More light shed on perplexing Australian neurological disease

Two more cases of a rare parasitic myositis endemic to Australia have been reported from far north Queensland.

The two cases of biopsy-confirmed Haycocknema perplexum myositis included a man in his early 40s presenting to the neurologist for assessment of musculoskeletal lower back pain following a workplace incident.

The second case was a woman in her late 20s in her first trimester of pregnancy presenting to the neurologist with a 3-year history of progressive symmetrical muscle weakness.

Elevated creatine kinase, mildly deranged liver function tests and eosinophilia were observed. Myositis antibody panels were negative. Quadriceps muscle biopsy confirmed H. perplexum myositis.

The case report said that in nine previously reported cases, from North Queensland and Tasmania, symptoms were apparent for years.

“There would be a higher clinical suspicion in patients with clinical features suggestive of myositis, including symmetrical weakness and muscle wasting along with bulbar dysfunction and constitutional symptoms and in those with the appropriate geographical exposure.”

Read more in BMJ Neurology Open

Hospitals must act on staff psychological wellbeing

Hospitals and other employers must take “proactive and meaningful steps” to care for the mental health and wellbeing of workers, a leading medical indemnity provider says.

The warning from Avant Mutual follows a decision last month by the High Court, which found in favour of a public prosecutor who sued her former employer for failing to protect her from workplace trauma.

She was ultimately awarded significant damages.

“The decision is a sad reminder to employers that they cannot adopt a ‘wait and see’ approach where the work of their employees inherently involves psychosocial hazards,” said Avant senior solicitor Frances Thomas.

She suggested employers conduct health and safety risk assessments to identify challenging situations, including violent, angry or distressed patients and extremely high workloads.

It was also likely that many staff had seen their mental health impacted through COVID-19, adding to the need for workplace health and safety systems to be agile and proactive, Ms Thomas added.

“We recommend that all practices have systems in place to manage psychosocial hazards,” she said.

AMA vice president Dr Chris Moy said more protections were needed, calling on all states and territories to enact legislation making hospital boards directly and explicitly responsible for the psychosocial wellbeing of their staff.

Laws that did so were currently only in place in South Australia, he said.

Air pollution increases risk of epileptic seizures

An Australian study has shown that ambient air pollution may increase the riskof epileptic seizures.

Data from 3273 seizures recorded using intracranial electroencephalography in 15 patients with refractory focal epilepsy in Australia in 2010–2012 revealed  a significant association between carbon monoxide concentrations and an increased seizure risk.

The risk of seizures was increased by 4% when CO concentrations were 0.13 parts per million higher. However no overall significant associations were found for four other air pollutants: nitrogen dioxide (NO2), ozone (O3), particulate matter ≤10 μm in diameter (PM10), and sulfur dioxide (SO2).

Researchers from St Vincent’s Hospital and the University of Melbourne, Melbourne said the findings followed other research showing that exposure to carbon monoxide levels could cause neurotoxic symptoms such as headaches, dizziness, and disorientation by reducing the amount of oxygen reaching the brain and tissues.

Air pollution may also increase the risk of seizures through adverse effects on brain metabolism, inflammation and oxidative stress, they added.

The findings are published in Epilepsia.

https://onlinelibrary.wiley.com/doi/10.1111/epi.17253

In addition, a significant association was observed between CO and the risk of subclinical seizures (RR: 1.20, 95% CI: 1.12–1.28).

Significance