Epilepsy

Epilepsy is the most common neurological disorder globally, affecting approximately 50 million people of all ages. It is one of the oldest diseases described in literature from remote ancient civilizations 2000-3000 years ago. Despite its long history and wide spread, epilepsy is still surrounded by myth and prejudice, which can only be overcome with great difficulty. The term epilepsy is derived from the Greek verb epilambanein, which by itself means to be seized and to be overwhelmed by surprise or attack. Therefore, epilepsy is a condition of getting over, seized, or attacked. The twelve very interesting chapters of this book cover various aspects of epileptology from the history and milestones of epilepsy as a disease entity, to the most recent advances in understanding and diagnosing epilepsy

Epilepsy

With the vision of including authors from different parts of the world, different educational backgrounds, and offering open-access to their published work, InTech proudly presents the latest edited book in epilepsy research, Epilepsy: Histological, electroencephalographic, and psychological aspects. Here are twelve interesting and inspiring chapters dealing with basic molecular and cellular mechanisms underlying epileptic seizures, electroencephalographic findings, and neuropsychological, psychological, and psychiatric aspects of epileptic seizures, but non-epileptic as well

Standard of care for people with epilepsy in sub-Saharan Africa: the case of Nigeria.

Epilepsy in low- and middle-income countries (LMICs) present unique challenges, as the burden is high and the majority of sufferers are not receiving even basic epilepsy care. This work aimed to determine the prevalence, incidence, treatment gap, determinants of access to care and potential risk factors for epilepsy in three Nigerian rural districts of Afikpo, Ijebu-Jesa and Gwandu. A population-based door-to-door screening was undertaken to identify people with epilepsy. This was preceded by a validation study of a screening questionnaire translated into three Nigerian languages. Of the 42,427 persons (six years and above) screened, 254 persons were confirmed to have active epilepsy. The overall age-standardised prevalence was 9.8/1,000 (95% CI: 8.6, 11.1). The prevalence varied between sites; 17.7 (95% CI: 14.2, 20.6) in Gwandu, 4.8 (95% CI: 3.4, 6.6) in Afikpo and 3.3 (95% CI: 2.0, 5.1) in Ijebu Jesa. The overall estimated 1-year age-standardized retrospective incidence was 101.3/100,000 (95% CI: 57.9, 167.6), higher in Gwandu compared to Afikpo and Ijebu-Jesa. The overall peak age-specific prevalence was 10–14 years, while the median age of seizure onset was 6 (IQR: 4–10) years. Epilepsy was of focal onset in 45.2% of the subjects. The treatment gap was 94.4% (95% CI: 90.9, 96.9). Cultural beliefs and stigma are the most important factors associated with the failure to seek medical care. Febrile seizures, poor perinatal care, family history, measles and meningitis are the main contributory factors associated with epilepsy in children and adults, while head injury and consanguinity were peculiar to adults. Physicians interviewed reported significant deficits in manpower, training, available facilities and antiseizure medications. In conclusion, this study hopes to contribute to the understanding and eradication of epilepsy in Nigeria. The varied estimates and potential risk factors observed require larger prospective cohort studies. Strengthening the primary health care and community education would improve the current treatment gap

Robots, Cyborgs, and Humans. A Model of Consumer Behavior in Services: A Study in the Healthcare Services Sector

La present tesi es basa en una investigació que proposa un ús futurista de l'robot i el cyborg com cirurgians oculars. El model desenvolupat investiga la intenció de l'consumidor per elegir cada cirurgià (és a dir: cirurgià robot, cirurgià cyborg o cirurgià humà). Les dades es van analitzar utilitzant la tècnica PLS-SEM. Els resultats de la investigació mostren que l'expectativa d'esforç, l'expectativa de rendiment, el risc percebut i la influència social van mostrar un impacte significatiu en la intenció d'utilitzar els serveis de l'robot cirurgià. Els resultats de el model per al cyborg cirurgià van confirmar l'impacte significatiu de l'expectativa d'esforç, l'excitació, l'expectativa de rendiment i la influència social en la intenció d'utilitzar els seus serveis. L'expectativa d'esforç i la influència social van confirmar un impacte significatiu en la intenció d'utilitzar els serveis de l'cirurgià humà. Els resultats mostren que en els tres models les variables influència social i expectativa d'esforç afecten significativament a la intenció d'utilitzar aquests serveis de cirurgia i que amb diferent intensitat entre els models per expectativa de esforç-. L'impacte de la influència social dóna una idea general sobre la naturalesa de el sector de la salut a Jordània, on una part de la societat presta més atenció a les recomanacions dels altres a l'elegir els seus cirurgians. A més, l'impacte de l'expectativa d'esforç contribueix a les expectatives per la simplicitat de l'servei dels pacients, en termes d'ús i interacció amb els cirurgians proposats. L'anàlisi multigrup va confirmar que les variables dels models estan afectant de la mateixa manera a l'comparar la intenció d'usar cyborgs i humans, i a l'comparar cyborgs i robots. No obstant això, sí que hi ha diferències significatives a l'comparar l'elecció entre robots i humans en l'impacte de l'expectativa d'esforç per utilitzar els serveis de cirurgia. D'altra banda, els participants van mostrar la seva preferència pel cirurgià humà sobre els cirurgians cyborg i robot, respectivament. Com a resultat, l'acceptació de les tecnologies de robot i cyborg per part de la societat podria donar una idea sobre la lluita esperada en el futur entre el desenvolupament de robots i la millora de les capacitats humanes.La presente tesis se basa en una investigación que propone un uso futurista del robot y el cyborg como cirujanos oculares. El modelo desarrollado investiga la intención del consumidor para elegir a cada cirujano (es decir: cirujano robot, cirujano cyborg o cirujano humano). Los datos se analizaron utilizando la técnica PLS-SEM. Los resultados de la investigación muestran que la expectativa de esfuerzo, la expectativa de rendimiento, el riesgo percibido y la influencia social mostraron un impacto significativo en la intención de utilizar los servicios del robot cirujano. Los resultados del modelo para el cyborg cirujano confirmaron el impacto significativo de la expectativa de esfuerzo, la excitación, la expectativa de rendimiento y la influencia social en la intención de usar sus servicios. La expectativa de esfuerzo y la influencia social confirmaron un impacto significativo en la intención de utilizar los servicios del cirujano humano. Los resultados muestran que en los tres modelos las variables influencia social y expectativa de esfuerzo afectan significativamente a la intención de usar esos servicios de cirugía –aunque con distinta intensidad entre los modelos para expectativa de esfuerzo-. El impacto de la influencia social da una idea general sobre la naturaleza del sector de la salud en Jordania, donde una parte de la sociedad presta más atención a las recomendaciones de los demás al elegir a sus cirujanos. Además, el impacto de la expectativa de esfuerzo contribuye a las expectativas por la simplicidad del servicio de los pacientes, en términos de uso e interacción con los cirujanos propuestos. El análisis multigrupo confirmó que las variables de los modelos están afectando de la misma manera al comparar la intención de usar cyborgs y humanos, y al comparar cyborgs y robots. Sin embargo, sí que existen diferencias significativas al comparar la elección entre robots y humanos en el impacto de la expectativa de esfuerzo para utilizar los servicios de cirugía. Por otro lado, los participantes mostraron su preferencia por el cirujano humano sobre los cirujanos cyborg y robot, respectivamente. Como resultado, la aceptación de las tecnologías de robot y cyborg por parte de la sociedad podría dar una idea sobre la lucha esperada en el futuro entre el desarrollo de robots y la mejora de las capacidades humanThe research proposes a futuristic use of robot and cyborg as surgeons in an eye surgery. Thereafter, the developed model has been applied to investigate the intention to use each surgeon (i.e. robot surgeon, cyborg surgeon, and human surgeon). The data was analyzed using the PLS-SEM technique. According to the research results, effort expectancy, performance expectancy, perceived risk, and social influence showed a significant impact on intention to use robot services. However, the results of the cyborg service model confirmed the significant impact of effort expectancy, arousal, performance expectancy, and social influence on the intention to use cyborg services. Furthermore, effort expectancy and social influence confirmed their significant impact on the intention to use human services. The results of the three models showed that the variables social influence and effort expectancy significantly affected the intention to use these surgical services, with a different intensity between the models for effort expectancy. The social influence impact gives a general idea about the nature of the healthcare sector in Jordan, where a part of society gives more attention to the recommendation from others while choosing their surgeons. Also, the effort expectancy impact contributes to patients' expectations of simplicity, in terms of use and interaction with the proposed surgeons. The multigroup analysis confirmed that the models' variables are affecting the intention to use cyborg and human service, and cyborg and robots in the same way. However, the differences were confirmed between robot and human cyborgs in terms of the impact of effort expectancy on the intention to use these services. On the other side, the participants showed their preference of the human surgeon over the cyborg and robot surgeons, respectively. As a result, the acceptance of the robot and cyborg technologies by a part of the society could give an idea about the expected struggle in the future among developing robots and enhancing human capabilities

Augmentation of Brain Function: Facts, Fiction and Controversy. Volume III: From Clinical Applications to Ethical Issues and Futuristic Ideas

The final volume in this tripartite series on Brain Augmentation is entitled “From Clinical Applications to Ethical Issues and Futuristic Ideas”. Many of the articles within this volume deal with translational efforts taking the results of experiments on laboratory animals and applying them to humans. In many cases, these interventions are intended to help people with disabilities in such a way so as to either restore or extend brain function. Traditionally, therapies in brain augmentation have included electrical and pharmacological techniques. In contrast, some of the techniques discussed in this volume add specificity by targeting select neural populations. This approach opens the door to where and how to promote the best interventions. Along the way, results have empowered the medical profession by expanding their understanding of brain function. Articles in this volume relate novel clinical solutions for a host of neurological and psychiatric conditions such as stroke, Parkinson’s disease, Huntington’s disease, epilepsy, dementia, Alzheimer’s disease, autism spectrum disorders (ASD), traumatic brain injury, and disorders of consciousness. In disease, symptoms and signs denote a departure from normal function. Brain augmentation has now been used to target both the core symptoms that provide specificity in the diagnosis of a disease, as well as other constitutional symptoms that may greatly handicap the individual. The volume provides a report on the use of repetitive transcranial magnetic stimulation (rTMS) in ASD with reported improvements of core deficits (i.e., executive functions). TMS in this regard departs from the present-day trend towards symptomatic treatment that leaves unaltered the root cause of the condition. In diseases, such as schizophrenia, brain augmentation approaches hold promise to avoid lengthy pharmacological interventions that are usually riddled with side effects or those with limiting returns as in the case of Parkinson’s disease. Brain stimulation can also be used to treat auditory verbal hallucination, visuospatial (hemispatial) neglect, and pain in patients suffering from multiple sclerosis. The brain acts as a telecommunication transceiver wherein different bandwidth of frequencies (brainwave oscillations) transmit information. Their baseline levels correlate with certain behavioral states. The proper integration of brain oscillations provides for the phenomenon of binding and central coherence. Brain augmentation may foster the normalization of brain oscillations in nervous system disorders. These techniques hold the promise of being applied remotely (under the supervision of medical personnel), thus overcoming the obstacle of travel in order to obtain healthcare. At present, traditional thinking would argue the possibility of synergism among different modalities of brain augmentation as a way of increasing their overall effectiveness and improving therapeutic selectivity. Thinking outside of the box would also provide for the implementation of brain-to-brain interfaces where techniques, proper to artificial intelligence, could allow us to surpass the limits of natural selection or enable communications between several individual brains sharing memories, or even a global brain capable of self-organization. Not all brains are created equal. Brain stimulation studies suggest large individual variability in response that may affect overall recovery/treatment, or modify desired effects of a given intervention. The subject’s age, gender, hormonal levels may affect an individual’s cortical excitability. In addition, this volume discusses the role of social interactions in the operations of augmenting technologies. Finally, augmenting methods could be applied to modulate consciousness, even though its neural mechanisms are poorly understood. Finally, this volume should be taken as a debate on social, moral and ethical issues on neurotechnologies. Brain enhancement may transform the individual into someone or something else. These techniques bypass the usual routes of accommodation to environmental exigencies that exalted our personal fortitude: learning, exercising, and diet. This will allow humans to preselect desired characteristics and realize consequent rewards without having to overcome adversity through more laborious means. The concern is that humans may be playing God, and the possibility of an expanding gap in social equity where brain enhancements may be selectively available to the wealthier individuals. These issues are discussed by a number of articles in this volume. Also discussed are the relationship between the diminishment and enhancement following the application of brain-augmenting technologies, the problem of “mind control” with BMI technologies, free will the duty to use cognitive enhancers in high-responsibility professions, determining the population of people in need of brain enhancement, informed public policy, cognitive biases, and the hype caused by the development of brain- augmenting approaches

Obesity-induced chronic inflammation in C57Bl6J mice, a novel risk factor in the progression of renal AA amyloidosis?

Background: Compelling evidence links obesity induced systemic inflammation to the development of chronic kidney disease (CKD). This systemic inflammation may result from exacerbated adipose inflammation. Besides the known detrimental effects of typical pro-inflammatory factors secreted by the adipose tissue (TNF-α, MCP-1 and IL-6) on the kidney, we hypothesize the enhanced obesity-induced secretion of serum amyloid A (SAA), an acute inflammatory protein, to play a key role in aggravating obesity-induced CKD. Methods: Groups of male C57Bl/6J mice (n = 99 in total) were fed a low (10% lard) or high (45% lard) fat diet for a maximum of 52 weeks. Mice were sacrificed after 24, 40 and 52 weeks. Whole blood samples, kidneys and adipose tissues were collected. The development of adipose and renal tissue inflammation was assessed on gene expression and protein level. Adipocytokine levels were measured in plasma samples. Results: A distinct inflammatory phenotype was observed in the adipose tissue of HFD mice prior to renal inflammation, which was associated with an early systemic elevation of TNF-α, leptin and SAA (1A-C). With aging, sclerotic lesions appeared in the kidney, the extent of which was severely aggravated by HFD feeding. Lesions exhibited typical amyloid characteristics (2A) and pathological severity positively correlated with bodyweight (2B). Interestingly, more SAA protein was detected in lesions of HFD mice. Conclusion: Our data suggest a causal link between obesity induced chronic inflammation and AA amyloidosis in C57Bl/6J mice. Though future studies are necessary to prove this causal link and to determine its relevance for the human situation, obesity may hence be considered a risk factor for the development and progression of renal AA amyloidosis in the course of CKD. (Figure Presented)

Effects of Diversity and Neuropsychological Performance in an NFL Cohort

Objective: The aim of this study was to examine the effect of ethnicity on neuropsychological test performance by comparing scores of white and black former NFL athletes on each subtest of the WMS. Participants and Methods: Data was derived from a de-identified database in South Florida consisting of 63 former NFL white (n=28, 44.4%) and black (n=35, 55.6%) athletes (Mage= 50.38; SD= 11.57). Participants completed the following subtests of the WMS: Logical Memory I and II, Verbal Paired Associates I and II, and Visual Reproduction I and II. Results: A One-Way ANOVA yielded significant effect between ethnicity and performance on several subtests from the WMS-IV. Black athletes had significantly lower scores compared to white athletes on Logical Memory II: F(1,61) = 4.667, p= .035, Verbal Paired Associates I: F(1,61) = 4.536, p = .037, Verbal Paired Associates: II F(1,61) = 4.677, p = .034, and Visual Reproduction I: F(1,61) = 6.562, p = .013. Conclusions: Results suggest significant differences exist between white and black athletes on neuropsychological test performance, necessitating the need for proper normative samples for each ethnic group. It is possible the differences found can be explained by the psychometric properties of the assessment and possibility of a non-representative sample for minorities, or simply individual differences. Previous literature has found white individuals to outperform African-Americans on verbal and non-verbal cognitive tasks after controlling for socioeconomic and other demographic variables (Manly & Jacobs, 2002). This highlights the need for future investigators to identify cultural factors and evaluate how ethnicity specifically plays a role on neuropsychological test performance. Notably, differences between ethnic groups can have significant implications when evaluating a sample of former athletes for cognitive impairment, as these results suggest retired NFL minorities may be more impaired compared to retired NFL white athletes