routine EEG.

The EEG signal is very often contaminated by electrical activity external to the brain. These artefacts make the accurate detection of epileptiform activity more difficult. A scheme developed to improve the detection of these artefacts (and hence epileptiform event detection) is introduced. A structure of parallel Support Vector Machine classifiers is assembled, one classifier tuned to perform the identification of epileptiform activity, the remainder trained for the detection of ocular and movement-related artefacts. This strategy enables an absolute reduction in false detection rate of 21.6% with the constraint of ensuring all epileptic events are recognized. Such a scheme is desirable given that sections of data which are heavily contaminated with artefact need not be excluded from analysis.

Unusual paraneoplastic syndromes of breast carcinoma: a combination of cerebellar degeneration and Lambert-Eaton Myasthenic Syndrome.

INTRODUCTION: Paraneoplastic neurological disorders are rare complications of breast carcinoma. Lambert-Eaton Myasthenic Syndrome (LEMS) is most commonly associated with small cell lung cancer. However, a combination of LEMS and subacute cerebellar degeneration as paraneoplastic syndromes is extremely rare, and has never been described in association with breast cancer. CASE: We report for the first time an unusual association of LEMS and paraneoplastic subacute cerebellar degeneration with breast carcinoma. CONCLUSION: In patients with atypical LEMS, when there is no evidence of respiratory malignancy, breast cancer should be included in the differential diagnosis.

Brachial neuritis masquerading as acute coronary syndrome.

BACKGROUND: Brachial neuritis is a frequently misdiagnosed condition which can present to many medical or surgical specialties. OBJECTIVE: To report a case of brachial neuritis with bilateral phrenic nerve involvement and diaphragmatic weakness. CASE DESCRIPTION: A 63-year-old man presented with acute-onset proximal upper extremity pain and weakness. He also developed severe orthopnoea. Examination revealed proximal upper limb wasting and dramatic paradoxical breathing. Cardiac investigations were unremarkable. Electromyographic studies were consistent with a C5 radiculopathy. Phrenic nerve studies were abnormal bilaterally and Sniff test was positive. A diagnosis of brachial neuritis with predominant C5 and bilateral phrenic nerve involvement was made. His symptoms resolved spontaneously over 3 months. CONCLUSIONS: Brachial neuritis can mimic an acute coronary syndrome and is a rare cause of bilateral phrenic neuropathy. Phrenic nerve palsy should be considered in patients presenting with shortness of breath without any underlying respiratory or cardiovascular illness.

A review of nerve conduction studies in cases of suspected compression neuropathies of the upper limb.

INTRODUCTION: Entrapment neuropathies, particularly those affecting upper limbs, are common reasons for referral for nerve conduction studies (NCS). However, concordance between clinical findings and NCS findings, especially in patients being considered for intervention including decompressive surgery, has not been assessed. METHODS: We conducted a retrospective study using records from a tertiary referral centre's neurophysiology database. We aimed to establish the proportions of agreement between the suspected clinical diagnosis as defined by the referring clinician and NCS findings in the setting of an upper limb entrapment neuropathy. RESULTS: Of the 571 referrals for NCS, suspected bilateral carpal tunnel syndrome was the commonest reason for referral (30.5%). In total, there was 51.5% concordance between suspected clinical diagnosis and NCS findings. Patients with NCS evidence of an entrapment neuropathy (n = 437) were more likely to be older compared to those with normal studies (54.0 +/- 15.6 years vs. 45.9 +/- 13.4 years, p < 0.001). Those with normal NCS findings were more likely to be female (72%, p = 0.001). An alternative or additional diagnosis was found in 14%. CONCLUSION: This study raises concerns regarding the appropriateness of referral for decompressive surgery based on clinical diagnosis alone as many have an additional or alternative diagnosis as suggested by NCS findings.

An audit of traumatic nerve injury.

The impact of trauma in the Irish healthcare setting is considerable. We present the results of a retrospective assessment of referrals to a Neurophysiology department for suspected traumatic nerve injury. A broad range of traumatic neuropathies was demonstrated on testing, from numerous causes. We demonstrate an increased liklihood of traumatic nerve injury after fracture / dislocation (p = 0.007). Our series demonstrates the need for clinicians to be aware of the possibility of nerve injury post trauma, especially after bony injury.