Effect of anticysticercal treatment on the prognosis of epilepsy in neurocysticercosis: a pilot trial

Epilepsy secondary to active or inactive neurocysticercosis (NCC) is a major public health problem in Latin American countries. In an open-label pilot trial, we evaluated and followed (mean = 13 months) 16 patients with epilepsy resulting from active NCC which was treated with anticisticercal (ACC) drugs. These patients were aged 12-68 years with confirmed active NCC and seizures not controlled by adequate antiepileptic drug (AED) therapy. Patients were treated with albendazole or praziquantel (ALB and PZQ, ACC drugs) and AED monotherapy. The number of NCC cysts was markedly reduced by ACC therapy. Thirteen patients remained seizure-free and 2 had only one seizure during follow-up. Our data suggest a positive effect of ACC treatment on the prognosis of epilepsy caused by active NCC, but a prospective, double-blind, controlled study with long-term follow-up must be performed to determine whether ACC therapy improves long-term seizure control.     

Haplotype sharing analysis in affected individuals from nuclear families with at least one affected offspring

In diseases with a complex mode of inheritance, families with multiple affected individuals are difficult to ascertain. The haplotype sharing statistic (HSS) uses (hidden) co-ancestry between affected individuals from a founder population. These affected individuals will likely not only share the same mutation(s), but also the surrounding haplotype. We show that this method gives a low false positive rate, but does not detect genes in the nuclear families of Problem 2A of the GAW data. We also give evidence based on simulations and empirical studies in real population based data that the HSS method has statistical power.     

Prevalence of epilepsy in children of Multnomah County, Oregon

The prevalence of epilepsy among children in the third grade in Multnomah County, Oregon, was investigated by use of a questionnaire similar to that used by Rose et al. (1973). Of the 7,039 potential respondents, 5,317 (75.5%) responded to the questionnaire. A stratified random sample of 161 children was drawn from the respondents, and of these 129 (80%) underwent physical and EEG examinations. This replication of the study by Rose et al. (1973) yielded prevalence estimates which were somewhat lower than those reported by Rose et al. for Washington County, Maryland. Our findings suggest that the questionnaire method of estimating the prevalence of epilepsy has promise; further investigation of the method is in progress.     

The Cornelia de Lange syndrome: a study of 9 affected individuals

Nine children with the Cornelia de Lange syndrome have been examined and investigated. Prominent among the clinically important features are retarded physical and mental development, limb malformation and limited life expectancy. Early diagnosis is important for prognostication and management, and is based on the recognition of the combination of the stigmata and typical facial characteristics.     

Prevalence, classification, and severity of epilepsy and epileptic syndromes in children

PURPOSE: To determine the point prevalence of active childhood epilepsy in a defined area and evaluate the usefulness of ILAE classification of seizures, and epilepsies/syndromes with special interest in severe epilepsies. METHODS: By using the latest ILAE International Classification of Epileptic Seizures (ICES, 1981) and Epilepsies and Epileptic Syndromes (ICE, 1989), we determined the age- and sex-specific prevalence rates of epilepsy, type of seizures, epilepsies, and recognizable epileptic syndromes, as well as the proportion of severe cases in each seizure/epilepsy/syndrome category in all children 0-15 years of age from a geographically defined area in Finland. All medical records, neurophysiological recordings and available clinical data were reviewed retrospectively. RESULTS: Point prevalence of active epilepsy on December 12, 1992 was 3.94 per 1,000. According to ICES/ICE, we were able to classify 96% of seizures and 90% of epilepsies and syndromes. Generalized seizure and epilepsy/syndrome types were more prevalent in children 0-6 years of age and partial/localization-related in children 6-15 years of age. Epilepsy was intractable in 17% of all cases and correlated significantly with symptomatic etiology and early onset of epilepsy, as well as with additional neuroimpairments. CONCLUSIONS: A considerable number of cases fell into the nonspecific categories of ICE, which limits the value of present epilepsy/syndrome classification in terms of prognosis, prediction, and indication for special investigations in individual cases. A number of intractable cases was relatively low, indicating good prognosis in many childhood epilepsies, especially when additional neuroimpairments are absent.     

Mindfulness-based cognitive therapy for individuals whose lives have been affected by cancer: A randomized controlled trial.

Objective: This study evaluated the effectiveness of mindfulness-based cognitive therapy (MBCT) for individuals with a diagnosis of cancer. Method: Participants (N = 115) diagnosed with cancer, across site and stage, were randomly allocated to either the treatment or the wait-list condition. Treatment was conducted at 1 site, by a single therapist, and involved participation in 8 weekly 2-hr sessions that focused on mindfulness. Participants meditated for up to 1 hr daily and attended an additional full-day session during the course. Participants were assessed before treatment and 10 weeks later; this second assessment occurred immediately after completion of the program for the treatment condition. The treatment condition was also assessed at 3 months postintervention. All postinitial assessments were completed by assessors who were blind to treatment allocation. Results: There were large and significant improvements in mindfulness (effect size [ES] = 0.55), depression (ES = 0.83), anxiety (ES = 0.59), and distress (ES = 0.53) as well as a trend for quality of life (ES = 0.30) for MBCT participants compared to those who had not received the training. The wait-list group was assessed before and after receiving the intervention and demonstrated similar change. Conclusions: These improvements represent clinically meaningful change and provide evidence for the provision of MBCT within oncology settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Epilepsy, cysticercosis and neurocysticercosis in Benin

Retroperitoneal extravasation is an extremely uncommon complication of duodenal ulcer perforation. The preoperative diagnosis is difficult and may even by missed at operation. There were 25 cases reported in the literature. Only one patient was correctly diagnosed preoperatively and only seven patients survived. We describe the first case of retroperitoneal extravasation from perforated duodenal ulcer presenting as scrotal sepsis.     

Active epilepsy in mentally retarded children. I. Prevalence and additional neuro-impairments

A population-based study of active epilepsy was conducted in 6-13-year-old mentally retarded children born between 1975 and 1986. The population at risk comprised 48,873 children. Ninety-eight children were identified, 35 mildly and 63 severely retarded. The prevalence was 2.0 per 1000; 0.7 per 1000 for mildly and 1.3 per 1000 for severely retarded children. Sixty-nine children had at least one additional neuroimpairment. Cerebral palsy was found in 42 children with a majority of spastic/dystonic tetraplegias; visual impairment was present in 24 and autism in 24. Thirty-three children had only a mild or no gross motor disability and mild mental retardation, while 23 had IQs < 20 and a very severe gross motor disability. This study underlines the fact that active epilepsy in mentally retarded children is often associated with additional neuroimpairments, especially a combination of severe cerebral palsy and severe visual impairment.     

Pharmacokinetic optimisation of the treatment of neurocysticercosis

Neurocysticercosis is the most important parasitic infection of the nervous system. It is common in communities living in conditions with poor hygiene. Until the last 2 decades, there was no specific pharmacological treatment: surgery and corticosteroids were the only medical alternatives. The recent introduction of anticysticercal drugs, an isoquinoline (praziquantel) and a benzimidazole (albendazole), has dramatically changed the medical management of neurocysticercosis. Praziquantel is taken orally and undergoes extensive first pass hepatic biotransformation. Peak concentration in serum is reached after 1 to 2 hours and the elimination half-life is between 1 and 3 hours. Praziquantel permeates the blood-brain barrier, thus explaining its effectiveness on parenchymal brain cysticercosis. Plasma concentrations of the drug are increased when a high carbohydrate diet is administered. Cimetidine also increases the plasma concentration of praziquantel by inhibition of cytochrome P450. Bioavailability of the drug is markedly reduced when given jointly with antiepileptics or corticosteroids, specially carbamazepine, phenytoin or dexamethasone. The current schedule for neurocysticercosis treatment lasts 2 weeks at daily doses of 50 mg/kg. Recently, a new therapeutic scheme has been proposed that considers the pharmacokinetics of the drug. This regime lasts only 1 day and includes 3 dosages of 25 mg/kg at 2-hour intervals. This increases the time that the parasite is exposed to high drug concentrations. This therapeutic scheme has produced similar results to longer schemes, with the additional advantages of cost, length of usual treatments and reduction in total dose received (being one-tenth of the total dosage). Albendazole is considered by many as the drug of choice for treatment of neurocysticercosis. It is given orally and is rapidly and extensively metabolised to albendazole sulfoxide (ALBSO), which is considered to be the metabolite directly or indirectly responsible for both toxicity and efficacy outside the gastrointestinal tract. Concentrations of ALBSO are highly variable between individuals and it has a half-life of between 6 and 15 hours. It also crosses the blood-brain barrier. In patients with extrahepatic obstruction, the elimination process is prolonged and plasma concentration is increased. Fatty meals improve absorption. Concomitant administration of albendazole with dexamethasone or with praziquantel increases plasma concentration of ALBSO. Albendazole is administered in an 8 day course of 15 mg/kg per day in 2 divided doses 12 hours apart. This scheme, based on drug pharmacokinetics, has proven to be highly effective. Inflammation is a common accompaniment of neurocysticercosis; in many cases it is the aetiopathogen responsible for histological damage. Corticosteroid therapy is useful for preventing further tissue injury. Long term corticosteroid therapy can be accomplished with 50 mg of oral prednisone 3 times a week. Acute corticosteroid therapy includes brief courses with high dosages of intramuscular dexamethasone or intravenous methylprednisolone. Clinical decisions on cysticidal and anti-inflammatory treatments must be made with the information gathered by neuroimaging studies, either computed tomography or magnetic resonance, and by the analysis of cerebrospinal fluid.     

Elevated concentrations of eotaxin and interleukin-5 in human neurocysticercosis

Symptomatic neurocysticercosis, a major cause of epilepsy worldwide, results from inflammation around Taenia solium larvae, but the mechanisms are unknown. Eotaxin, not previously reported in cases of human infection, and interleukin-5 (IL-5) but not IL-8 concentrations were elevated in patient serum, and IL-5 levels were also elevated in cerebrospinal fluid (CSF). Eosinophil-selective mediators may be involved in the pathogenesis of cysticercosis. IL-6 concentrations were also elevated in patient CSF, possibly indicative of an acute-phase response.     

Xq28-linked noncompaction of the left ventricular myocardium: prenatal diagnosis and pathologic analysis of affected individuals

Cerebellar granule cells (CGC) at different stages of maturation in vitro (1 or 6 DIV), were treated with beta 25-35 and acetyl-L-carnitine arginine amide (ST857) in presence of 25 mM KCl in the culture medium, and neuronal viability was assessed. Three days of treatment slightly modified the survival of 1 DIV-treated cells, which degenerate and die five days later beta-amyloid matching. Similarly, a significative neurotoxic effect was observed on 6 DIV treated-cells after 5 days of exposure to the peptide, while the death occurred within 8 days. ST857 coincubated with beta 25-35 was able to rescue neurons from beta 25-35-induced neurotoxicity. We also studied the changes in Ca2+ homeostasis following glutamate stimulation, in control and beta-amyloid treated single cells, either in presence or in absence of ST857. beta 25-35 did not affect basal [Ca2+]i, while modified glutamate-induced [Ca2+]i increase, causing a sustained plateau phase of [Ca2+]i, that persisted after the removal of the agonist. ST857 pretreatment completely reverted this effect suggesting that, in CGC chronically treated with beta 25-35, ST857 could protect the cells by neurotoxic insults of the peptide likely interfering with the cellular mechanisms involved in the control of Ca2+ homeostasis.     

Caring for children affected by disaster

The child and adolescent psychiatrist must play an essential role in the wake of disaster. The focus of the community and the world understandably turns to the physical devastation wrought, and emergency and medical efforts take center stage. Physical evidence of the past may be lost, but the child psychiatrist is able to maintain focus on what cannot be seen. He or she may be the only one to advocate the child's emotional needs. It may be too difficult for others who lack the specialized expertise of mental health training to attend to both the child's physical and emotional needs, and it may be impossible for those without medical training to impress on medical personnel the importance of emotional issues. The child and adolescent psychiatrist, with his or her understanding of medical, mental health, and developmental concerns, is well positioned to support the child, the child's community, and the helpers whose own responses may complicate recovery.     

Cytokine levels affected by gamma-linolenic acid

The adrenergic receptors (ARs) belong to the superfamily of membrane-bound G protein coupled receptors (GPCRs). Our investigation has focused on the structure-function relationship of the alpha 1b-AR subtype used as the model system for other GPCRs. Site-directed mutagenesis studies have elucidated the structural domains of the alpha 1b-AR involved in ligand binding, G protein coupling or desensitization. In addition, a combined approach using site-directed mutagenesis and molecular dynamics analysis of the alpha 1b-AR has provided information about the potential mechanisms underlying the activation process of the receptor, i.e. its transition from the 'inactive' to the 'active' conformation.     

Energy metabolism in young pigs as affected by mixing

The effect of mixing on energy metabolism was studied in 8-wk-old pigs. In each of two trials, two clusters of 20 pigs (two litters of 10 pigs) were randomly assigned to one of two treatments: control or mixing. Each cluster was housed in two pens. In each trial, after a preliminary period od 2 wk, the two litters within the mixing treatment were mixed at the start of a 2-wk experimental period. During mixing, the five heaviest pigs of each litter were put together in one pen, and the five lightest pigs of each litter were put together in the other pen. In the control treatment, the social structure of both litters in one climatic chamber was not altered. After mixing, a short-term effect on total heat production and activity-related heat production was present. Both were increased (P < .01) only during the 1st h after mixing. Only 57.3% of this increased total heat production was caused by an increased activity. However, no long-term effects of mixing on energy partitioning were present during the total experimental period. The absence of a long-term mixing effect might be caused by the optimal conditions at the moment of mixing. In the preliminary period the transposition of GE into ME increased 1.3% (P < .05), and ME for maintenance decreased 80 kJ.kg(-.75).d(-1) (P < .01) between wk 1 and 2. These large alterations in energy metabolism are probably a carry-over effect of the transportation of the pigs and (or) the changes in housing environment.     

Prevalence of HTLV-I and HTLV-II infections among HIV-1-infected asymptomatic individuals in S?o Paulo, Brazil

OBJECTIVE: To investigate the pharmaceutical effect of Spatholobus Suberectus Composita (SEC) on bone marrow hematopoiesis and microenvironment of aplastic anemia. METHODS: One hundred and six cases of aplastic anemia patients were treated by SEC and the pathological change of bone marrow were observed before and after treatment for 24 months, and compared with 17 cases of normal volunteers as control. RESULTS: The total effective rate was 77.4%. The degree of marrow hyperplasia (15.7 +/- 10.2 vol% vs 39.2 +/- 13.9 vol%), the percentage of the granulocytes (31.4 +/- 12.4% vs 39.9 +/- 10.4%), the erythroblastes (19.8 +/- 15.9% vs 36.7 +/- 13.5%), megakaryocytes (1.4 +/- 2.3 cell/section vs 24.0 +/- 24.6 cells/section), and the microvessel number (40.0 +/- 23.4 ves/100 mm2 vs 201.0 +/- 141.0 ves/100 mm2) ascended significantly (P < 0.01 or P < 0.05). CONCLUSION: SEC could not only irritate the hematopoiesis, but also exert reconstructive action to marrow microenvironment.     

Treatment of neurocysticercosis with a two week course of albendazole

Ten cases of cerebral cysticercosis, treated with 2-week course of albendazole, were reported. The results were excellent. 9 patients were responded to this regimen in both the clinical outcomes and CT scan findings. These results indicated that a 2-week course of albendazole is effective for treatment of neurocysticercosis.     

Emergency services use by elderly individuals

The enzyme methanol dehydrogenase (EC 1.1.99.8) from Hyphomicrobium X was used in an attempt to develop a rapid colorimetric test for methanol. The enzyme was stabilized for storage by lyophilization in the presence of the disaccharide trehalose. It was found that the enzyme retained significantly greater activity in the dried state with trehalose than without. The enzyme was partially purified by ammonium sulphate fractionation, after which it was found to be more stable in solution at pH 9 than at pH 7. A procedure is given which involves mixing a defined amount of enzyme with the methanol-containing water together with phenazine methosulphate (PMS), 2-6-dichlorophenol-indophenol (DCPIP) and cyanide, and observing the resultant colour change from blue to yellow if methanol is present. The sensitivity of the procedure is such that 9 mg L-1 of methanol can be readily detected.