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The COVID-19 pandemic has resulted in periods of remote working for some junior doctors, due to shielding and clinical vulnerability. This report offers practical guidance for junior doctors and their supervisors on how to make a period of remote working safe and effective, while maintaining education, training progression and morale. We outline specific challenges and practicalities that should be considered prior to commencing remote working and discuss what tasks and activities are best suited to a remote-working junior doctor. We offer a positive outlook that, with adequate support, a junior doctor can continue to progress in their training while working remotely, and can make a period of remote working an opportunity for personal and professional development while remaining an effective and valuable member of the clinical team.

Abnormal EEG features are a hallmark of epilepsy, and abnormal frequency and network features are apparent in EEGs from people with idiopathic generalized epilepsy in both ictal and interictal states. Here, we characterize differences in the resting-state EEG of individuals with juvenile myoclonic epilepsy and assess factors influencing the heterogeneity of EEG features. We collected EEG data from 147 participants with juvenile myoclonic epilepsy through the Biology of Juvenile Myoclonic Epilepsy study. Ninety-five control EEGs were acquired from two independent studies [Chowdhury et al. (2014) and EU-AIMS Longitudinal European Autism Project]. We extracted frequency and functional network-based features from 10 to 20 s epochs of resting-state EEG, including relative power spectral density, peak alpha frequency, network topology measures and brain network ictogenicity: a computational measure of the propensity of networks to generate seizure dynamics. We tested for differences between epilepsy and control EEGs using univariate, multivariable and receiver operating curve analysis. In addition, we explored the heterogeneity of EEG features within and between cohorts by testing for associations with potentially influential factors such as age, sex, epoch length and time, as well as testing for associations with clinical phenotypes including anti-seizure medication, and seizure characteristics in the epilepsy cohort. P-values were corrected for multiple comparisons. Univariate analysis showed significant differences in power spectral density in delta (2–5 Hz) (P = 0.0007, hedges’ g = 0.55) and low-alpha (6–9 Hz) (P = 2.9 × 10−8, g = 0.80) frequency bands, peak alpha frequency (P = 0.000007, g = 0.66), functional network mean degree (P = 0.0006, g = 0.48) and brain network ictogenicity (P = 0.00006, g = 0.56) between epilepsy and controls. Since age (P = 0.009) and epoch length (P = 1.7 × 10−8) differed between the two groups and were potential confounders, we controlled for these covariates in multivariable analysis where disparities in EEG features between epilepsy and controls remained. Receiver operating curve analysis showed low-alpha power spectral density was optimal at distinguishing epilepsy from controls, with an area under the curve of 0.72. Lower average normalized clustering coefficient and shorter average normalized path length were associated with poorer seizure control in epilepsy patients. To conclude, individuals with juvenile myoclonic epilepsy have increased power of neural oscillatory activity at low-alpha frequencies, and increased brain network ictogenicity compared with controls, supporting evidence from studies in other epilepsies with considerable external validity. In addition, the impact of confounders on different frequency-based and network-based EEG features observed in this study highlights the need for careful consideration and control of these factors in future EEG research in idiopathic generalized epilepsy particularly for their use as biomarkers.

5 years ago we embarked on a series of novel developments to improve our DGH neurology services. The key was ever closer integrated working between consultant neurologists and specialist nurses with support from our Trust and commissioners.We highlight 6 very diverse ongoing projects:1. Acute neurology ward referrals have increased by 49% between 2016-2021 with nurses triaging referrals prior to consultant review.2. Post discharge nurse telephone review for selected patients since 2020 to try and reduce readmission rates.3. Consultant delivered helpline for all local GPs Monday to Friday since 2020 to discuss urgent cases of concern.4. Nurse delivered lumbar puncture service, since 2019 138 procedures carried out.5. Diagnostic coding for all neurology outpatients started in 2021. Within 8 months all 5 consultants were coding over 70% of attendances.6. Patient initiated follow up (PIFU) – 2020 NHS England initiative. Specialist nurse Helpline for patients with epilepsy, multiple sclerosis and Parkinson’s running successfully since 2018.Service improvements need not be expensive or onerous but require imagination and team cohesion. We strongly recommend others to try what seems most appropriate to their service.

Croydon University HospitalRemote consultations were rapidly introduced in the spring of 2020 in the neurology outpatient setting across the UK and worldwide due to the Covid-19 pandemic. Consulting remotely provides new chal- lenges to previously familiar practices. Here we present four different but commonly seen cases in a south London outpatient neurology service. With each case we address a key domain: history taking, examina- tion, the digital divide and changing the consulting environment. History taking is largely unchanged and indeed may improve the patient experience when performed in a familiar environment. The examina- tion is different and a greater understanding of which aspects of the neurological exam are and are not possible remotely continues to be discussed. The adoption of remote consultations requires patients to have a confident ability to activate and interact with technologies. The future development of technolo- gies and guidelines should proactively engage with patients of all ages and abilities to avoid biases in their development. Remote consultations are likely to continue to play a part in the future of outpatient neurology; understanding their most effective allocation and proactively developing technologies with patients will be essential for their success.josephhogan1@nhs.net|ABN Bursary46

An otherwise well 23 year old lady had a septorhinoplasty with bilateral implants under general anaesthesia for nasal blockage and right sided nasal deviation.The operation was successful but six hours later the left side of her tongue felt odd, she had dysphonia and ‘it felt funny to swallow’. She had deviation of the tongue to the left on protrusion; couldn’t quickly it it from side to side; and the sensation on its left side was altered. There wasn’t obvious tongue swelling or haematoma and no weakness or numbness in the face or limbs. Naso-endoscopy confirmed a left vocal cord paralysis.This was recognised as a left sided hypoglossal and vagal nerve palsy. The ENT and anaesthetic teams, felt that it might have been due to over-packing of the throat causing compression and neuropraxia. Her symptoms substantially improved after 5 days with a course of dexamethasone.This case will be discussed with reference to both the first described and more recent case reports of Tapia’s syndrome along with the hypothesised mechanisms of injury. Tapia’s syndrome is a thought to be due to pressure during intubation but most case reports follow surgeries with hammering and other sudden applications of force, rather than in emergency situations which would be expected to have more problems resulting from intubation. It seems important that those who resuscitate patients are aware of this potential complication.hut898@gmail.com

Aim:This study describes the implementation of a group intervention using Video Interaction Guidance (VIG) to decrease maternal postnatal depression and increase attunement and pleasure in mother-infant relationships.Rationale:Interventions that focus on reducing maternal depression levels do not always have an impact on the relationship between mother and child. Yet depression can limit a parent’s emotional availability and thereby impair the child’s emotional, social, cognitive and physical development, in the long as well as in the short term. An intervention using VIG was designed to increase parental sensitivity and confidence.Method:22 participants received the ‘Fun with Mum’ intervention in closed groups of six to eight mothers and infants. Individuals were referred by health visitors, midwives, family doctors or through the Family Support Service. Criteria for referral included a score of 10 or above on the Edinburgh Postnatal Depression Scale (EPDS) and a stated desire for support.Findings:Pre- and post-intervention EPDS data was collected from 20 of the participants. Sixteen individuals reported a marked decrease in maternal depression. All 22 participants indicated positive change on individually defined targets. Qualitative analysis of targets showed the nature of change experienced. Feedback from mothers indicated improved mindfulness and enjoyment in the relationship with their infant. In addition to video work, organised activities and peer support were identified by mothers as crucial aspects of the intervention.Conclusions:Group-based interventions using VIG can offer an effective approach to developing positive relationships between mothers and their infants in vulnerable circumstances.

PurposeThe purpose of this paper is to share and report on practice development.Design/methodology/approachA description of a joint neuropsychiatric clinic, including demographics of patients seen, is provided.FindingsThe paper expresses the opinion that the experience of running a joint clinic for complex cases with neurological and psychiatric pathology was professionally rewarding and that clinicians found it a more effective way of delivering care.Originality/valueThis is the first description of such a clinic to the authors' knowledge. Development of similar services may be of value.