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IntroductionPatients with Functional Neurological Symptoms (FNS) can present acutely, but many hospitals lack specific pathways or services for them. Outpatient FNS cohorts have been studied, but there is little data regarding acute FNS to inform service improvement.MethodOver an 8 month period at Leeds Teaching Hospitals NHS Trust (UK), the on-call neurology and stroke teams were telephoned regularly. Acute referrals with possible FNS were recorded. Electronic documentation was searched for the following events: symptoms, first presentation, diagnosis, A and E, outpatient clinic, inpatient admission, investigation, and psychological/psychiatric referral. This data was analysed with process mapping software (Fluxicon disco).ResultsWe present a dynamic care pathway map using real data, showing 205 patients with possible FNS moving through hospital services over time. Our map visualises the temporal relationships between healthcare utilisation, first presentation, diagnosis and therapy. The picture shows high healthcare burden, with incomplete and slow movement towards appropriate therapy (e.g. clear diagnosis documented in only 66%; referral to psychological therapy in 26%).ConclusionPatients with FNS are regularly referred to acute neurological services in Leeds. Our dynamic map shows a high healthcare burden, and slow or incomplete movement to appropriate care, which suggests potential targets for service improvement.

BackgroundBrivaracetam received its UK licence as an adjuvant drug for focal epilepsy in adults in 2016. There is little data on its efficacy and tolerability in ‘real life’ settings. We present an interim analysis of a multicentre service evaluation of brivaracetam.MethodsData was retrospectively collected from clinical records at two UK centres of consecutive patients treated with brivaracetam and at least one follow up. Data were also extracted on previous levetiracetam use. Seizure frequency was categorised at baseline and follow-up (daily/weekly/monthly/yearly/none).Results: Of the 44 patients identified (17 male, mean age 39, range 19–66), 75% had a history of levetiracetam exposure (LE+) and 25% did not (LE−). Mean brivaracetam exposure was 10.3 months (2–21), the mean daily dose was 200 mg (50–400). Retention was 91% vs 100% in LE+ versus LE− groups at 3 months and 82% in both groups at 6 months. Seizure category improvements were seen in 20%/36.4% in the LE+ vs LE− groups, seizure category deteriorations in 0% vs 9%. There were no serious adverse events.ConclusionBrivaracetam emerges as a potentially useful adjuvant medication for focal epilepsy. It may be better tolerated by some patients than Levetiracetam and more effective than this drug.