A case of botulism in New Zealand Smyth, Duncan; Deverall, Eamonn; Balm, Michelle ...
New Zealand medical journal,
2015-Nov-20, Volume:
128, Issue:
1425
Journal Article
Peer reviewed
Open access
We describe the first case of food-borne botulism seen in New Zealand for 30 years. Botulism is an important diagnosis to consider in a patient with rapidly progressive descending paralysis and ...normal sensorium. Early recognition, timely institution of intensive care support and administration of botulism antitoxin are the most important aspects of management.
Drug-induced subacute cutaneous lupus is a very rare adverse reaction to medications. This case report describes onset of this condition caused by Interferon beta-1a, which has been rarely reported ...previously.
We wanted to determine whether adult patients presenting with a seizure to the emergency department (ED) of Wellington Hospital and Hutt Hospital, in the Wellington region, were equally likely to be ...referred for neurology input.
A retrospective review was conducted of 250 consecutive patients presenting with a seizure to the ED of each hospital. Patient electronic records were examined to determine the proportion of patients discussed with the inpatient neurology team and referred to neurology outpatient clinic.
Fifty-two per cent of the patients presenting to Wellington Hospital ED with a seizure were referred to neurology, compared to 13.4% of those presenting to Hutt Hospital ED. The proportion of 'first seizure' patients referred to neurology was 63.1% for Wellington Hospital and 9.8% for Hutt Hospital. The difference in referral rates was primarily attributable to the difference in inpatient referrals. Māori were over-represented in the patients presenting to ED with a seizure, compared to their population composition.
This study demonstrated unequal referral practices and therefore provision of neurology care for adult seizure patients across the Wellington region, for patients with established epilepsy and those with a first seizure. There were a disproportionately high number of Māori accessing acute seizure care.
Cannabidiol has shown efficacy in randomized clinical trials for drug-resistant epilepsy in specific syndromes that predominantly affect children. However, high-level evidence for the efficacy and ...safety of cannabidiol in the most common form of drug-resistant epilepsy in adults, focal epilepsy, is lacking.
To investigate the efficacy, safety, and tolerability of transdermally administered cannabidiol in adults with drug-resistant focal epilepsy.
A randomized, double-blind, placebo-controlled, multicenter clinical trial at 14 epilepsy trial centers in Australia and New Zealand. Participants were adults with drug-resistant focal epilepsy receiving a stable regimen of up to 3 antiseizure medications. Data were analyzed from July 2017 to November 2018.
Eligible participants were randomized (1:1:1) to 195-mg or 390-mg transdermal cannabidiol or placebo twice daily for 12 weeks, after which they could enroll in an open-label extension study for up to 2 years.
Seizure frequency was self-reported using a daily diary. The primary efficacy end point was the least squares mean difference in the log-transformed total seizure frequency per 28-day period, adjusted to a common baseline log seizure rate, during the 12-week treatment period.
A total of 188 patients (45% male 85 patients and 54.8% female 103 patients) with a mean (SD) age of 39.2 (12.78) years were randomized, treated, and analyzed (195-mg cannabidiol, 63 participants; 390-mg cannabidiol, 62 participants; placebo, 63 participants). At week 12 of the double-blind period, there was no difference in seizure frequency between placebo (mean SD 2.49 1.31 seizures per 28 days) and 195-mg cannabidiol (mean SD 2.51 1.15 seizures per 28 days; least squares mean difference, 0.014; 95% CI, -0.175 to 0.203; P = .89) or 390-mg cannabidiol (mean SD 2.59 1.12 seizures per 28 days; least squares mean difference, 0.096; 95% CI, -0.093 to 0.285; P = .32). By month 6 of the open-label extension, 115 patients (60.8%) achieved a seizure reduction of at least 50%. Treatment-emergent adverse events occurred in 50.4% (63 of 125 participants) of the cannabidiol group vs 41.3% (26 of 63 participants) in the placebo group, with a treatment difference of 9.1% (95% CI, -6.0% to 23.6%), and occurred at similar rates in the cannabidiol groups. Few participants discontinued (7% 14 of 188 participants), and most (98% 171 of 174 participants) continued into the open-label extension.
Both doses of transdermal cannabidiol were well tolerated and safe. No significant difference in efficacy was observed between cannabidiol and placebo during the double-blind treatment period. The open-label extension demonstrated the long-term safety, tolerability, and acceptability of transdermal cannabidiol delivery.
ACTRN12616000510448 (double-blind); ACTRN12616001455459 (open-label).
Positional vomiting is an important alerting sign for the presence of a brainstem central nervous system (CNS) lesion. Failure to identify another cause of protracted vomiting should prompt ...consideration of a CNS cause.
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