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THE IMPACT OF ABUSE & OTHER ADVERSE EVENTS IN THE GENERAL NEUROLOGY CLINIC–FROM FREUD TO SAVILE?
  1. Graham Warner
  1. Royal Surrey County

    Abstract

    An inherently emotive issue ‘abuse’ is variably defined in part depending upon individuals' subjective interpretation. However, it is generally believed to be significantly under–reported. It has been increasingly recognised in some areas of Neurology including Epilepsy & Movement Disorders. To investigate its broader prevalence the author scrutinised new patient clinic documentation for 4 years 1/1/09 to 31/12/12 inclusive in an observational/descriptive study.

    Electronic data was ‘searched’ using terms ‘abuse’, ‘bull’, ‘sex’, ‘rape’ using standard tools within Window XP to analyse content of the 3 standard general Neurology clinic letters which were then all scrutinised to identify positive statements rather than those of exclusion. Subjective judgement was made as to the significance of the life event in relation to ‘diagnosis’ on the basis of whether it was felt important enough to raise with the GP as possibly aetiologically relevant & needing managing in its own right but otherwise recorded as ‘incidental’.

    Sixty–four cases were identified (58 female, 6 male), 45 deemed ‘relevant’, 18 incidental. This compares to 19 new MND/ALS diagnoses.

    Primary ‘symptoms’ included altered consciousness (21–13 NEAD, 13 epilepsy), headache (12), weakness (7), sensory upset (8), cognitive disturbance (4), tremor/shake (4), somatic pain (4), (global) fatigue (2), ‘dizziness’ (2) & bulbar dysfunction (1) but (multiple) combinations were common.

    Rape was reported by 9, sexual abuse 26, bullying/mental/psychological 25 & physical 25, & combinations were frequent. Hypervigilance was common (19) after all abuses. Investigation & follow–up were uncommon without coincident problems. Specific patterns of presentation could be identified. Files weighing more than 1.6kg were notable.

    Disclosures required specific enquiry & were made only once symptoms were ‘drained’. This challenges currently prescribed working practices but is possible within ABN guidelines.

    Whilst there is potential bias of clinician interpretation & diagnostic significance, the evidence is that Neurologists achieve 95% accuracy for non–organic conditions. And record of disclosure of events by patient is objective & raises the possibility of relevance in all cases. As such this paper re–ignites the debate about refining diagnosis of any presenting symptom such that even with benign labels such as Tension Type Headache there may need to be reference to a primary aetiology to effect best care & treatment. The American Academy of Neurology published a position statement on abuse and violence1 & the opportunity exists for the ABN to debate the importance such is the potential significance within Neurological practice.

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