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Concerns have emerged about the impact of paracetamol use in pregnancy on child neurodevelopment, particularly in relation to autism spectrum disorder. This study published in The Lancet Obstetrics, Gynaecology, & Women’s Health journal aimed to synthesise available evidence to investigate associations between prenatal paracetamol exposure and autism spectrum disorder, attention-deficit hyperactivity disorder (ADHD), and intellectual disability. The current evidence does not indicate a clinically important increase in the likelihood of autism spectrum disorder, ADHD, or intellectual disability in children of pregnant individuals who use paracetamol as directed, supporting existing recommendations on its safety.

The World Health Organization (WHO) has published the third edition of the Mental Health Gap Action Programme (mhGAP) guideline which includes important new, and updated, recommendations for the treatment and care of mental, neurological and substance use (MNS) disorders. MNS disorders are major contributors to morbidity and premature mortality in all regions of the world. Yet it is estimated that over 75% of people with MNS disorders are unable to access the treatment or care they need. The mhGAP guideline supports countries to strengthen capacity to deal with the growing burden of these conditions. It is intended for use by doctors, nurses, other health workers working in non-specialist settings at primary health care level, as well as health planners and managers. The guideline contains a new module on anxiety reflecting the increased number of people with anxiety disorders, which are among the world’s most common mental disorders. The module includes the following recommendations: Psychological interventions based on cognitive behavioural therapy (CBT) should be offered to adults with generalized anxiety disorder and/or panic disorder. These interventions can be offered in a variety of formats including online, in-person, in groups, or self-guided. Stress management techniques should be considered for adults with generalised anxiety and/or panic disorder. Selective Serotonin Reuptake Inhibitors (SSRIs) should be considered for treating adults with generalized anxiety and/or panic disorder. Psychological and psychosocial interventions The guideline sets out the continuing importance of psychological treatments for a range of MNS conditions. The mhGAP guideline contains new recommendations on psychosocial interventions for carers of persons with psychosis or bipolar disorder as well as new recommendations on psychosocial interventions for psychosis, alcohol dependence, substance use, dementia, and children and adolescents with neurodevelopmental disorders including autism, ADHD and cerebral palsy. Women and girls who want to become pregnant or may become pregnant should not use valproic acid (sodium valproate) The guideline contains an updated recommendation which advises against the use of valproic acid (sodium valproate), a medicine for the treatment of epilepsy and bipolar disorder, due to risk of birth defects if taken during pregnancy. The guideline recommends the following: Valproic acid (sodium valproate) should not be prescribed to women and girls who want to become pregnant or may become pregnant because of the high risk of birth defects and developmental disorders in children exposed to valproic acid in the womb. For women and girls currently prescribed valproic acid (sodium valproate), advice should be provided on use of effective contraception. It is important that women and girls do not stop taking valproic acid (sodium valproate) without first discussing it with their doctor. Women should be advised to consult their physician as soon as they are planning pregnancy and the need to urgently consult their physician in case of pregnancy. Every effort should be made to switch to appropriate alternative treatment prior to conception. A specialist should periodically review whether valproic acid (sodium valproate) is the most suitable treatment for the person. Other recommendations: Digitally-delivered psychological and psychosocial interventions feature across multiple modules - alcohol use disorders, anxiety, conditions related to stress, drug use disorders, and self-harm and suicide Recommendations for non-pharmacological interventions to improve outcomes for people with dementia have been updated to include physical exercise, CBT, cognitive stimulation therapy and cognitive training. The antipsychotic medicines quetiapine, aripiprazole, olanzapine, paliperidone, and the long-acting antipsychotics haloperidol and zuclopenthixol are included for treatment of psychosis and bipolar disorder. Levetiracetam and lamotrigine are included for treatment of epilepsy.

This WHO report includes six case studies from 12 individuals with lived experience of diverse health conditions. These case studies explore the topics of power dynamics and power reorientation towards individuals with lived experience; informed decision-making and health literacy; community engagement across broader health networks and health systems; lived experience as evidence and expertise; exclusion and the importance of involving groups that are marginalized; and advocacy and human rights. It is the first publication in the WHO Intention to action series, which aims to enhance the limited evidence base on the impact of meaningful engagement and address the lack of standardized approaches on how to operationalise meaningful engagement. The Intention to action series aims to do this by providing a platform from which individuals with lived experience, and organisational and institutional champions, can share solutions, challenges and promising practices related to this cross-cutting agenda.

The emotional effects of Multiple Sclerosis often go undiagnosed. It's not unusual to experience depression, stress and anxiety when you have MS. Medication, talking therapies and self-help techniques can all make it easier to cope. This webpage from the MS Society includes information on: depression stress and anxiety causes of mental health problems other mood and behaviour changes coping with losss grief and guilt supporting someone who has MS getting help staying active mindfulness and MS.

The authors of this paper describe here the content and structure of their patient registry along the Standards for Quality Improvement Reporting Excellence (SQUIRE) with the aim of transparent in-house quality monitoring, communication with patients, and also to facilitate benchmarking with other neurosurgery health care providers.

In the UK over 1000 people with epilepsy die every year and it's estimated that more than half of these deaths could be avoided. This is a free evidence-based tool, supporting clinicians in discussing risk with people with epilepsy. It includes risk factors linked to epilepsy mortality, including (but not restricted to) Sudden Unexpected Death in Epilepsy (SUDEP). To watch the introductory video and register for access to checklist, follow the link below to the SUDEP Action website.

Infants and very young children with cerebral palsy need effective, early intervention to improve life outcomes and minimise secondary complications. This report, from the All-Party Parliamentary Group on Cerebral Palsy, outlines several recommendations to improve early identification, intervention and pathways of care of infants and young children with cerebral palsy. The report also looks at: Identification, and the Role of Health Visitors Referral pathways Pathways of care Support for families Better data collection and a National Cerebral Palsy Register Examples of best practice.

Dr Ian Carroll discusses neuropathic pain, which involves damage to the nerve. The condition causes the nerves to fire incessantly, even if the initial source of the pain has been remedied. The brain responds by creating an ongoing message of pain.

Getting It Right First Time (GIRFT) is designed to improve the quality of care within the NHS by reducing unwarranted variations. By tackling variations in the way services are delivered across the NHS, and by sharing best practice between trusts, GIRFT identifies changes that will help improve care and patient outcomes, as well as delivering efficiencies such as the reduction of unnecessary procedures and cost savings. Neurology deals with disorders of the nervous system, which includes the brain, the nerves and muscles. Around 1 in 6 people in the UK have a neurological condition such as encephalitis, Parkinson's disease or migraine. The GIRFT neurology report is based on visits to 139 neurology units across England. Key recommendations include: Ensure all patients with acute neurological disorders can promptly access neurology services Develop care pathways for chronic neurological disorders Improve the outpatient referral process You will need a FutureNHS account to view this report, or you can view a short video summary which includes the key recommendations.

Preventable harm during labour can be catastrophic for parents, babies and families, as well as for the staff involved. Reducing avoidable brain injury in childbirth means building on everyone’s experiences and expertise, working together to improve care in labour for all. THIS Institute, in partnership with The Royal College of Midwives and The Royal College of Obstetricians & Gynaecologists, is inviting maternity staff, parents and birth partners from across the UK to contribute their views to their Avoiding Brain Injury in Childbirth (ABC) campaign. The focus is on monitoring and responding to babies’ wellbeing during labour and on managing the emergency complication at caesarean section known as impacted fetal head. The ABC campaign aims to give maternity staff tools and support to be able to provide the highest quality of care when there are concerns about the baby’s wellbeing during labour. It also aims to improve communication with everyone using maternity services and make sure they are listened to and involved in decisions about their care.

In response to the rapid spread of COVID-19, this paper from Tamar Wildwing and Nicole Holt provides health professionals with better accessibility to available evidence, summarising findings from a systematic overview of systematic reviews of the neurological symptoms seen in patients with COVID-19. Implications of so-called Long Covid on neurological services and primary care and similarities with other neurological disorders are discussed. Note: This article is a preprint and has not yet been peer-reviewed.

Group B streptococcus (GBS) is a naturally occurring bacterium, often found in the mother’s vagina, which can be dangerous for babies during labour and immediately after birth. The mothers carry this bacterium in the birth canal without any problem to themselves. Giving antibiotics to the mother during labour reduces the incidence of GBS infection passing on to the baby (National Institute for Health and Care Excellence, 2012). The Healthcare Safety Investigation Branch (HSIB) published ‘Summary of themes arising from the Healthcare Safety Investigation Branch maternity programme (April 2018-December 2019)’ in February 2020. This described eight themes for further exploration in order to highlight opportunities for system-wide learning; one of these themes was group B streptococcus (GBS). This report, Severe brain injury, early neonatal death and intrapartum stillbirth associated with group B streptococcus infection, highlights a number of patient safety concerns and recommends that maternity care providers should consider the findings and make necessary changes to their local systems to ensure that mothers and babies receive care in line with national guidance. The Healthcare Safety Investigation Branch will keep the theme of group B streptococcus under review and consider a future national investigation to explore this subject further.

The results of this study, published in the Journal of Translational Medicine, confirm previous work that demonstrated an abnormal response to exercise in fatigued ME/CFS patients.

From acute delirium to long term fatigue, COVID-19 has serious neuropsychiatric effects. Viral infections of the respiratory tract can have multisystemic effects, including on the central nervous system (CNS), and thus may precipitate a spectrum of psychiatric and neurological disorders. Some patients with COVID-19 are now known to develop various CNS abnormalities with potentially serious and long term consequences, including stroke and isolated psychiatric syndromes. As COVID-19 cases rise again worldwide, Butler et al. review what we know and don’t know about the acute and chronic neuropsychiatric sequelae and their potential mechanisms.

People aged under 60 who are hospitalised with COVID-19 are more likely than expected to experience severe psychiatric symptoms. Research found that altered mental states such as psychosis are being reported in these younger patients. It confirmed that strokes and other neurological symptoms are common in severe COVID-19. The authors are gathering and analysing more detailed clinical information about the patients reported in this study, and others reported since (540 are now included). They are seeking funding for a further study to include more clinical investigations such as analysis of spinal fluid, blood and brain imaging. Author Benedict Michael is co-chairing a World Health Organization commissioned task force which will consider how to use the information from the ongoing research project in guidance for clinicians. The task force will consider whether people with new-onset altered mental state or another acute neurological problem should be tested for COVID-19. Some patients with few respiratory signs present with this symptom. They will consider which tests and investigations people with COVID-19 and neurological symptoms should undergo. Doctors need to be sure COVID-19 is the cause of the symptoms, and to know how patients should be managed.