A case of a ‘rude’ but not to be missed manifestation of epilepsy: ictal swearing

Swearing or profanity is offensive language, which can be vulgar or curse words or phrases deemed inappropriate for formal conversations. It has been deeply rooted in our community and seen as a common human act. In fact, swearing is described in various neurological conditions, such as Tourette syndrome, Lesch–Nyhan syndrome and post stroke or encephalitis.

Ictal asystole: a diagnostic and management conundrum

We report two cases of adults presenting with transient loss of consciousness (TLoC) followed by a rapid recovery. Careful history taking revealed a stereotyped prodrome of déjà vu, raising the possibility of these events being focal seizures rather than syncope. The patients were commenced on antiepileptic drugs (AEDs) at the same time as having cardiac monitoring organised. This confirmed asystole during the seizure symptoms, resulting in TLoC.

A mitochondrial malady: stubborn seizures and atypical migraine

A 22-year-old female migraineur presented with recurrent convulsive status epilepticus and ataxia. Her epilepsy proved refractory to treatment, necessitating the use of five anti-epileptic drugs and a course of steroids. Genetic testing revealed compound heterozygosity for two mutations of the polymerase-? gene. The case highlights the clinical features and therapeutic challenges associated with this relatively common, but probably under-recognised, mitochondrial disease.

A survey of the management of transient loss of consciousness in the emergency department

Background: Transient loss of consciousness (TLoC) is a common presentation to the emergency department (ED). We sought to evaluate current practice in the management of patients with TLoC presenting to a large, city centre ED, against national standards.
Methods: The ED admissions database was searched to identify all patients attending with TLoC during October 2012. The clinical record of the attendance was reviewed to determine if the initial assessment met national standards.

Absinthe, epileptic seizures and Valentin Magnan

Absinthe is an alcoholic liquor containing extracts from the wormwood plant. It was widely consumed in France in the late nineteenth century. Its production was banned in 1915, partly because it was thought to cause neurological disturbances, including mental changes and epileptic seizures. Modern knowledge of an acceptable content of the convulsant a-thujone in absinthe has allowed the lifting of the production bans, and called into question the experimental work of Valentin Magnan in the 1870s, which formed the scientific background to the campaign against absinthe.

Acute neurological problems: frequency, consultation patterns and the uses of a rapid access neurology clinic

In secondary care, some patients with acute neurological symptoms are never seen by a neurologist. Rapid access neurology clinics could provide patients with timely access to neurology services. We analysed a retrospective cohort of 12,024 consecutive patients attending the ‘immediate care’ area of the emergency department or the acute medical admissions unit of the Royal Infirmary of Edinburgh. A total of 1,036 patients (9%) presented with a neurological complaint, of whom 680 (66%) did not have any contact with neurology services.

All that shakes is not epilepsy

This review is based in part on Dr Hart’s lecture at the RCPE Symposium on Neurology in Edinburgh on 16 November 2011.Experience from the clinic suggests that many people equate the term ‘epilepsy’ with the occurrence of convulsions, with the corollary that attacks involving shaking are likely to be due to epilepsy.