Patients with refractory epilepsy undergo video electroencephalography for seizure characterization; among whom approximately 10–30% will be discharged with the diagnosis of psychogenic non-epileptic seizures (PNES). Clinical PNES predictors have been described, but in general are not sensitive or specific. We evaluated whether multiple complaints in routine review of system (ROS) questionnaire could serve as a sensitive and specific marker of PNES. We performed a retrospective analysis of standardized ROS questionnaire completed by patients with definite PNES and epileptic seizures (ES) diagnosed in our adult epilepsy monitoring unit. A multivariate analysis of covariance (MANCOVA) was used to determine whether PNES and ES groups differed with respect to the percentage of complaints on ROS. Ten-fold cross-validation was used to evaluate the predictive error of a logistic regression classifier for PNES status based on percentage of positive complaints on ROS. A total of 44 patients were included for analysis. Patients with PNES had a significantly higher number of complaints on the ROS questionnaire compared to patients with epilepsy. A threshold of 17% positive complaints achieved a 78% specificity and 85% sensitivity for discriminating between PNES and ES. We conclude that routine ROS questionnaire may be a sensitive and specific predictive tool for discriminating between PNES and ES.

Multiple sclerosis (MS) is most prevalent in women of childbearing age. It is well established that the relapse rate decreases during pregnancy but increases significantly during the first postpartum trimester. The objective of this retrospective study was to evaluate the effectiveness of the administration of 1 g of intravenous methylprednisolone (IVMP) after delivery in the prevention of MS relapses. The study involved 47 women with one or more documented pregnancies; each pregnancy was treated as a separate case. There were 50 cases with relapsing-remitting MS and 2 with secondary progressive MS. The cases were divided into two groups: the IVMP group (those who received 1 g of IVMP after delivery) and the no-IVMP group (those who did not receive IVMP after delivery). There were 39 cases in the IVMP group and 13 in the no-IVMP group. During the first postpartum trimester, relapses occurred in 17.9% of the IVMP group, compared with 46.2% of the no-IVMP group (P = .0448). The difference in relapse percentage between the two groups during the second and third postpartum trimesters was not statistically significant. Our study shows a statistically significant benefit of postpartum IVMP administration in reducing MS relapses. Int J MS Care. 2011;13:91-93. Multiple sclerosis (MS) is most prevalent among women of childbearing age. 1 Recent studies have shown that pregnant MS patients have the same risk of pregnancy complications as the general population. 2 The influence of pregnancy on the course of disease in MS has also been studied over the years.According to the Pregnancy in Multiple Sclerosis (PRIMS) trial, the mean ± SD number of relapses was 0.7 ± 0.9 per woman per year in the year before pregnancy; it was 0.5 ± 1.3 during the first trimester of pregnancy, 0.6 ± 1.6 during the second trimester, and 0.2 ± 1.0 during the third trimester. It increased to 1.2 ± 2.0 during the first 3 months postpartum and then returned to the pre-pregnancy rate. 3 After a 2-year follow-up analysis, the researchers described clinical factors that might predict the likelihood of relapse in the 3 months after delivery: an increased relapse rate in the pre-pregnancy year, an increased relapse rate during pregnancy, and a higher Expanded Disability Status Scale (EDSS) score at pregnancy onset. 4 The reason for the increased postpartum activity is not yet clear, but many factors have been considered, including the decrease in estrogen levels and the reduced activity of some immune-inhibitory molecules. 5 Previous studies suggested a reduction in the postpartum relapse rate for MS patients after exclusive breastfeeding, 6,7 but this tendency was not shown in a more recent study. 8 Breastfeeding was also not shown to affect postpartum relapse activity in PRIMS. 4 Data published by Oliveri et al. 9 showed that intravenous methylprednisolone (IVMP) reduced magnetic resonance imaging (MRI) activity, defined as the number of contrast-enhancing lesions over a 2-month period. Therefore, we hypothesized that a dose of IVMP in the immediate pos...

Objective. To describe a unique case of familial Bell's palsy and summarize the current literature regarding possible hereditary influences. Design. Case report. Main Outcome Measures. Clinical exam, CSF analysis, and family history provided per the patient. Results. We report the case of a 58-year-old female who presented with recurrent and bilateral episodes of facial palsy. The patient underwent multiple CSF investigations to rule out a possible infectious and rheumatologic etiology that were all negative. Further questioning revealed she was one of seven family members with a history of unilateral facial nerve paralysis. Conclusion. The sheer number of similar case studies to date suggests that familial clustering of Bell's palsy is a real, noncoincidental phenomenon. Our case represents a unique and perplexing example of one such family. Familial Bell's palsy may represent an autoimmune disease secondary to inherited HLA alloantigens or a structural predisposition to disease based on the dimensions of the facial canal.

311 Background: Stereotactic ablative radiotherapy (SAbR) is a promising treatment option for selected oligometastatic renal cell carcinoma (RCC) patients that can provide longitudinal disease control while preserving quality of life. Retrospective data have shown a local control (LC) rate greater than 90% and longitudinal disease control of over a year without systemic therapy. However, prospective validation of SAbR for oligometastatic RCC is lacking. In this prospective phase II single arm trial, we evaluated the impact of SAbR on freedom from systemic therapy (FFST). Methods: Treatment naïve patients with RCC confirmed by pathology and radiographic evidence of three or fewer extracranial metastases received SAbR with curative intent to all measurable sites of disease. Follow-up included radiographic imaging at three-month intervals to assess disease control. The primary endpoint was FFST defined as time from SAbR to the initiation of systemic therapy. Secondary endpoints included LC, modified progression-free survival (mPFS) (time from first SAbR to progression not amenable to further SAbR), PFS on subsequent systemic therapy, cancer-specific survival (CSS), overall survival (OS), toxicity and health-related quality of life (QOL) indices as measured with EQ-5D-5L and FACT-G. A Wilcoxon signed-rank test was used to evaluate the QOL indices. Results: The trial completed accrual with the enrollment of 23 patients who received SAbR to a total of 38 sites. At a median follow-up of 12 months (interquartile range 1.8-16), 1-year FFST was 87% (95% CI: 56%-96%). The 1-year mPFS was 79% (95% CI:49%-93%), while the median mPFS has not yet been reached. Three patients had disease progression at individual time points of 3.5, 4.0, and 12 months. One of these patients developed brain metastases that were controlled with gamma knife radiosurgery without initiating systemic therapy. The LC, CSS, and OS were 100% (38/38), 100% (23/23), and 95% (22/23), respectively. When compared to baseline, no significant decline in QOL was detected. Three patients experienced treatment-related grade 1 toxicity; no ≥grade 2 toxicities were reported. One patient died of an unrelated cause. Conclusions: SAbR is a safe and effective treatment for oligometastatic RCC that can provide longitudinal disease control and preserve quality of life. These data support further evaluation of SAbR for oligometastatic RCC in a randomized study. Clinical trial information: NCT02956798 .

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