Signal Lorazepam confirmed as first-line treatment for stopping prolonged seizures in children

NIHR Signal Lorazepam confirmed as first-line treatment for stopping prolonged seizures in children


Published on 17 April 2018


Intravenous lorazepam is as effective as intravenous diazepam for stopping children’s tonic-clonic seizures in hospital. https://discover.dc.nihr.ac.uk/content/signal-00586/lorazepam-confirmed-as-first-line-treatment-for-stopping-prolonged-seizures-in-children
From the NIHR Dissemination Centre

New NICE Interventional procedures guidance [IPG610] Nerve transfer to partially restore upper limb function in tetraplegia

New NICE Interventional procedures guidance [IPG610] Nerve transfer to partially restore upper limb function in tetraplegia


Published date: April 2018 Next review: April 2021




Evidence-based recommendations on nerve transfer to partially restore upper limb function in people with tetraplegia. This involves connecting an undamaged, functioning, but non-essential nerve near the injury to the damaged essential nerve.


For full guidance https://www.nice.org.uk/guidance/ipg610

This quality standard covers the management of Parkinson’s disease in adults. It does not include treatment of parkinsonism not caused by Parkinson’s disease. It describes high-quality care in priority areas for improvement.[QS164]

New: Quality standard


This quality standard covers the management of Parkinson’s disease in adults. It does not include treatment of parkinsonism not caused by Parkinson’s disease. It describes high-quality care in priority areas for improvement.

Faculty of Pain/British Pain Society consensus statement on the use of Corticosteroids for Neuraxial Procedures in the UK

The Faculty of Pain Medicine and the British Pain Society have released a joint statement on this important topic.

Screening for malnutrition in patients with gastro-entero-pancreatic neuroendocrine tumours: a cross-sectional study

BMJ Open. 2016 May 4;6(5):e010765. doi: 10.1136/bmjopen-2015-010765.

OBJECTIVES: To investigate whether screening for malnutrition using the validated malnutrition universal screening tool (MUST) identifies specific characteristics of patients at risk, in patients with gastro-entero-pancreatic neuroendocrine tumours (GEP-NET).

CONCLUSIONS: Given the frequency of patients identified at malnutrition risk using MUST in our relatively large and diverse GEP-NET cohort and the clinical implications of detecting malnutrition early, we recommend routine use of malnutrition screening in all patients with GEP-NET, and particularly in patients who are treated with long-acting somatostatin analogues.

UHCW Research: Qureshi SA, Burch N, Hattersley JG, Khan S, Gopalakrishnan K, Darby C, Wong JL, Davies L, Fletcher S, Shatwell W, Sothi S, Randeva HS, Dimitriadis GK and Weickert MO.

Ponesimod for Relapsing-remitting Multiple Sclerosis

Ponesimod is a drug which works by blocking the signals which allow the body’s immune cells to travel to and damage the nerve cells. By preventing the immune cells from damaging the nerves, it is thought this drug will stop the damage which causes MS ‘relapses’. In clinical trials it has been shown that ponesimod reduces the number of ‘relapses’ in people with MS and reduced the amount of damage to the nerves (measured by brain scans) compared to a placebo.

From the NIHR Innovation Observatory

NIHR Signal Two nerve drugs are not suitable for treating long-term low back pain

The drugs gabapentin and pregabalin (gabapentinoids) were found not to help lower back pain that had lasted more than three months. Gabapentin gave no benefit compared with placebo, while pregabalin was less effective than other painkillers. Both were associated with several side effects, such as dizziness.

From the NIHR Dissemination Centre

PO199 An autoimmune cranial and peripheral polyneuropathy with myositis

Association of British Neurologists (ABN) Annual Meeting 20172,3–5th May 2017 ACC, Liverpool

A 69 year old man presented in 2006 with diplopia, facial weakness, bulbar dysfunction, profound sensory motor neuropathy (distally more than proximally), and hyporeflexia. Blood at the time did not reveal any major abnormalities. Electrophysiology confirmed severe sensory and motor axonal polyneuropathies. Sural nerve biopsy was non-specific, whereas muscle biopsy specifically showed peri-vascular inflammatory cells. Following significant improvement with intra-venous methylprednisolone, he returned to a functional independent life. More debilitating similar episodes recurred six and nine years later with involvement of cranial nerves 2–7, 9–12, accompanied by predominantly upper limb weakness and hyporeflexia. Post-contrast neural MR and CSF constituents remained normal (negative antiganglioside antibodies). Electrophysiology confirmed progressive axonal peripheral polyneuropathy. Liver biopsy ruled out cirrhosis/autoimmune hepatitis. In 2016, repeat Ro antibodies were positive, with3-year history of Raynaud’s phenomenon. Patient was treated with immunoglobulin, intravenous Methylprednisolone, followed by oral steroids. Subsequently, intravenous Cyclophosphamide then Mycophenolate with ongoing tapered steroids resulted in good response, despite persistent muscle wasting without fasciculations.

UHCW Research: Akram A Hosseini, Fizzah Ali, Shirish Dubey, and Antony Thomas

PO108 Susac syndrome: a case for early, aggressive and sustained treatment

Association of British Neurologists (ABN) Annual Meeting 20172,3–5th May 2017 ACC, Liverpool

We report a case of Susac syndrome, initially suspected to be multiple sclerosis, and advocate diagnostic caution and high suspicion. We describe a successful therapeutic approach comprising corticosteroids, intra-venous immunoglobulin and cyclophosphamide for encephalopathic relapse of Susac syndrome.

UHCW Research: Fizzah Ali, Akram A Hosseini and Antony Thomas

PO179 Aggressive disseminated intracranial anaplastic astrocytoma

Association of British Neurologists (ABN) Annual Meeting 20172,3–5th May 2017 ACC, Liverpool

A 21-year-old male immigrant from Afghanistan presented with seizures 2 years previously. MRI brain was suggestive of a possible low-grade glioma affecting the right temporal lobe. After 2 years, he re-presented with symptoms of headache, intermittent pyrexia, raised intracranial pressure (opening pressure of >42 cm/H2O) requiring ventriculoperitoneal shunt to preserve his vision. MRI head revealed slight progression in appearance within the right medial temporal lobe and extension into the right cerebral peduncle with enhancement of the basal meninges as well as 7th and 8th nerve complexes. CSF consistently showed two-digit lymphocytes, with raised protein and moderately reduced glucose ratio. Large CSF samples for cytology and flow-cytometry, Acid-Fast-Bacilli, and IgG subtypes remained negative. He had lymphopaenia. CT body/PET scans revealed no lymphadenopathy. Originally, tuberculosis was considered and quadruple anti-tuberculosis therapy was given along with oral Prednisolone. His first negative tuberculosis culture after 6 weeks coincided with increasing widespread leptomeningeal spread into the intradural spinal cord. Brain biopsy from the basal leptomeninges and temporal lobe confirmed anaplastic astrocytoma.

UHCW Research: Akram A Hosseini, Fizzah Ali and Holger Allroggen

Processed nerve allografts to repair peripheral nerve discontinuities [IPG597]

New interventional procedures guidance from NICE:

Current evidence on the safety and efficacy of processed nerve allografts to repair peripheral nerve discontinuities is adequate to support the use of this procedure for digital nerves provided that standard arrangements are in place for clinical governance, consent and audit.

The evidence on the safety of processed nerve allografts to repair peripheral nerve discontinuities in other sites raises no major safety concerns. However, current evidence on its efficacy in these sites is limited in quantity. Therefore, for indications other than digital nerve repair, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.

Reducing the Pressure on Hospitals: 12 months on

With this winter fast approaching, has the Royal College of Occupational Therapists’s call to deploy occupational therapists to achieve optimum patient flow through hospital services made any difference? 12 months on from the launch, we contacted the services featured in our reports to find out. Click here to see report

UCLH robots help stroke patients regain upper limb movement

Staff at UCLH’s stroke rehabilitation unit have become the first in the NHS to use robotic devices in conjunction with more traditional therapies to help patients regain arm and hand movement.

The robots, which help patients practise exercises to build up strength and dexterity, can be supervised by a physiotherapy assistant and were introduced as part of UCLH’s intensive three-week upper limb neuro rehabilitation programme.

Fremanezumab for chronic and episodic migraine

Fremanezumab is a new medicine under development for preventative treatment of chronic and episodic migraine. It acts by targeting a very specific type of protein called the human calcitonin gene-related peptide (CGRP) which is a well-known to be involved in migraine. Therefore, if licensed it will offer a potential new treatment option for patients with migraine.

From the NIHR Innovation Observatory

NIHR Signal A commonly used treatment does not improve chronic low back pain

This trial found that destroying nerves that take pain signals to the brain using heat (radiofrequency denervation) did not improve pain, function or a sense of “recovery”. The treatment was used alongside exercise and was a variation of the technique commonly used in the UK. In this large study, it was compared to exercise alone.

Low back pain is usually short-lived, but some people develop long-term back pain which can negatively impact their lives. NICE recommends exercise, pain relief and self-management to cope with pain. If these treatments are not effective and pain is severe, then more intensive options, such as radiofrequency denervation can be considered.

From the NIHR Dissemination Centre

Extracranial to intracranial bypass for intracranial atherosclerosis [IPG596]

New interventional procedures guidance from NICE:

Evidence-based recommendations on extracranial to intracranial bypass for intracranial atherosclerosis. This involves joining a blood vessel from outside the skull to one inside the skull to bypass a narrowed or partially blocked vessel.

Current evidence on the safety and efficacy of extracranial to intracranial bypass for intracranial atherosclerosis shows that there is no benefit to the patient from the intervention. There are major concerns around its safety, therefore this procedure should not be used to treat this condition.

NIHR Signal Head position after acute stroke does not affect disability outcomes

Lying flat for 24 hours after a stroke is no better than sitting up at an angle of at least 30 degrees. These differences in early head position did not affect people’s levels of disability or survival to 90 days, which was more than 92% in both groups. It had been thought that the head down position might increase the chance of pneumonia, but in this trial, the rates were also similar for people cared for in either position.


The results of this large international randomised controlled trial are likely to be applicable to adults with different types of stroke in varied settings. As lying position did not affect outcomes, this suggests that clinicians can be guided by patients’ clinical condition, preferences and levels of comfort during the initial management of care.


The current NICE guideline on diagnosis and initial management of stroke suggests that people with acute stroke should be helped to sit up as soon as possible (when their clinical condition permits).


From NIHR Dissemination Centre

Physios help reduce London’s neuromuscular emergency admissions

Physiotherapists have helped cut the number of emergency admissions and readmissions for people with neuromuscular conditions in London and the South East over the last five years.

An audit led by consultant neurologist Michael Hanna has revealed that emergency admissions for neuromuscular patients fell from 63 per cent to 32.8 per cent between 2012 and 2017, while readmissions halved from 25.1 per cent to 12.4 per cent.

The mortality rate over the same period dropped from 4.5 per cent to 0.3 per cent, with only one death in the 2017 sample compared to 24 in 2012.

One major factor in these improvements has been better coordination between specialist neuromuscular teams, including physios, and hospital staff. 

Triheptanoin (UX-007) for glucose transporter type 1 deficiency syndrome (de vivo disease) – first line

Glucose transporter type 1 deficiency syndrome (Glut1 DS) is a rare genetic disorder that affects how the body moves glucose (used for energy) into the brain. The most common symptom of this condition is seizures (epilepsy), which usually begin within the first few months of life. However, the symptoms and severity of Glut1 deficiency syndrome can vary substantially from one person to another.

Triheptanoin is a novel drug being developed to reduce seizures and other symptoms in patients with Glut1 DS. The drug acts by producing a substitute compound that can produce glucose in the brain. The safety and efficacy of triheptanion is currently being evaluated. If marketed this will become the first licensed treatment in reduction of seizures in patients with Glut1 DS.

From the NIHR Innovation Observatory

Cethrin for traumatic spinal cord injury

A traumatic cervical spinal cord injury results from trauma (such as a fall or car crash, rather than from a disease), and affects the spinal cord in the upper part of the spine (known as the cervical spine). The spinal cord is the bundle of nerves that runs down the middle of the back, and damage to these nerves disrupts how the brain and body communicate. This can result in a variety of complications including death, paralysis (loss of the ability to move one or more muscles) and breathing issues. Spinal cord injuries to the cervical spinal cord are the most severe of all spinal cord injuries. The risk of death is highest within the first year of injury.
Cethrin is being developed to treat traumatic cervical spinal cord injuries in adolescents and adults. The current treatment option for traumatic spinal cord injuries is methylprednisolone (a steroid) used to reduce inflammation. Surgery is an option in cases when the spinal fluid or tissue presses on the spinal cord. If marketed, Cethrin may help repair damaged nerve cells, allowing the brain and body to better communicate. This could help restore movement in patients with traumatic spinal cord injuries.


From the NIHR Innovation Observatory