Numbers and types of neurological emergencies in England and the influence of socioeconomic deprivation: a retrospective analysis of hospital episode statistics data.

OBJECTIVES: In this first large-scale analysis of neurological emergency admissions in England, we determine the number and types of emergency admissions with neurological emergency diagnostic codes, how many are under the care of a neurologist or neurosurgeon and how such admissions vary by levels of deprivation. DESIGN: Retrospective empirical research employing a derived list of neurological emergency diagnostic codes SETTING: This study used the Hospital Episode Statistics data set for the financial year 2019/2020 based on 17 million in-year inpatient admissions in England including 6.5 million (100%) emergency admissions with any diagnosis codes. RESULTS: There were 1.4 million (21.2%) emergency inpatient admissions with a mention of any neurological code, approx. 248 455 (3.8%) with mention of a specific neurological emergency code from the derived list, and 72 485 (1.1%) included such a code as the primary reason for admission. The highest number of in-year admissions for adults was for epilepsy (145 995), with epilepsy as the primary diagnostic code in 15 945 (10.9%). Acute nerve root/spinal cord syndrome (41 215), head injury (29 235) and subarachnoid haemorrhage (18 505) accounted for the next three highest number of admissions. 3230 (1.4%) in-year emergency hospital admissions with mention of a neurological emergency code were under the care of a neurologist or neurosurgeon, with only 1315 (0.9%) admissions with mention of an epilepsy code under a neurologist. There was significant variation for epilepsy and functional neurological disorders (FNDs) in particular by Index of Multiple Deprivation decile. The association between deprivation and epilepsy and FND was significant with p-values of 2.5e-6 and 1.5e-8, respectively. CONCLUSIONS: This study has identified important findings in relation to the burden of neurological emergency admissions but further work is needed, with greater clinical engagement in diagnostic coding, to better understand the implications for workforce and changes to service delivery needing to be implemented.

Epilepsy deaths: Learning from health service delivery and trying to reduce risk.

Two recent UK reports have highlighted data of concern in relation to potentially preventable epilepsy deaths. Public Health England, an executive agency of the Government Department of Health, using National Health Service data from 2001 to 2014 reported a rise in direct age-standardised mortality for epilepsy-associated deaths, in contrast to a reduction in all-cause deaths over the same period. Premature death was seen in people aged below 50 years, especially in men, and where epilepsy was a contributory cause rather than an association. The Scottish Epilepsy Deaths Study, analysing deaths between 2009 and 2016, similarly found death in those with epilepsy was significantly higher than the matched population below the age of 54, especially between the ages of 16 and 24 (6 times higher). Sudden unexpected death in epilepsy accounted for 38% of epilepsy-related deaths under the age of 45. Both studies found a strong relationship between risk of death and deprivation; we discuss the implications of these and other data for planning service delivery and improving epilepsy care. This paper is for the Special Issue: Prevent 21: SUDEP Summit - Time to Listen.

Acute hepatitis E infection as a cause of unexplained neurological symptoms.

Neurological disease is the most common extrahepatic manifestation of autochthonous infection with hepatitis E virus (HEV). The association between acute neurological symptoms and hepatitis E is not well known, and hence HEV testing is often omitted. This case describes aberrant neurology in a 35-year-old woman with a background of HEV infection, highlighting the need for increased awareness of acute hepatitis E infection as a cause of unexplained neurological illness.

Prescribing in Parkinson's disease: a story of hope and adverse events.

A review of National Health Service spending in England on prescription drugs used in Parkinsonism over the last 10 years shows that spending has risen rapidly and that newly introduced drugs are quickly and expensively adopted. This paper explores the gains and costs of such prescribing.

Coma in 20 questions.

Many colleagues find teaching neurology to today's medical students can be more frustrating than rewarding. Although students are encouraged to expect excellence, some lack enthusiasm and fail to engage with the subject. Medical teachers may have to take some of the responsibility, and it is important that we learn from our own and each other's teaching practice. This is a description of a teaching session for final year medical students. The subject is coma and some of the session takes the form of a game. The rationale and the desired outcome are explained. There is no copyright on this method of teaching.

The changing relationship between neurology and general practice in the UK.

The full involvement of primary care in an organised and balanced health service is vital to neurological patients' health. However, the available evidence suggests that GPs are, if anything, withdrawing or being pushed out of caring for this patient group. This article tries to identify why this may be happening, considers the implications, and suggests alternative ways forward.

What is happening to English neurology?

Neurology in England is expanding rapidly. In 2005 there were, on average, 7.2 (2.5) new and 16.8 (8.6) follow-up appointments per 1,000 population, an increase of 24% and 19% respectively since 2003. The chance of an individual being seen in this specialty varies widely according to primary care trust. This paper considers the causes and implications for neurological health, service delivery and neurology training.

How valid is dopamine transporter imaging as a surrogate marker in research trials in Parkinson's disease?

To use functional imaging data as indices of disease progression, it is essential that methods are valid. It is not possible for that validation to come from pathology and the methods can only gain validity from the relationship to clinical indices of progression. Validity as a measurement of disease progression depends upon sensitivity to clinical progression, low scan-to-scan error, and resilience to confounding effects. Data from the available dopamine transporter (DAT) positron emission tomography (PET) and single photon emission computed tomography (SPECT) studies are examined for these three key factors. Presently, there are insufficient data to enable the satisfactory design of neuroprotection studies and to enable statements on their relevance to disease progression and neuroprotection. The recently completed CALM-PD neuroimaging study is examined. There is sufficient doubt surrounding the sensitivity, reproducibility, and confounding effects in this study that these data should not be used to formulate a decision on de novo therapy in Parkinson's disease.