The promise of AI Large Language Models for Epilepsy care.

Artificial intelligence (AI) has been supporting our digital life for decades, but public interest in this has exploded with the recognition of large language models, such as GPT-4. We examine and evaluate the potential uses for generative AI technologies in epilepsy and neurological services. Generative AI could not only improve patient care and safety by refining communication and removing certain barriers to healthcare but may also extend to streamlining a doctor's practice through strategies such as automating paperwork. Challenges with the integration of generative AI in epilepsy services are also explored and include the risk of producing inaccurate and biased information. The impact generative AI could have on the provision of healthcare, both positive and negative, should be understood and considered carefully when deciding on the steps that need to be taken before AI is ready for use in hospitals and epilepsy services.

Clinicians embracing social media: Potential and pitfalls.

The bedrock of clinical medicine is effective communication. A generation ago, this was primarily the clinical consultation, the letter to the general practitioner, and the occasional scientific paper. In 2019, the avenues and opportunities for communication have exploded and include a pantheon of new and social media. We review the current state of how doctors use social media, and what can be gained by doing so. We provide strategies about how best to utilize these tools, depending on what you wish to gain. We discuss why every clinician needs a 'social media strategy' even if this is one of increasing your privacy levels and removing incorrect information from the web. We discuss the risks and harms of these newer forms of communication and how best to avoid embarrassment or censure. Social media fills an information vacuum, and in many ways, patients have embraced the opportunities with greater enthusiasm than have clinicians. To 'speak their language', we need to know how best to engage in social media.

Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study.

BACKGROUND: Concerns regarding potential neurological complications of COVID-19 are being increasingly reported, primarily in small series. Larger studies have been limited by both geography and specialty. Comprehensive characterisation of clinical syndromes is crucial to allow rational selection and evaluation of potential therapies. The aim of this study was to investigate the breadth of complications of COVID-19 across the UK that affected the brain. METHODS: During the exponential phase of the pandemic, we developed an online network of secure rapid-response case report notification portals across the spectrum of major UK neuroscience bodies, comprising the Association of British Neurologists (ABN), the British Association of Stroke Physicians (BASP), and the Royal College of Psychiatrists (RCPsych), and representing neurology, stroke, psychiatry, and intensive care. Broad clinical syndromes associated with COVID-19 were classified as a cerebrovascular event (defined as an acute ischaemic, haemorrhagic, or thrombotic vascular event involving the brain parenchyma or subarachnoid space), altered mental status (defined as an acute alteration in personality, behaviour, cognition, or consciousness), peripheral neurology (defined as involving nerve roots, peripheral nerves, neuromuscular junction, or muscle), or other (with free text boxes for those not meeting these syndromic presentations). Physicians were encouraged to report cases prospectively and we permitted recent cases to be notified retrospectively when assigned a confirmed date of admission or initial clinical assessment, allowing identification of cases that occurred before notification portals were available. Data collected were compared with the geographical, demographic, and temporal presentation of overall cases of COVID-19 as reported by UK Government public health bodies. FINDINGS: The ABN portal was launched on April 2, 2020, the BASP portal on April 3, 2020, and the RCPsych portal on April 21, 2020. Data lock for this report was on April 26, 2020. During this period, the platforms received notification of 153 unique cases that met the clinical case definitions by clinicians in the UK, with an exponential growth in reported cases that was similar to overall COVID-19 data from UK Government public health bodies. Median patient age was 71 years (range 23-94; IQR 58-79). Complete clinical datasets were available for 125 (82%) of 153 patients. 77 (62%) of 125 patients presented with a cerebrovascular event, of whom 57 (74%) had an ischaemic stroke, nine (12%) an intracerebral haemorrhage, and one (1%) CNS vasculitis. 39 (31%) of 125 patients presented with altered mental status, comprising nine (23%) patients with unspecified encephalopathy and seven (18%) patients with encephalitis. The remaining 23 (59%) patients with altered mental status fulfilled the clinical case definitions for psychiatric diagnoses as classified by the notifying psychiatrist or neuropsychiatrist, and 21 (92%) of these were new diagnoses. Ten (43%) of 23 patients with neuropsychiatric disorders had new-onset psychosis, six (26%) had a neurocognitive (dementia-like) syndrome, and four (17%) had an affective disorder. 18 (49%) of 37 patients with altered mental status were younger than 60 years and 19 (51%) were older than 60 years, whereas 13 (18%) of 74 patients with cerebrovascular events were younger than 60 years versus 61 (82%) patients older than 60 years. INTERPRETATION: To our knowledge, this is the first nationwide, cross-specialty surveillance study of acute neurological and psychiatric complications of COVID-19. Altered mental status was the second most common presentation, comprising encephalopathy or encephalitis and primary psychiatric diagnoses, often occurring in younger patients. This study provides valuable and timely data that are urgently needed by clinicians, researchers, and funders to inform immediate steps in COVID-19 neuroscience research and health policy. FUNDING: None.

Efficacy of Omega-3 Fatty Acids Supplementation versus Sublingual Immunotherapy in Patients with Bronchial Asthma.

Omega-3 fatty acids and sublingual immunotherapy have a considerable interest in the potential therapeutic value in asthmatic patients. The aim of the study was to compare the efficacy of omega-3 fatty acids and sublingual immunotherapy in treating patients with bronchial asthma and evaluate the value of IL17A as a marker for effective treatment. The effect on asthma control test (ACT), peak expiratory flow rate (PEFR), forced expiratory volume in the first second (FEV1) and serum interleukin 17A (IL17A) in patients with mild to moderate persistent asthma were measured. A total of 48 patients were enrolled and divided into two groups. Group A included 24 patients treated with sublingual immunotherapy for 6 months and group B, 24 patients given omega-3 fatty acids for 3 months. Serum level of IL17A was measured by Enzyme linked immunosorbent assay (ELISA). A statistically significant difference was demonstrated in each parameter between before and after treatment (p < 001, for each). Comparison between omega-3 fatty acids and sublingual immunotherapy as regards ACT, PEFR, and FEV1and IL17A showed that omega-3 fatty acids treatment was better than sublingual immunotherapy in decreasing IL17A, but both were effective in decreasing PEFR, FEV1 and ACT. In conclusion, administration of omega-3 fatty acids and sublingual immunotherapy are promising in management of asthma.