J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp-2019-ABN-2.35 on 14 November 2019. Downloaded from http://jnnp.bmj.
com/ on November 19, 2019 at Karolinska BIBSAM
Abstracts
001 RISPERIDONE INDUCED SEIZURES AFTER CESSATION OF
CLOZAPINE
Muhammad-Kazim Kanani. Coventry and Warwickshire Partnership Trust
10.1136/jnnp-2019-ABN-2.35
Introduction Antipsychotic drugs are known to reduce the
seizure threshold. clozapine, a second-generation antipsychotic
is most associated with causing convulsions.
Case report A 70-year old gentleman with a diagnosis of Para-
noid Schizophrenia had been stable on a daily dose of cloza-
pine 150 mg. The patient wished to stop clozapine for a
number of reasons. His clozapine was stopped and he was
titrated on to risperidone 3 mg daily. Two weeks after being
on risperidone monotherapy the patient attended the emer-
gency department following a fall. Within the department he
had two witnessed seizures. Following normal investigations a
diagnosis of risperidone induced seizures was made and the
medication stopped.
Discussion The incidence of seizures in non-epileptic patients
attributed to the use of risperidone has been reported as
0.3%. The mechanism is unclear but it is interesting to note
that a moderate risk of EEG abnormalities has been associated
with it. Other risk factors such as old age and hypertension
can also influence EEG changes. In contrast seizures with clo-
zapine are dose-dependent (5% at doses above 600 mg/day)
and associated with rapid titration. These effects are consistent
with the process of kindling.
Conclusion A reminder that all antipsychotics can cause seiz-
ures. Clozapine is most commonly associated but has specific
risk factors. Consideration of patient specific pro-convulsive
factors is required before prescribing antipsychotics.
002 MANAGEMENT OF IDIOPATHIC INTRACRANIAL
HYPERTENSION: AN AUDIT OF THE 2018 ABN
GUIDELINES
Matthew McWilliam, Rebecca Broad, Oliver Cousins,
Sreedharan Harikrishnan. East Kent Foundation Trust
10.1136/jnnp-2019-ABN-2.36
The annual incidence of idiopathic intracranial hypertension
(IIH) has increased from 1.0 per 100000 (1990–2001) to 2.4
per 100000 (2002–2014). Strong correlation exists with rising
levels of obesity. We conducted an audit within East Kent
Hospitals NHS Trust utilising the 2018 ABN guidelines. A ret-
rospective analysis was performed on 33 patients diagnosed
with IIH, from September 2017 to September 2018.
The results demonstrated that all patients had CSF opening
pressure recorded. However, only 42% had MRI brain and
24% had MR-venogram within 24 hours, while just 27%
completed all neuroimaging within 48 hours. Formal visual
field testing at identification of papilloedema was performed
in 27% and ongoing ophthalmology assessment was arranged
in 82%. BMI was recorded in only 3% and weight manage-
ment discussion was recorded in 27%. Headache management
was initiated in 91%. Discussion regarding drug side effects
(e.g. Acetazolamide and Topiramate) were documented in just
15% and teratogenicity in 3%.
These findings demonstrate clear areas for improvement.
Working alongside acute physicians and ophthalmologists to
formalise neuroimaging pathways and visual field assessments
e8
is paramount. Information leaflets including drug side effects
and teratogenicity, as well as weight loss advice, should be
given at diagnosis. BMI should be recorded at each
appointment.
003 DIAGNOSTIC WORKUP IN SUSPECTED VIRAL
ENCEPHALITIS-A SINGLE CENTRE AUDIT
Faizan Aslam, Helee Patel, Pablo Garcia-Reitboeck. St George’s University Hospital
10.1136/jnnp-2019-ABN-2.37
The British Infection Society and Association of British Neu-
rologists published joint guidelines in 2012 for the manage-
ment of encephalitis. We wanted to audit our practice. We
analysed data from discharge summaries of 150 patients
admitted to St George’s Hospital who underwent a lumbar
puncture (LP) between March-December 2017. We identified
30 patients with suspected encephalitis. Time to LP was 30.47
± 6.98 hours. Opening pressure was documented in 14/30
(46.6%) whereas paired serum glucose was sent in 6/30(20%)
cases. Neuroimaging was performed prior to lumbar puncture
with a mean time of 7.68 ± 3.93 hours in 26/30 (86.6%)
cases, 16 (61.5%) of whom had a clear indication with focal
Consortia. Protected by copyright.
neurological signs and/or low Glasgow coma score (GCS) (no
documentation of ophthalmoscopy was found). Time to acy-
clovir administration was 10.43 ± 4.01 hours. Repeat LP after
24 hours was performed in 3/30(10%) cases. Viral PCR was
performed in 27/30(90%) cases; 3/30(10%) cases were HSV-1
positive. MRI scan done in 12/30(40%) cases.
We recommend a clear protocol for clinicians to improve
timeliness and completeness of the workup of suspected viral
encephalitis.
004 A TRIAGING BLOOD TEST FOR NEUROLOGY? SERUM
Lorena Flores,
NEUROFILAMENT LEVELS IN A COHORT OF GP
REFERRALS
Josephine Robertson, Elizabeth Gray, Alexander Thompson, Emily Feneberg, Kevin Talbot,
Martin Turner. Nuffield Department of Clinical Neurosciences, University of Oxford
10.1136/jnnp-2019-ABN-2.38
Increased serum neurofilament is associated with CNS axonal
loss from a range of causes. We assessed its potential as a
minimally-invasive indicator of active CNS pathology in those
with neurological symptoms.
GP referrals to the Neurology Rapid Access Clinic (RAC)
at the John Radcliffe Hospital, Oxford were approached to
take part. Informed consent was taken under a local Research
Ethics Committee-approved protocol. Serum was taken prior
to clinical assessment and tested for phosphorylated neurofila-
ment heavy chain (pNFH) using a commercial ELISA (Euroim-
mun, Germany). Participants were followed up for final
diagnosis.
The 62 participants had a range of symptoms, with final
diagnoses including migraine, functional, neurodegenerative
and inflammatory conditions. Receiver Operating Curve analy-
sis defined cut-off levels based on serum pNfH levels in
healthy controls and patients with motor neurone disease
measured as part of an independent local biomarker study.
pNFH levels in the ‘pathological’ range were associated with
J Neurol Neurosurg Psychiatry 2019;90(12):e1–e65