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Roy Beran

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Roy is trained as a consultant neurologist and accredited sleep physician, in addition to working within legal medicine, military medicine and aviation medicine. His qualifications include: MBBS, MD, FRACP, FRACGP, Grad. Dip. Tertiary Ed., Grad. Dip. Further Ed., FAFPHM, FACLM, FRCP, FAAN, FACBS, B Leg. S, MHL and FFFLM (Hon). He is a Conjoint Professor of Medicine at the University of New South Wales, Professor in the School of Medicine at Griffith University, Queensland and Professor, Chair of Medical Law at Sechenov Moscow First State University, Moscow, Russia. He continues to serve as a visiting Professor at Macau University. He is: a founding Fellow of the Australasian College of Legal Medicine

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Udaya Seneviratne

The University of Sydney

The University of Western Australia

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Papers by Roy Beran

030 Management and attitudes towards persons with epilepsy in general practice: how far have we come?

Journal of Neurology, Neurosurgery & Psychiatry, 2019

IntroductionPrevious surveys of general practitioners (GP) attitudes regarding epilepsy and peopl... more IntroductionPrevious surveys of general practitioners (GP) attitudes regarding epilepsy and people with epilepsy (PWE), conducted 20–30 years ago1 2, identified the need for further education in epilepsy care for GPs. This follow up study of GPs in Sydney, Australia, was conducted to determine the degree of changes in knowledge, attitudes and management of PWE, to evaluate if there had been significant improvement during this period.MethodsA piloted questionnaire addressing epilepsy investigations, preferred care provider and attitudes towards epilepsy was developed and completed by a representative sample of Sydney GPs.ResultsA total of 52 completed responses were received. 36 out of 47 GPs (77%) chose neurologists as the most important care giver, followed by the GP (9/47; 18.7%), 25/51 respondents (49%) mentioned they never personally initiated anti-epileptic medication (AEM) and another 27% (14/51 GPs) rarely commenced AEM therapy. 6/50 GPs did not mention EEG as a routine inves...

The Value of Concurrent Electrocardiography When Performing an Electroencephalograph

Clinical EEG and Neuroscience

Introduction. The use of concurrent, single lead electrocardiograph (ECG) recording, when perform... more Introduction. The use of concurrent, single lead electrocardiograph (ECG) recording, when performing a routine electroencephalograph (EEG), has been standard practice for many years. Previous studies have reported on the usefulness of concurrent EEG in assessing syncope and the detection of newly identified cardiac dysrhythmia but have relied on specialist cardiologist interpretation of the ECG trace. This study expands the understanding of concurrent ECG and provides demographic information regarding the incidence, nature of ECG changes and diagnostic utility of ECG interpretation, during routine EEGs, as evaluated by neurologists. Methods. A single center, retrospective study of routine concurrent EEG and ECG recordings was performed. All routine EEGs, performed within a 12 month period were analysed. Demographic data, underlying comorbidities, reasons for referral and ECG changes were assessed. Results. ECG abnormalities were identified in 147 (13.5%) of concurrent ECG/EEG routin...

Cerebrovascular Disease Profiles of Culturally and Linguistically Diverse Communities in South Western Sydney and New South Wales

Cerebrovascular Diseases

Introduction: Culturally and linguistically diverse (CALD) communities are growing globally. Unde... more Introduction: Culturally and linguistically diverse (CALD) communities are growing globally. Understanding patterns of cerebrovascular disease in CALD communities may improve health outcomes through culturally specific interventions. We compared rates of transient ischaemic attack (TIA)/stroke (ischaemic stroke, intracerebral haemorrhage) and stroke risk factor prevalence in overseas and Australian-born people in South Western Sydney (SWS) and New South Wales (NSW). Methods: This was a 10-year retrospective analysis (2011–2020) of SWS and NSW age-standardized rates per 100,000 person-years of TIA/stroke. Data were extracted from Health Information Exchange and Secure Analytics for Population Health Research and Intelligence systems. Rates of hypertension, type 2 diabetes mellitus (T2DM), atrial fibrillation (AF), smoking, and obesity were also calculated. Results: The SWS and NSW age-standardized rate of TIA/stroke for people born in Australia was 100 per 100,000 person-years (100/1...

Treating stroke patients with a poor prognosis - what’s law got to do with it?

Medicine and law, 2016

Background: Clinicians treating stroke often are unfamiliar with the legal imperatives applicable... more Background: Clinicians treating stroke often are unfamiliar with the legal imperatives applicable to enforced or expected treatments as compared with refusal to provide intervention considered to be contrary to the patient’s best interests. Aims: Review of the legal framework accompanying the treatment of severe stroke. Methods: Legal medicine imperatives of treatment sought by a patient or their relatives, considered to be inappropriate and not in the patient’s best interests, were analysed. Results: A stroke physician who does not provide treatment to a patient with a severe stroke has no liability in negligence if a representative group of medical practitioners, in the field of stroke management, also would not have offered this treatment. Even if a relative or patient is able to demonstrate that a reasonable doctor would have provided such treatment, it is only if failure to have done so caused damage to the patient, that liability will sound in negligence. There is also an argu...

Neurology in Aviation

Journal of Military and Veterans' Health, 2010

Preparing an overview of neurology in aviation starts with a review of the Civil Aviation Safety ... more Preparing an overview of neurology in aviation starts with a review of the Civil Aviation Safety Authority (CASA) guidelines. The CASA guidelines cover a range of neurological conditions such as: headaches; syncope and seizures; disequilibrium; degenerative diseases; and peripheral neuropathy. Trauma and post-traumatic amnesia are discussed, as is neurosurgical management. The role of routine neurophysiologic testing, such as electroencephalogy, is appraised and seizure receives further attention beyond the CASA rules. Other pathophysiologic factors are also examined to complete the overview and to serve as a basis upon which to evaluate aircrew, determine fitness to fly and offer support for ADF flying operations.

Creutzfeldt-Jakob Disease in South West Sydney 2014–2020: An Unusually High Incidence of a Rare Disease

Neuroepidemiology, 2021

Introduction: Creutzfeldt-Jakob disease (CJD), a spongiform encephalopathy, caused by a transmiss... more Introduction: Creutzfeldt-Jakob disease (CJD), a spongiform encephalopathy, caused by a transmissible misfolded cellular prion protein, is a rapidly progressive, debilitating neurodegenerative disorder with no effective treatment. The estimated global incidence is at 1/million inhabitants. This retrospective study examined the incidence of CJD in South Western Sydney Local Health District (SWSLHD) from 2014 to 2020. Background: SWSLHD had an estimated population of 1,038,534 in 2020, with CJD data being limited. Methods: The New South Wales (NSW) Health Information Exchange (HIE) database, for all admissions with CJD diagnoses in SWSLHD, between 2014 and 2020, was reviewed according to the WHO diagnostic criteria, consistent with the Australian national CJD registry. Only probable CJD cases were included. Incidence was calculated based on the projected SWSLHD population. Results: Thirty-five patients, diagnosed with CJD, were identified. Each was evaluated by 2 independent investiga...

Optimising Prehospital Pathways to Improve Acute Stroke Reperfusion Therapy Delivery: Systems-Based Approaches

SN Comprehensive Clinical Medicine, 2021

Intravenous thrombolysis and endovascular thrombectomy are the only approved reperfusion treatmen... more Intravenous thrombolysis and endovascular thrombectomy are the only approved reperfusion treatments available for patients with acute ischemic stroke. Despite the advances in reperfusion therapy, time continues to be a critical factor in the delivery of reperfusion treatment in acute stroke settings. In recent years, some systems-based approaches have been pursued with considerable success. However, approaches aimed at optimising and reducing treatment delays specifically in the prehospital settings are limited. A systems-based approach aimed at improving the process of care in the prehospital setting may result in the reduction of treatment delays and potentially improve clinical outcomes. In this article, we present an overview of the current prehospital acute stroke pathway. Areas to reduce treatment delays are identified and optimisations to the prehospital workflow addressing the identified gaps in acute stroke settings are proposed. Improving process and system gaps would translate to improved post-stroke outcomes following reperfusion therapy.

Astra zeneca Covid vaccination conversion reaction

Global Journal of Medical and Clinical Case Reports, 2021

Introduction: This paper reports a patient who presented with hemiparesis and hemisensory hypo-ae... more Introduction: This paper reports a patient who presented with hemiparesis and hemisensory hypo-aesthesia following the AstraZeneca vaccine. Formal neurological assessment diagnosed a conversion reaction. Case report: A 60 year old lady presented with left sided weakness and hypo-aesthesia after her fi rst dose of the AstraZeneca vaccine. She became unable to walk, had blurred vision and a bitter taste. There was no similar previous history. Depression and anxiety were diagnosed in 2007. Physical examination revealed positive Hoover's signs, without features to suggest either upper or lower motor neurone defi cit. She had non-anatomic loss of sensation, across her torso, plus non-anatomical demarcation of decreased trigeminal sensation. She was advised that her most likely diagnosis was that of a non-organic conversion reaction but she did undergo cerebral imaging together with a psychiatric assessment, prior to discharge. Discussion: The AstraZeneca Covid-19 vaccine has received signifi cant publicity regarding potential for clotting. This case highlights the consequences of this concern. Physical examination suggested a non-organic complaint, allowing the provisional diagnosis of a conversion reaction. Advising the patient allowed her to accept that, when all the tests came back normal, it did not refl ect lack of knowledge to make a correct diagnosis. The correct procedure is to make a provisional diagnosis (namely conversion reaction) and to exclude differential diagnoses, such as clotting. It is believed that this represents the fi rst reported case of an AstraZeneca Covid vaccination conversion reaction but it is highly unlikely that it will be the last one to be encountered.

Glyphosate–surfactant herbicide-induced reversible encephalopathy

Journal of Clinical Neuroscience, Nov 1, 2010

Glyphosate-surfactant (GlySH) is a commonly used herbicide that has been used in attempted suicid... more Glyphosate-surfactant (GlySH) is a commonly used herbicide that has been used in attempted suicide. Most reports of GlySH toxicity in patients have followed ingestion of the commercial product ''Roundup" (Monsanto Ltd; Melbourne, Victoria, Australia), which consists of a mixture of glyphosate (as a isopropylanine salt) and a surfactant (polyoxyethyleneamine). Ingestion of Roundup is reported to cause significant toxicity including nausea, vomiting, oral and abdominal pain. Renal and hepatic impairment and pulmonary oedema may also occur. Impaired consciousness and encephalopathy have been reported as sequelae but there are limited data on the central nervous system (CNS) effects of Roundup toxicity. We report a 71-year-old male who attempted suicide with GlySH and developed a prolonged but reversible encephalopathy suggestive of acute CNS toxicity.

Medical Negligence Law in Australia

Ius Gentium: Comparative Perspectives on Law and Justice, 2021

Lamotrigine — Interactions matter!

Epilepsy & Behavior, 2020

Association of Lesion Topography with Functional Outcomes in Acute Ischemic Stroke Patients Considered for, or Receiving, Reperfusion Therapy: A Meta-Analysis

Neurology International

Background: The impact of lesion topography (LT), characterised by the Alberta Stroke Programme E... more Background: The impact of lesion topography (LT), characterised by the Alberta Stroke Programme Early CT Score (ASPECTS), on outcomes after reperfusion therapy in acute ischemic stroke (AIS) is poorly elucidated. We investigated the prognostic accuracy of ASPECTS-based LT assessment and its association with clinical outcomes in AIS patients considered for reperfusion therapy or receiving intravenous thrombolysis (IVT), endovascular thrombectomy (EVT), or none or both. Methods: Studies were identified from PubMed with additional studies added from Google Scholar. The prevalence of individual ASPECTS regions will also be determined. The association of individual ASPECTS regions with the functional outcome at 90 days will be assessed using random-effects modelling for various cut-offs, such as 6, 7 and 8. The association of continuous ASPECTS with the functional outcome at 90 days will also be undertaken. Forest plots of odds ratios (ORs) will be generated. Results: A total of 25 studi...

The Role of Computed Tomography in the Assessment of Neurologic Sequelae of Decompression Sickness

Archives of neurology, Sep 1, 1988

Computed tomographic (CT) scans were performed on 47 patients who had received recompression trea... more Computed tomographic (CT) scans were performed on 47 patients who had received recompression treatment for decompression sickness. A retrospective review of the case notes disclosed that 24 of the 47 patients had symptoms that suggested cerebral involvement. None of the reported CT abnormalities could be correlated with the clinical manifestations at presentation. It was concluded that the CT scan is not a cost-effective investigative tool for the posttreatment evaluation of decompression sickness.

Editorial: Multidisciplinary approaches to diagnosis and management of traumatic encephalopathy syndrome (TES)

Frontiers in Neurology

Cross-Reactive Skin Eruption with Both Carbamazepine and Oxcarbazepine

Epilepsia, 1993

Oxcarbazepine (OCBZ), a 10-keto derivative of carbamazepine (CBZ) has been reported to have a sim... more Oxcarbazepine (OCBZ), a 10-keto derivative of carbamazepine (CBZ) has been reported to have a similar range of efficacy and fewer unwanted effects than CBZ since it is a prodrug for the monohydroxy derivative (MHD). A cross-reactivity of only 1 in 4 has been reported between OCBZ and CBZ. For these reasons, we tried OCBZ with 3 consecutive patients with poorly controlled epilepsy who had had a therapeutic response to CBZ but in whom CBZ was discontinued because of serious skin reaction. Each patient had a similar skin response after exposure to only 600-900 mg OCBZ, which suggests a need to practice caution when substituting OCBZ for CBZ in patients known to have serious skin reaction to CBZ.

Double-Blind, Placebo-Controlled, Lamotrigine in Treatment-Resistant Generalised Epilepsy

by Abdalla Awidi, Roy Beran, Roy Beran, and A. Hasan

Epilepsia, 1998

Purpose: Lamotrigine (LTG) is recognised as effective add-on therapy for focal epilepsies, but th... more

AUStralian Study of Titration to Effect Profile of Safety (AUS-STEPS): High-Dose Gabapentin (Neurontin) in Partial Seizures

Epilepsia, 2001

Purpose:To evaluate the safety, tolerability, efficacy, and impact on quality of life of gabapent... more

Melatonin Response in Active Epilepsy

Epilepsia, 1995

Urinary excretion of 6-sulfatoxymelatonin (aMT.6S), the hepatic metabolite of melatonin, was meas... more Urinary excretion of 6-sulfatoxymelatonin (aMT.6S), the hepatic metabolite of melatonin, was measured for three consecutive 8-h intervals, beginning at 0600 h, in 30 patients with untreated active epilepsy and in 19 healthy subjects. Excretion of aMT.6S in a 24-h period in patients with active epilepsy was 77.3 +/- 55 nmol (median 68.0, range 8.7-280 nmol), significantly higher (p &lt; 0.05) than that of healthy subjects (49.1 +/- 14 nmol, median 49.0, range 19.7-68.0 nmol). Sequential 8-h urinary aMT.6S excretion rates in patients with active epilepsy were 2.45 +/- 2.8 nmol/h (0600-1400 h), 0.83 +/- 0.5 nmol (1400-2200 h) and 6.38 +/- 5.0 nmol/h (2200-0600 h) as compared with 1.43 +/- 0.8, 1.10 +/- 0.8 and 3.81 +/- 1.3 nmol/h, respectively, in healthy subjects. Analysis of variance (ANOVA) indicated that the difference in total output resulted from greater nocturnal excretion (F = 5.58, p = 0.018). Melatonin production in untreated patients with active epilepsy is increased and has a circadian pattern with a phase difference as compared with that of normal subjects.

Economics in Epilepsy Treatment Choices: Our Certain Fate?

Epilepsia, 2002

Management and Attitudes of Epilepsy by a Group of Sydney General Practitioners

Epilepsia, 1994

Previous surveys of general practitioners (GPs) have shown stereotypic attitudes and management o... more Previous surveys of general practitioners (GPs) have shown stereotypic attitudes and management of persons with epilepsy (PWE). We mailed a questionnaire to 107 GPs in the Sydney and Illawarra regions of Australia to evaluate changes in knowledge and management of epilepsy and attitudes of GPs toward PWE as compared with results of a similar study made 10 years previously. Most GPs referred patients with epilepsy to a neurologist for initial management in preference to initiating investigation and treatment themselves. GPs were very satisfied with their sharing of care with neurologists, but indicated their high level of dissatisfaction with other health care therapists because of impractical advice and lack of empathy. The GPs&#39; objectives of continuing management were mainly to prevent seizures, monitor of medication and its effects, and reduce the impact of patients&#39; epilepsy on their daily life. Although many GPs believed that PWE were more likely to have emotional and relationship problems, most also believed that such persons contribute equally to society and can have normal quality of life (QOL). Although the GPs prefer to use a neurologist for initial management of PWE, they see themselves as having a role in continuing care and providing psychosocial support. The stereotyped perceptions of GPs indicated in the previous study have improved, although in some respects they remain negative. This study offers an audit of the outcome of a decade of educational promotion regarding epilepsy.

030 Management and attitudes towards persons with epilepsy in general practice: how far have we come?

Journal of Neurology, Neurosurgery & Psychiatry, 2019

IntroductionPrevious surveys of general practitioners (GP) attitudes regarding epilepsy and peopl... more IntroductionPrevious surveys of general practitioners (GP) attitudes regarding epilepsy and people with epilepsy (PWE), conducted 20–30 years ago1 2, identified the need for further education in epilepsy care for GPs. This follow up study of GPs in Sydney, Australia, was conducted to determine the degree of changes in knowledge, attitudes and management of PWE, to evaluate if there had been significant improvement during this period.MethodsA piloted questionnaire addressing epilepsy investigations, preferred care provider and attitudes towards epilepsy was developed and completed by a representative sample of Sydney GPs.ResultsA total of 52 completed responses were received. 36 out of 47 GPs (77%) chose neurologists as the most important care giver, followed by the GP (9/47; 18.7%), 25/51 respondents (49%) mentioned they never personally initiated anti-epileptic medication (AEM) and another 27% (14/51 GPs) rarely commenced AEM therapy. 6/50 GPs did not mention EEG as a routine inves...

The Value of Concurrent Electrocardiography When Performing an Electroencephalograph

Clinical EEG and Neuroscience

Introduction. The use of concurrent, single lead electrocardiograph (ECG) recording, when perform... more Introduction. The use of concurrent, single lead electrocardiograph (ECG) recording, when performing a routine electroencephalograph (EEG), has been standard practice for many years. Previous studies have reported on the usefulness of concurrent EEG in assessing syncope and the detection of newly identified cardiac dysrhythmia but have relied on specialist cardiologist interpretation of the ECG trace. This study expands the understanding of concurrent ECG and provides demographic information regarding the incidence, nature of ECG changes and diagnostic utility of ECG interpretation, during routine EEGs, as evaluated by neurologists. Methods. A single center, retrospective study of routine concurrent EEG and ECG recordings was performed. All routine EEGs, performed within a 12 month period were analysed. Demographic data, underlying comorbidities, reasons for referral and ECG changes were assessed. Results. ECG abnormalities were identified in 147 (13.5%) of concurrent ECG/EEG routin...

Cerebrovascular Disease Profiles of Culturally and Linguistically Diverse Communities in South Western Sydney and New South Wales

Cerebrovascular Diseases

Introduction: Culturally and linguistically diverse (CALD) communities are growing globally. Unde... more Introduction: Culturally and linguistically diverse (CALD) communities are growing globally. Understanding patterns of cerebrovascular disease in CALD communities may improve health outcomes through culturally specific interventions. We compared rates of transient ischaemic attack (TIA)/stroke (ischaemic stroke, intracerebral haemorrhage) and stroke risk factor prevalence in overseas and Australian-born people in South Western Sydney (SWS) and New South Wales (NSW). Methods: This was a 10-year retrospective analysis (2011–2020) of SWS and NSW age-standardized rates per 100,000 person-years of TIA/stroke. Data were extracted from Health Information Exchange and Secure Analytics for Population Health Research and Intelligence systems. Rates of hypertension, type 2 diabetes mellitus (T2DM), atrial fibrillation (AF), smoking, and obesity were also calculated. Results: The SWS and NSW age-standardized rate of TIA/stroke for people born in Australia was 100 per 100,000 person-years (100/1...

Treating stroke patients with a poor prognosis - what’s law got to do with it?

Medicine and law, 2016

Background: Clinicians treating stroke often are unfamiliar with the legal imperatives applicable... more Background: Clinicians treating stroke often are unfamiliar with the legal imperatives applicable to enforced or expected treatments as compared with refusal to provide intervention considered to be contrary to the patient’s best interests. Aims: Review of the legal framework accompanying the treatment of severe stroke. Methods: Legal medicine imperatives of treatment sought by a patient or their relatives, considered to be inappropriate and not in the patient’s best interests, were analysed. Results: A stroke physician who does not provide treatment to a patient with a severe stroke has no liability in negligence if a representative group of medical practitioners, in the field of stroke management, also would not have offered this treatment. Even if a relative or patient is able to demonstrate that a reasonable doctor would have provided such treatment, it is only if failure to have done so caused damage to the patient, that liability will sound in negligence. There is also an argu...

Neurology in Aviation

Journal of Military and Veterans' Health, 2010

Preparing an overview of neurology in aviation starts with a review of the Civil Aviation Safety ... more Preparing an overview of neurology in aviation starts with a review of the Civil Aviation Safety Authority (CASA) guidelines. The CASA guidelines cover a range of neurological conditions such as: headaches; syncope and seizures; disequilibrium; degenerative diseases; and peripheral neuropathy. Trauma and post-traumatic amnesia are discussed, as is neurosurgical management. The role of routine neurophysiologic testing, such as electroencephalogy, is appraised and seizure receives further attention beyond the CASA rules. Other pathophysiologic factors are also examined to complete the overview and to serve as a basis upon which to evaluate aircrew, determine fitness to fly and offer support for ADF flying operations.

Creutzfeldt-Jakob Disease in South West Sydney 2014–2020: An Unusually High Incidence of a Rare Disease

Neuroepidemiology, 2021

Introduction: Creutzfeldt-Jakob disease (CJD), a spongiform encephalopathy, caused by a transmiss... more Introduction: Creutzfeldt-Jakob disease (CJD), a spongiform encephalopathy, caused by a transmissible misfolded cellular prion protein, is a rapidly progressive, debilitating neurodegenerative disorder with no effective treatment. The estimated global incidence is at 1/million inhabitants. This retrospective study examined the incidence of CJD in South Western Sydney Local Health District (SWSLHD) from 2014 to 2020. Background: SWSLHD had an estimated population of 1,038,534 in 2020, with CJD data being limited. Methods: The New South Wales (NSW) Health Information Exchange (HIE) database, for all admissions with CJD diagnoses in SWSLHD, between 2014 and 2020, was reviewed according to the WHO diagnostic criteria, consistent with the Australian national CJD registry. Only probable CJD cases were included. Incidence was calculated based on the projected SWSLHD population. Results: Thirty-five patients, diagnosed with CJD, were identified. Each was evaluated by 2 independent investiga...

Optimising Prehospital Pathways to Improve Acute Stroke Reperfusion Therapy Delivery: Systems-Based Approaches

SN Comprehensive Clinical Medicine, 2021

Intravenous thrombolysis and endovascular thrombectomy are the only approved reperfusion treatmen... more Intravenous thrombolysis and endovascular thrombectomy are the only approved reperfusion treatments available for patients with acute ischemic stroke. Despite the advances in reperfusion therapy, time continues to be a critical factor in the delivery of reperfusion treatment in acute stroke settings. In recent years, some systems-based approaches have been pursued with considerable success. However, approaches aimed at optimising and reducing treatment delays specifically in the prehospital settings are limited. A systems-based approach aimed at improving the process of care in the prehospital setting may result in the reduction of treatment delays and potentially improve clinical outcomes. In this article, we present an overview of the current prehospital acute stroke pathway. Areas to reduce treatment delays are identified and optimisations to the prehospital workflow addressing the identified gaps in acute stroke settings are proposed. Improving process and system gaps would translate to improved post-stroke outcomes following reperfusion therapy.

Astra zeneca Covid vaccination conversion reaction

Global Journal of Medical and Clinical Case Reports, 2021

Introduction: This paper reports a patient who presented with hemiparesis and hemisensory hypo-ae... more Introduction: This paper reports a patient who presented with hemiparesis and hemisensory hypo-aesthesia following the AstraZeneca vaccine. Formal neurological assessment diagnosed a conversion reaction. Case report: A 60 year old lady presented with left sided weakness and hypo-aesthesia after her fi rst dose of the AstraZeneca vaccine. She became unable to walk, had blurred vision and a bitter taste. There was no similar previous history. Depression and anxiety were diagnosed in 2007. Physical examination revealed positive Hoover's signs, without features to suggest either upper or lower motor neurone defi cit. She had non-anatomic loss of sensation, across her torso, plus non-anatomical demarcation of decreased trigeminal sensation. She was advised that her most likely diagnosis was that of a non-organic conversion reaction but she did undergo cerebral imaging together with a psychiatric assessment, prior to discharge. Discussion: The AstraZeneca Covid-19 vaccine has received signifi cant publicity regarding potential for clotting. This case highlights the consequences of this concern. Physical examination suggested a non-organic complaint, allowing the provisional diagnosis of a conversion reaction. Advising the patient allowed her to accept that, when all the tests came back normal, it did not refl ect lack of knowledge to make a correct diagnosis. The correct procedure is to make a provisional diagnosis (namely conversion reaction) and to exclude differential diagnoses, such as clotting. It is believed that this represents the fi rst reported case of an AstraZeneca Covid vaccination conversion reaction but it is highly unlikely that it will be the last one to be encountered.

Glyphosate–surfactant herbicide-induced reversible encephalopathy

Journal of Clinical Neuroscience, Nov 1, 2010

Glyphosate-surfactant (GlySH) is a commonly used herbicide that has been used in attempted suicid... more Glyphosate-surfactant (GlySH) is a commonly used herbicide that has been used in attempted suicide. Most reports of GlySH toxicity in patients have followed ingestion of the commercial product ''Roundup" (Monsanto Ltd; Melbourne, Victoria, Australia), which consists of a mixture of glyphosate (as a isopropylanine salt) and a surfactant (polyoxyethyleneamine). Ingestion of Roundup is reported to cause significant toxicity including nausea, vomiting, oral and abdominal pain. Renal and hepatic impairment and pulmonary oedema may also occur. Impaired consciousness and encephalopathy have been reported as sequelae but there are limited data on the central nervous system (CNS) effects of Roundup toxicity. We report a 71-year-old male who attempted suicide with GlySH and developed a prolonged but reversible encephalopathy suggestive of acute CNS toxicity.

Medical Negligence Law in Australia

Ius Gentium: Comparative Perspectives on Law and Justice, 2021

Lamotrigine — Interactions matter!

Epilepsy & Behavior, 2020

Association of Lesion Topography with Functional Outcomes in Acute Ischemic Stroke Patients Considered for, or Receiving, Reperfusion Therapy: A Meta-Analysis

Neurology International

Background: The impact of lesion topography (LT), characterised by the Alberta Stroke Programme E... more Background: The impact of lesion topography (LT), characterised by the Alberta Stroke Programme Early CT Score (ASPECTS), on outcomes after reperfusion therapy in acute ischemic stroke (AIS) is poorly elucidated. We investigated the prognostic accuracy of ASPECTS-based LT assessment and its association with clinical outcomes in AIS patients considered for reperfusion therapy or receiving intravenous thrombolysis (IVT), endovascular thrombectomy (EVT), or none or both. Methods: Studies were identified from PubMed with additional studies added from Google Scholar. The prevalence of individual ASPECTS regions will also be determined. The association of individual ASPECTS regions with the functional outcome at 90 days will be assessed using random-effects modelling for various cut-offs, such as 6, 7 and 8. The association of continuous ASPECTS with the functional outcome at 90 days will also be undertaken. Forest plots of odds ratios (ORs) will be generated. Results: A total of 25 studi...

The Role of Computed Tomography in the Assessment of Neurologic Sequelae of Decompression Sickness

Archives of neurology, Sep 1, 1988

Computed tomographic (CT) scans were performed on 47 patients who had received recompression trea... more Computed tomographic (CT) scans were performed on 47 patients who had received recompression treatment for decompression sickness. A retrospective review of the case notes disclosed that 24 of the 47 patients had symptoms that suggested cerebral involvement. None of the reported CT abnormalities could be correlated with the clinical manifestations at presentation. It was concluded that the CT scan is not a cost-effective investigative tool for the posttreatment evaluation of decompression sickness.

Editorial: Multidisciplinary approaches to diagnosis and management of traumatic encephalopathy syndrome (TES)

Frontiers in Neurology

Cross-Reactive Skin Eruption with Both Carbamazepine and Oxcarbazepine

Epilepsia, 1993

Oxcarbazepine (OCBZ), a 10-keto derivative of carbamazepine (CBZ) has been reported to have a sim... more Oxcarbazepine (OCBZ), a 10-keto derivative of carbamazepine (CBZ) has been reported to have a similar range of efficacy and fewer unwanted effects than CBZ since it is a prodrug for the monohydroxy derivative (MHD). A cross-reactivity of only 1 in 4 has been reported between OCBZ and CBZ. For these reasons, we tried OCBZ with 3 consecutive patients with poorly controlled epilepsy who had had a therapeutic response to CBZ but in whom CBZ was discontinued because of serious skin reaction. Each patient had a similar skin response after exposure to only 600-900 mg OCBZ, which suggests a need to practice caution when substituting OCBZ for CBZ in patients known to have serious skin reaction to CBZ.

Double-Blind, Placebo-Controlled, Lamotrigine in Treatment-Resistant Generalised Epilepsy

by Abdalla Awidi, Roy Beran, Roy Beran, and A. Hasan

Epilepsia, 1998

Purpose: Lamotrigine (LTG) is recognised as effective add-on therapy for focal epilepsies, but th... more

AUStralian Study of Titration to Effect Profile of Safety (AUS-STEPS): High-Dose Gabapentin (Neurontin) in Partial Seizures

Epilepsia, 2001

Purpose:To evaluate the safety, tolerability, efficacy, and impact on quality of life of gabapent... more

Melatonin Response in Active Epilepsy

Epilepsia, 1995

Urinary excretion of 6-sulfatoxymelatonin (aMT.6S), the hepatic metabolite of melatonin, was meas... more Urinary excretion of 6-sulfatoxymelatonin (aMT.6S), the hepatic metabolite of melatonin, was measured for three consecutive 8-h intervals, beginning at 0600 h, in 30 patients with untreated active epilepsy and in 19 healthy subjects. Excretion of aMT.6S in a 24-h period in patients with active epilepsy was 77.3 +/- 55 nmol (median 68.0, range 8.7-280 nmol), significantly higher (p &lt; 0.05) than that of healthy subjects (49.1 +/- 14 nmol, median 49.0, range 19.7-68.0 nmol). Sequential 8-h urinary aMT.6S excretion rates in patients with active epilepsy were 2.45 +/- 2.8 nmol/h (0600-1400 h), 0.83 +/- 0.5 nmol (1400-2200 h) and 6.38 +/- 5.0 nmol/h (2200-0600 h) as compared with 1.43 +/- 0.8, 1.10 +/- 0.8 and 3.81 +/- 1.3 nmol/h, respectively, in healthy subjects. Analysis of variance (ANOVA) indicated that the difference in total output resulted from greater nocturnal excretion (F = 5.58, p = 0.018). Melatonin production in untreated patients with active epilepsy is increased and has a circadian pattern with a phase difference as compared with that of normal subjects.

Economics in Epilepsy Treatment Choices: Our Certain Fate?

Epilepsia, 2002

Management and Attitudes of Epilepsy by a Group of Sydney General Practitioners

Epilepsia, 1994

Previous surveys of general practitioners (GPs) have shown stereotypic attitudes and management o... more Previous surveys of general practitioners (GPs) have shown stereotypic attitudes and management of persons with epilepsy (PWE). We mailed a questionnaire to 107 GPs in the Sydney and Illawarra regions of Australia to evaluate changes in knowledge and management of epilepsy and attitudes of GPs toward PWE as compared with results of a similar study made 10 years previously. Most GPs referred patients with epilepsy to a neurologist for initial management in preference to initiating investigation and treatment themselves. GPs were very satisfied with their sharing of care with neurologists, but indicated their high level of dissatisfaction with other health care therapists because of impractical advice and lack of empathy. The GPs&#39; objectives of continuing management were mainly to prevent seizures, monitor of medication and its effects, and reduce the impact of patients&#39; epilepsy on their daily life. Although many GPs believed that PWE were more likely to have emotional and relationship problems, most also believed that such persons contribute equally to society and can have normal quality of life (QOL). Although the GPs prefer to use a neurologist for initial management of PWE, they see themselves as having a role in continuing care and providing psychosocial support. The stereotyped perceptions of GPs indicated in the previous study have improved, although in some respects they remain negative. This study offers an audit of the outcome of a decade of educational promotion regarding epilepsy.