eLetters

608 e-Letters

  • Neurologists have an important role in follow up of patients with functional neurological symptoms.

    It is good to see that trials are being done to answer the critical question of how best to provide care for those patients with functional neurological symptoms (FNS). The research paper, ‘Management of patients with functional neurological symptoms: a single-centre randomised controlled trial’, by Pleizier, de Haan and Vermeulen, randomizes outpatients with functional neurological symptoms after diagnosis, to either two outpatient appointments with a neurologist, or referral back to a GP. Intriguingly, it finds no difference in outcome, that is quality of life scores, between the two groups.[1] While this study attempts to address an important question, namely the role of the neurologist in the care of patients with functional neurological disorders, we feel it has a number of problems that limit its generalizability, particularly to UK neurology practice.
    The Netherlands is a country that compared to the UK, has approximately four times as many neurologists per head of the population, and many more GPs with higher levels of job satisfaction,[2] and often have mental health nurse support in the practice itself. Neurology outpatient waiting times are shorter in the Netherlands, and in-patient neurology review happens routinely and is quicker, unlike in the UK where it may not occur at all.[3] Because of this lack of prompt neurological review in the UK, it is common for patients to receive erroneous diagnoses, often necessitating an “undiagnosis” at the eventual neu...

    Show More
  • Re:Accumulation of MRI Markers of Cerebral Small Vessel Disease in Depression
    Xin Xu

    We agree that an evaluation of the total cerebrovascular disease (CeVD) burden is important to understand the effect of brain structural abnormalities on clinical outcomes such as cognitive impairment and neuropsychiatric disorders. Recently, integrated measures of total brain MRI burden have been employed to understand neuropathological changes in elderly. However, global CeVD burden may not be best measured by the sim...

    Show More
  • Re: A Val30Met sporadic familial amyloid polyneuropathy case with atypical presentation: Upper limp onset of symptoms
    Erdi Sahin

    Transthyretin-related familial amyloid polyneuropathy (TTR-FAP) is an autosomal dominant disorder caused by the mutations of the transthyretin (TTR) gene. The mutant amyloidogenic TTR protein causes systemic accumulation of amyloid fibrils that result in organ dysfunction [1]. Over 100 mutations in TTR gene are associated with the disease but still, the first identified Val30Met mutation make up 50% of the cases worldwide....

    Show More
  • Accumulation of MRI Markers of Cerebral Small Vessel Disease in Depression
    Zhiwei Xia

    In a study published in J Neurol Neurosurg Psychiatry, Xu et al.1 aimed to investigate the relation between microbleeds (CMBs) and Neuropsychiatric symptoms (NPS) in an elderly population, through a cross- sectional study related to 802 participants. Interestingly, they found a statistically significant increment of the incidence of depression, with the presence of multiple CMBs, in particular lobar CMBs. This finding is...

    Show More
  • Re:Deep brain stimulation as a feedback control system
    Simon J Little

    We are very grateful to Dr Keller for his comments and support for the feedback control approach to deep brain stimulation for Parkinson's disease. As he points out, "reducing or turning off the stimulation current when it is not needed conforms to the clinical axiom if it ain't broke, don't fix it". This is further borne out by a publication currently in press in this journal in which we show that feedback-controlled dee...

    Show More
  • Correction
    Narayan Rao Rao

    It is mentioned that Sherrington introduced the term Synapse. In fact the word synapse was introduced By Macheal Foster,then Professor of Physiology at Cambridge along with his mentor Arthur Woodllgar Verrall coined the word Synapse,meaning Clasp.Thus Sherrington made no such discovery,and is ti be credited only with having solicited the name. As he was working on Reflexes,he has advocated the physiological concept of Syn...

    Show More
  • Deep brain stimulation as a feedback control system
    David L. Keller

    As a physician with Parkinson's disease, and as a former Bell Labs electrical engineer, I recognize that Professor Brown's group is pursuing an important and fundamental improvement to deep brain stimulation. The theory of electronic feedback control systems has been extensively studied and applied in areas such as aircraft and missile guidance; Brown's work may expand the existing theoretical domain of control systems,...

    Show More
  • profound benefits for melatonin
    David Donohue

    We physicians are trained to push Rx medicines but increasingly we find that supplements are efficacious and safer. That melatonin is associated with weight loss is news to me. This paper does an excellent job summarizing the clinical implications and cautions in using melatonin. The dosage information is helpful as well.

    Conflict of Interest:

    None declared

  • Also patients with dementia need motor examination, but do we need more examination tools?
    Liuba Papeo

    In an editorial commentary accompanying a recent study on the prevalence of apraxia in dementia patients [1], Bak emphasizes two facts: 1) research in cognitive neuroscience is contributing to increase the awareness of a close relationship between cognitive and motor functions and, by extension, cognitive and motor disorders in clinical populations; 2) despite so, the examination of motor functions in patients with cogn...

    Show More
  • REPLY TO: "RETINAL NERVE FIBRE LAYER THINNING IS ASSOCIATED WITH DRUG RESISTANCE IN EPILEPSY: PROMISING YET OPEN ENDED"
    Simona Balestrini

    Sir, We thank Kumar et al. for their interest in our recent article on retinal nerve fibre layer thickness (RNFL) in people with epilepsy. In their letter they raise a few points that we would like to address.

    1. Comparison between people with epilepsy and healthy controls. They suggest that a comparison between people with drug-resistant versus non- resistant epilepsy might have been more appropriate. However, a...

    Show More

Pages