Enriched environment attenuates behavioral seizures and depression in chronic temporal lobe epilepsy

Summary

Objective

Temporal lobe epilepsy (TLE) is commonly associated with depression, anxiety, and cognitive impairment. Despite significant progress in our understanding of the pathophysiology of TLE, it remains the most common form of refractory epilepsy. Enriched environment (EE) has a beneficial effect in many neuropsychiatric disorders. However, the effect of EE on cognitive changes in chronic TLE has not been evaluated. Accordingly, the present study evaluated the effects of EE on chronic epilepsy–induced alterations in cognitive functions, electrophysiology, and cellular changes in the hippocampus.

Methods

Status epilepticus (SE) was induced in 2-month-old male Wistar rats with lithium and pilocarpine. Six weeks' post SE, epileptic rats were either housed in their respective home cages or in an enrichment cage (6 h/day) for 14 days. Seizure behavior was video-monitored 2 weeks before and during exposure to EE. Depression-like behavior, anxiety-like behavior, and spatial learning and memory were assessed using the sucrose preference test (SPT), elevated plus maze (EPM), and Morris water maze (MWM), respectively. Delta and theta power in the CA1 region of hippocampus was assessed from recordings of local field potentials (LFPs). Cellular changes in hippocampus were assessed by histochemistry followed by unbiased stereologic analysis.

Results

EE significantly reduced seizure episodes and seizure duration in epileptic rats. In addition, EE alleviated depression and hyperactivity, and restored delta and theta power of LFP in the hippocampal CA1 region. However, EE neither ameliorated epilepsy-induced spatial learning and memory deficits nor restored cell density in hippocampus.

Significance

This is the first study that evaluates the role of EE in a chronic TLE model, where rats were exposed to EE after occurrence of spontaneous recurrent seizures (SRS). Given that 30% of TLE patients are refractory to drug treatment, therapeutic strategies that utilize components of EE could be designed to alleviate seizures and psychiatric comorbidities associated with TLE.

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Weather as a risk factor for epileptic seizures: A case-crossover study

Summary

Objective

Most epileptic seizures occur unexpectedly and independently of known risk factors. We aimed to evaluate the clinical significance of patients' perception that weather is a risk factor for epileptic seizures.

Methods

Using a hospital-based, bidirectional case-crossover study, 604 adult patients admitted to a large university hospital in Central Germany for an unprovoked epileptic seizure between 2003 and 2010 were recruited. The effect of atmospheric pressure, relative air humidity, and ambient temperature on the onset of epileptic seizures under temperate climate conditions was estimated.

Results

We found a close-to-linear negative correlation between atmospheric pressure and seizure risk. For every 10.7 hPa lower atmospheric pressure, seizure risk increased in the entire study population by 14% (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.01–1.28). In patients with less severe epilepsy treated with one antiepileptic medication, seizure risk increased by 36% (1.36, 1.09–1.67). A high relative air humidity of >80% increased seizure risk in the entire study population by up to 48% (OR 1.48, 95% CI 1.11–1.96) 3 days after exposure in a J-shaped association. High ambient temperatures of >20°C decreased seizure risk by 46% in the overall study population (OR 0.54, 95% CI 0.32–0.90) and in subgroups, with the greatest effects observed in male patients (OR 0.33, 95% CI 0.14–0.74).

Significance

Low atmospheric pressure and high relative air humidity are associated with an increased risk for epileptic seizures, whereas high ambient temperatures seem to decrease seizure risk. Weather-dependent seizure risk may be accentuated in patients with less severe epilepsy. Our results require further replication across different climate regions and cohorts before reliable clinical recommendations can be made.

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Postmarketing experience with brivaracetam in the treatment of epilepsies: A multicenter cohort study from Germany

Summary

Objective

To evaluate factors predicting efficacy, retention, and tolerability of add-on brivaracetam (BRV) in clinical practice.

Methods

A multicenter, retrospective cohort study recruiting all patients who started BRV between February and November 2016 with observation time between 3 and 12 months.

Results

Of a total of 262 patients (mean age 40, range 5–81 years, 129 male) treated with BRV, 227 (87%) were diagnosed to have focal, 19 (7%) idiopathic generalized and 8 (3%) symptomatic generalized epilepsy, whereas 8 (3%) were unclassified. The length of exposure to BRV ranged from 1 day to 12 months, with a median retention time of 6.1 months, resulting in a total exposure time to BRV of 1,504 months. The retention rate was 79.4% at 3 months and 75.8% at 6 months. Efficacy at 3 months was 41.2% (50% responder rate) with 14.9% seizure-free for 3 months and, at 6 months, 40.5% with 15.3% seizure-free. Treatment-emergent adverse events were observed in 37.8% of the patients, with the most common being somnolence, dizziness, and behavioral adverse events (BAEs). BAE that presented under previous levetiracetam (LEV) treatment improved upon switch to BRV in 57.1% (20/35) and LEV-induced somnolence improved in 70.8% (17/24). Patients with BAE on LEV were more likely to develop BAE on BRV (odds ratio [OR] 3.48, 95% confidence interval [CI] 1.53–7.95).

Significance

BRV in broad clinical postmarketing use is a well-tolerated anticonvulsant drug with 50% responder rates, similar to those observed in the regulatory trials, even though 90% of the patients included had previously been exposed to LEV. An immediate switch from LEV to BRV at a ratio of 10:1 to 15:1 is feasible. The only independent significant predictor of efficacy was the start of BRV in patients not currently taking LEV. The occurrence of BAE during previous LEV exposure predicted poor psychobehavioral tolerability of BRV treatment. A switch to BRV can be considered in patients with LEV-induced BAE.

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Ultrasound biomicroscopy value in evaluation of restoration of ciliary muscles contractility after cataract extraction

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Transferable Organic Semiconductor Nanosheets for Application in Electronic Devices

A method has been developed to stabilize and transfer nanofilms of functional organic semiconductors. The method is based on crosslinking of their topmost layers by low energy electron irradiation. The films can then be detached from their original substrates and subsequently deposited onto new solid or holey substrates retaining their structural integrity. Grazing incidence X-ray diffraction, X-ray specular reflectivity, and UV–Vis spectroscopy measurements reveal that the electron irradiation of ≈50 nm thick pentacene films results in crosslinking of their only topmost ≈5 nm (3–4 monolayers), whereas the deeper pentacene layers preserve their pristine crystallinity. The electronic performance of the transferred pentacene nanosheets in bottom contact field-effect devices is studied and it is found that they are fully functional and demonstrate superior charge injection properties in comparison to the pentacene films directly grown on the contact structures by vapor deposition. The new approach paves the way to integration of the organic semiconductor nanofilms on substrates unfavorable for their direct growth as well as to their implementation in hybrid devices with unusual geometries, e.g., in devices incorporating free-standing sheets.

The surface of highly ordered organic semiconductor thin films is cross-linked by low energy electron beam irradiation. Irradiated films can be detached and transferred to other substrates including free standing geometries. The electronic properties of the organic thin films are preserved. Here, improved injection properties for transferred films in bottom contact field-effect transistors are demonstrated.

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Scrotal extraperitoneal ureteroinguinal hernia with a horseshoe kidney

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Management of recurrent bleeding after pancreatoduodenectomy

Background

Re-bleeding after management of a first haemorrhage following pancreatic surgery is an ever-present danger and often presents diagnostic and management dilemmas.

Methods

All cases of post-pancreatectomy haemorrhage (PPH) following pancreatoduodenectomy were identified from a tertiary referral, clinical database (April 2004–April 2013). Only those suffering a second re-bleeding episode were included in the final case notes review.

Results

A total of 301 patients underwent pancreatoduodenectomy during the study period (most common indication: pancreatic adenocarcinoma; 49.5%). Twenty-two (7.3%) patients suffered a PPH (five early). Of these cases, three suffered a re-bleeding event (one mortality). Endoscopy, interventional radiology and surgery were employed in each case.

Conclusion

PPH presents major clinical challenges and is associated with significant morbidity and mortality. Early detection of the site and type of bleeding are critical and multimodal therapy is usually required. Interventional radiology techniques are making a major contribution to overall management.

http://ift.tt/2pWR4y9