Background Paroxysmal neurological symptoms occurring with sex cause considerable anxiety and sometimes have a serious cause. Thunderclap headache is the most well-known and requires urgent investigation at first presentation for subarachnoid haemorrhage and other significant pathologies. After exclusion of underlying causes, many prove to be primary headache associated with sexual activity. Orgasmic migraine aura without headache is not currently recognised as a clinical entity. Case reports We report two patients with acephalgic orgasmic neurological symptoms fulfilling the criteria for migraine aura. Conclusions The incidence of acephalgic orgasmic migraine aura is unknown. It should be considered as part of the differential of paroxysmal sex-related neurological symptoms, and clinically differentiated from fixed deficits, reversible cerebral vasoconstriction syndrome and post-orgasmic illness syndrome.
COVID-19 and its aftermath highlight the importance of patient self-care and involvement in monitoring and improving their health. Resources to guide this are essential. Our objective was to create a web-based patient education tool, to facilitate patient education and empowerment for people with epilepsy, multiple sclerosis and Parkinson’s disease, available without cost to patients, carers and clinicians. This project was conducted within community and secondary neurology services. Patients and their carers were involved in designing, reviewing and revising the tool, as equal partners with clinicians and digital engineers. A web-based design template was developed with graphics and links to enable patients to create personalised plans. Participants are patients, carers, clinicians (neurology consultants and specialist nurses), neurological charities, the London Neuroscience Clinical Network, NHS England and Shift.ms (a service design team with experience in creating digital services for individuals living with neurological conditions). Shift.ms conducted in-depth interviews. Clinicians used evidence from personal and PubMed databases. Shift.ms analysed and co-ordinated the responses, and designed the pilot tool. Confidence College provides a delivery model for patient education relating to multiple sclerosis, epilepsy and Parkinson’s disease. It requires follow-up evaluation regarding uptake. This web-based accessible patient empowerment tool has no limit on recurrent use, low maintenance costs and no additional costs in up-scaling the number of users. It is ideally suited for use during and after the COVID-19 pandemic.
Khat leaves originate in East Africa and the Arabian Peninsula and are chewed socially for their psychoactive properties. The main constituents of khat, cathinone and cathine, are illegal substances in most of Europe, including the UK, which reclassified khat as a Class C drug in June 2014. Case reports of khat-induced psychosis and dependence are not supported with robust scientific studies, and evidence for a causal relationship is lacking. Cross-sectional population studies reveal that khat abuse is affected by a range of susceptibility factors, such as psychological trauma; this has been experienced by many khat users, due to civil war and/or migration. Most studies on animal models of khat-induced dependence or psychosis use its psychoactive ingredient, cathinone, rather than khat extract. However, the unique chewing method of khat diminishes its addictive potential due to slow and prolonged absorption. Furthermore, the effects of the other constituents present in khat leaves are not well understood. While there are multiple criteria for banning a drug, this review considers the scientific evidence regarding two frequently mentioned criteria: dependence potential and psychosis. It concludes that further investigation, which takes into account susceptibility factors, is required to justify such intervention.
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