The results suggest that approximately 70% of patients with existing VNS insertions could have significant additional benefit from cardiac based seizure detection and closed loop stimulation from the AspireSR device. For new insertions, the AspireSR device has efficacy in 59% of patients. The 'rule of thirds' used in counseling patients may need to be modified accordingly.

Pain is a rare manifestation of epileptic seizures. Yet, despite its rarity as a clinical entity, the pain associated with such seizures can be both severe and disabling. It thus remains important to consider epilepsy in the differential diagnosis of unexplained paroxysmal pain. By way of illustration, we present here a report of acute localised paroxysmal pain as the initial manifestation of focal epilepsy with EEG abnormalities in an otherwise neurodevelopmentally normal child. A brief discussion of the literature on epileptic pain then follows.

Practice regarding the use of thiamine in head-injured patients at risk of Wernicke-Korsakoff syndrome in Scottish neurosurgical units was surveyed by questionnaire and revealed no clear policy. A 2 year retrospective study of 218 admissions to one of these units of patients who had taken alcohol shortly before sustaining head injury is also described. The minority (20.6%) of the total had been given thiamine, with just over half (56.1%) of those categorized as alcoholic receiving this treatment. Additional carbohydrate loads, in the form of i.v. dextrose or parenteral nutrition, had been given to 44.5% of patients and only 28.9% of this group had also been given thiamine. The dose and duration of thiamine given was inadequate in most cases. It is suggested that failure to ensure that head injury patients at risk of Wernicke-Korsakoff syndrome receive appropriate thiamine prophylaxis represents a missed and treatable additional insult to the damaged brain.

No abstract

A retrospective survey of 78 patients with spontaneous haemorrhagic brain injury admitted to a regional neurorehabilitation centre over a three-year period is described. Residual neuropsychological impairments and the need for assistance in activities of daily living (ADL) were assessed. Little difference was found in terms of impairment or extent of disability between the 53 subarachnoid haemorrhage and 25 intracerebral haemorrhage survivors who comprised the study population. This population is compared to the findings in traumatically brain-injured patients managed in the same unit. Although there were some neuropsychological differences between the two groups, these were not reflected in the degree of dependence in ADL, which was remarkably similar. The length of stay for haemorrhagic brain injury patients on the unit was longer than that of the head injured. Haemorrhagic brain injury therefore, represents a major demand on rehabilitation services and similar provisions should be made for them as are advocated for the traumatically brain injured.