Motor cortex excitability in chronic low back pain.

Chronic pain is associated with dysfunctional cortical excitability. Research has identified altered intracortical motor cortex excitability in Chronic Lower Back Pain (CLBP). However, research identifying the specific intracortical changes underlying CLBP has been met with inconsistent findings. In the present case-control study, we examined intracortical excitability of the primary motor cortex using transcranial magnetic stimulation (TMS) in individuals with CLBP. Twenty participants with CLBP (Mage = 54.45 years, SDage = 15.89 years) and 18 age- and gender-matched, pain-free controls (M = 53.83, SD = 16.72) were included in this study. TMS was applied to the hand motor area of the right hemisphere and motor evoked potentials (MEPs) were recorded from the first dorsal interosseous muscle of the contralateral hand. Resting motor threshold (rMT) and MEP amplitude were measured using single-pulse stimulation. Short interval intracortical inhibition (SICI) and intracortical facilitation (ICF) were assessed using paired-pulse stimulation. Individuals with CLBP had significantly higher rMT (decreased corticospinal excitability) and lower ICF compared to controls. No significant differences were found in MEP amplitude and SICI. These findings add to the growing body of evidence that CLBP is associated with deficits in intracortical modulation involving glutamatergic mechanisms.

Meta-analysis and systematic review of population-based epidemiological studies in idiopathic intracranial hypertension.

Idiopathic intracranial hypertension (IIH) is positively associated with obesity, mostly in young women. The global increase in obesity may influence the burden of IIH. Using the PubMed, Embase, MEDLINE and Web of Science databases, a meta-analysis and systematic review of epidemiological studies of IIH were performed up to June 2017. Temporal changes in IIH incidence were measured, and incidence rates of IIH were correlated with country-specific World Health Organization obesity rates. Prevalence data and shunting rates of IIH were recorded. The quality of epidemiological studies was assessed using the Standards of Reporting of Neurological Disorders (STROND) criteria. In 15 identified studies, there were 889 patients (87% women), mean age 29.8 years. The incidence of IIH ranged from 0.03 to 2.36 per 100 000 per year. The pooled incidence of IIH was 1.20 per 100 000 per year although there was very high heterogeneity (I2 98%). The incidence rates of IIH were correlated with country-specific prevalence of obesity (Spearman's correlation 0.82, P < 0.01). The prevalence of IIH was rarely recorded. A shunting procedure was reported in 8% of patients. STROND criteria were variably reported, median of 26.5 of 43 (range 16-35). IIH is a public health concern as increased obesity prevalence is associated with increased incidence of IIH. A better quality of epidemiological studies is required to improve understanding of IIH and inform health policy for IIH management.

Impact of social prescribing on general practice workload and polypharmacy.

OBJECTIVES: Social prescribing has emerged as a useful tool for helping patients overcome some of the social and behavioural determinants of poor health. There has been little research on the impact of social prescribing on use of primary healthcare resources. This study sought to determine whether social prescribing activities influenced patient-general practitioner (GP) contacts and polypharmacy. STUDY DESIGN: Quality-improvement design with social prescribing activity interventions from an urban general practice in Northern Ireland. METHODS: Patients over 65 years of age with a chronic condition who attended their GP frequently or had multiple medications were offered a social prescribing activity. Participants' contacts with GP and the new repeat prescriptions before and during the social prescribing activity were measured. The total number of repeat prescriptions per patient was compared at the time of referral and 6-12 months later. Indications for referral, primary diagnoses and reasons for declining participation in a social prescribing activity after referral were prospectively recorded. RESULTS: Sixty-eight patients agreed to participate but only 28 (41%) engaged in a prescribed social activity. There was no statistically significant difference in GP contacts (visits to GP, home visits or telephone calls) or number of new repeat prescriptions between referral and completion of 12 weeks of social prescribing activity. Similarly there was no statistically significant difference in the total number of repeat prescriptions between referral and 6-12 months after social prescribing activity in either intention to treat or per protocol analyses. Social prescribing participants had similar demographic factors. Mental health issues (anxiety and/or depression) were more common among participants than those who were referred but declined participation in a social prescribing activity (P = 0.022). CONCLUSIONS: While social prescribing may help patients' self-esteem and well-being, it may not decrease GP workload. Further research is required to optimise social prescribing benefits.

Suitability of the Depression, Anxiety, and Stress Scale in Parkinson's Disease.

BACKGROUND: The Depression, Anxiety, and Stress Scale -21 (DASS-21) is a frequently used measure of emotional disturbance symptoms in Parkinson's disease (PD). However, the factor structure of the DASS-21 in PD has yet to be explored. OBJECTIVE: To assess whether the scale is measuring these symptoms in PD in the same way as the general population. METHODS: The present study fit a series of established DASS-21 factor structures with both confirmatory factor analysis (CFA) and exploratory structural equation modelling (ESEM) using data from 251 participants with PD. RESULTS: The 3-factor ESEM provided the best fit. The depression and stress scales fit well, however, few items on the anxiety subscale loaded clearly, with several items significantly loading onto the depression or stress factors. CONCLUSIONS: Whilst the depression and stress subscales appear suitable in PD, poor loadings and internal consistency indicate the anxiety subscale may not accurately assess anxiety symptomology in PD. This may be due to the scale's reliance on physiological symptoms as indicators of anxiety, when many of these are present in PD. Thus, the anxiety subscale of the DASS-21 may not be a suitable measure of anxiety in PD.

Testing the activation-orientation account of spatial attentional asymmetries using transcranial direct current stimulation.

The general population shows an attentional bias to the left, known as pseudoneglect. This bias is thought to be driven by higher levels of activation in right parietal areas. Using transcranial direct current stimulation (tDCS) to manipulate activation, this study examined whether tDCS over the left and right posterior parietal cortices (PPC) affects pseudoneglect. Normal participants received tDCS over the left or right PPCs (15 in each group). Pseudoneglect was measured using the greyscales task, which requires a forced-choice discrimination of luminance between two opposing luminance gradients. The greyscales task was administered both before and after; (a) anodal (b) cathodal and (c) sham tDCS. Participants who received tDCS over the left PPC demonstrated pseudoneglect for the greyscales task, which was significantly reduced by anodal tDCS, but was unaffected by sham or cathodal tDCS. In contrast, for those participants who received right PPC tDCS, pseudoneglect for the greyscales task was unaffected by tDCS. Anodal tDCS, which is known to elevate neural excitation, may have overcome lower levels of activation in the left PPC, resulting in decreased pseudoneglect. These findings provide convincing evidence in support of an activation-orientation model of pseudoneglect and have implications for models of left neglect.

Exercise and Parkinson's: benefits for cognition and quality of life.

OBJECTIVES: The benefits of physical exercise for psychological aspects of quality of life (QoL) are well established in normally ageing adults, yet potential benefits for people with Parkinson's disease (PD) have received limited attention. This study evaluated the benefits of exercise for cognitive functioning, mood and disease-specific QoL for people with PD. METHODS: Twenty-eight individuals with PD were allocated to an exercise intervention program (EIP, n = 15) or control group (n = 13). The EIP group undertook a programme of progressive anabolic and aerobic exercise twice weekly for 12 weeks. The control group maintained their usual lifestyle. RESULTS: Exercise was shown to have selective benefits for cognitive functioning by improving frontal lobe based executive function. No significant effects were demonstrated for mood or disease-specific QoL. CONCLUSIONS: These results are consistent with previous research demonstrating selective benefits of exercise for executive function among normal ageing adults and PD.

Coping processes and health-related quality of life in Parkinson's disease.

OBJECTIVE: This study investigated the predictive value of various coping processes for the psychological and disease specific aspects of health-related quality of life (HRQoL) in Parkinson's disease (PD). METHOD: Cross-sectional study of 85 participants with PD using the Ways of Coping Questionnaire (WCQ), Depression, Anxiety, and Stress Scale (DASS-21), quality of life (PDQ-39), and socio-demographic and clinical variables. RESULTS: Greater use of planful problem solving coping was found to be significantly associated with better HRQoL in relation to cognitive impairment, communication and bodily discomfort. In addition to greater disease duration, greater use of escape-avoidance coping processes were identified as significant predictors of poorer HRQoL outcomes in the domains of mood and emotional well-being. CONCLUSION: Psychological interventions such as mindfulness training, aimed at reducing the use of escape-avoidance copying, may help to improve HRQoL in PD.

Driving after a transient ischaemic attack or minor stroke.

The frequency of adherence to the UK Driver and Vehicle Licensing Authority (DVLA) guidelines for patients referred to a neurovascular clinic is not known. Of 166 consecutive patients, 95 (57.2%) had a group 1 licence and 71 (42.7%) drove within a month of the event. Fifty of 85 (59%) transient ischaemic attack (TIA)/minor stroke patients had a licence and 30 (35%) drove within a month of the TIA/stroke. Compliance with DVLA driving guidelines is poor among patients referred to hospital with suspected TIA or minor strokes.

The sporicidal activity and inactivation of chlorhexidine gluconate in aqueous and alcoholic solution.

The sporicidal activity of chlorhexidine gluconate in aqueous and alcoholic solution against spores of Bacillus subtilis was examined over a broad temperature range. Activity was not observed at 20 degrees C even with concentrations as high as 10% chlorhexidine. Temperatures of 37 degrees-70 degrees C in combination with such high concentrations were required for reductions in spore viability. No viable spores were recoverable after 4 h contact at 55 degrees C with 10% aqueous chlorhexidine and none after 3 h contact with the alcoholic solution. Because of the high concentrations necessary for activity and the possibility of sporostasis occurring from inefficient chlorhexidine inactivation, existing inactivation systems were examined and modified to obtain satisfactory results. The spores of other Bacillus species examined (B. cereus, B. megaterium and B. stearothermophilus) proved to be considerably less resistant than those of B. subtilis. Presence of organic matter had little effect on the activity.