Re-circular el cuidado en (post)pandemia: (in)movilidad e hiperconexión en las familias transnacionales chinas entre Zhejiang y España

Este artículo aborda el impacto de la pandemia de Covid-19 en la circulación del cuidado en las familias transnacionales chinas. Con base en una etnografía multisituada entre la provincia de Zhejiang y España (2016-2019) y posterior desarrollo de una etnografía virtual (marzo 2020-marzo 2022), los resultados apuntan a las cambiantes demandas productivas, las restricciones de movilidad internacional y trabas económicas y burocráticas adicionales, así como a las percepciones de seguridad en los diferentes contextos nacionales, como factores clave en la reconfiguración de la (in)movilidad física relacionada con el cuidado. En paralelo, se da una creciente movilidad virtual e hiperconexión que revela el rol clave de las tecnologías de la información y la comunicación (TIC) en este contexto. Las conclusiones enfatizan la alteración de algunos patrones de circulación de cuidado habituales y la necesidad de abordar una investigación longitudinal para conocer el alcance real de los efectos de la pandemia

Seizures and Epilepsy After Stroke: Epidemiology, Biomarkers and Management

Convulsions; Farmacodinàmica; ElectroencefalogramaConvulsiones; Farmacodinámica; ElectroencefalogramaSeizures; Pharmacodynamics; Electroencephalogram[Galovic M] Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland. Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK. Chalfont Centre for Epilepsy, Chalfont St Peter, UK. [Ferreira-Atuesta C] Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK. Chalfont Centre for Epilepsy, Chalfont St Peter, UK. Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA. [Abraira L] Unitat d’Epilèpsia, Servei de Neurologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain. [Döhler N] Specialist Clinic for Neurorehabilitation, Kliniken Beelitz, Beelitz-Heilstätten, Germany. [Sinka L] Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland. [Brigo F] Division of Neurology, “Franz Tappeiner” Hospital, Merano, ItalyOpen Access funding provided by Universität Zürich. No sources of funding were used to conduct this study or prepare this manuscript

Blood Biomarkers to Predict Long-Term Mortality after Ischemic Stroke

Biomarcador; Endostatina; Accident cerebrovascular isquèmicBiomarcador; Endostatina; Accidente cerebrovascular isquémicoBiomarker; Endostatin; Ischemic strokeStroke is a major cause of disability and death globally, and prediction of mortality represents a crucial challenge. We aimed to identify blood biomarkers measured during acute ischemic stroke that could predict long-term mortality. Nine hundred and forty-one ischemic stroke patients were prospectively recruited in the Stroke-Chip study. Post-stroke mortality was evaluated during a median 4.8-year follow-up. A 14-biomarker panel was analyzed by immunoassays in blood samples obtained at hospital admission. Biomarkers were normalized and standardized using Z-scores. Multiple Cox regression models were used to identify clinical variables and biomarkers independently associated with long-term mortality and mortality due to stroke. In the multivariate analysis, the independent predictors of long-term mortality were age, female sex, hypertension, glycemia, and baseline National Institutes of Health Stroke Scale (NIHSS) score. Independent blood biomarkers predictive of long-term mortality were endostatin > quartile 2, tumor necrosis factor receptor-1 (TNF-R1) > quartile 2, and interleukin (IL)-6 > quartile 2. The risk of mortality when these three biomarkers were combined increased up to 69%. The addition of the biomarkers to clinical predictors improved the discrimination (integrative discriminative improvement (IDI) 0.022 (0.007–0.048), p quartile 3 was an independent predictor of mortality due to stroke. Altogether, endostatin, TNF-R1, and IL-6 circulating levels may aid in long-term mortality prediction after stroke.This work has been funded by Instituto de Salud Carlos III (PI18/00804) and by La Fundació La Marató (Reg. 84/240 proj. 201702). Neurovascular Research Laboratory takes part in the Spanish stroke research network INVICTUS+ (RD16/0019/0021). L.R. is supported by a pre-doctoral fellowship from the Instituto de Salud Carlos III (IFI17/00012)

Overnight switch from levetiracetam to brivaracetam: safety and tolerability

Brivaracetam; Epilepsy; TolerabilityBrivaracetam; Epilepsia; TolerabilidadBrivaracetam; Epilèpsia; TolerabilitatBrivaracetam is a newer antiseizure medication than levetiracetam. It has a more selective action on the synaptic vesicle glycoprotein 2A binding site, and it seems to provide a more favorable neuropsychiatric profile. The aim of this study was to assess the safety and tolerability of an overnight switch from levetiracetam to brivaracetam. This was a retrospective descriptive study including patients with epilepsy treated with levetiracetam, who switched due to inefficacy or previous adverse events (AEs). In total, forty-one patients were included (mean age 40.9 ± 17.8 years, women 48.8%). Focal epilepsy represented 75.6% (n = 31) of patients (structural cause [n = 25], unknown cause [n = 6]). Four patients had idiopathic generalized epilepsy, two had developmental and epileptic encephalopathy and four patients were unclassified. The reason to start brivaracetam was inefficacy in 53.7% (n = 22), AEs in 65.9% (25/27 neuropsychiatric) and both in 19.5% (n = 8). Brivaracetam-related AEs were reported in 24.4%. Neuropsychological AEs associated with the previous use of levetiracetam improved in 76% of patients. Treatment was discontinued in 19.5% patients. Patients’ reported seizure frequency improved, worsened and remained stable in 26.8%, 12.2%, and 61.0% of the cases, respectively. An overnight switching to brivaracetam is safe and well tolerated. This treatment can improve levetiracetam-related neuropsychiatric AEs

Seizures after Ischemic Stroke: A Matched Multicenter Study

Accidente cerebrovascular isquémico; Tratamiento de reperfusión; Factores de riesgoIschemic Stroke; Reperfusion treatment; Risk factorsAccident cerebrovascular isquèmic; Tractament de reperfusió; Factor de riscObjective The purpose of this study was to identify risk factors for acute symptomatic seizures and post-stroke epilepsy after acute ischemic stroke and evaluate the effects of reperfusion treatment. Methods We assessed the risk factors for post-stroke seizures using logistic or Cox regression in a multicenter study, including adults from 8 European referral centers with neuroimaging-confirmed ischemic stroke. We compared the risk of post-stroke seizures between participants with or without reperfusion treatment following propensity score matching to reduce confounding due to treatment selection. Results In the overall cohort of 4,229 participants (mean age 71 years, 57% men), a higher risk of acute symptomatic seizures was observed in those with more severe strokes, infarcts located in the posterior cerebral artery territory, and strokes caused by large-artery atherosclerosis. Strokes caused by small-vessel occlusion carried a small risk of acute symptomatic seizures. 6% developed post-stroke epilepsy. Risk factors for post-stroke epilepsy were acute symptomatic seizures, more severe strokes, infarcts involving the cerebral cortex, and strokes caused by large-artery atherosclerosis. Electroencephalography findings within 7 days of stroke onset were not independently associated with the risk of post-stroke epilepsy. There was no association between reperfusion treatments in general or only intravenous thrombolysis or mechanical thrombectomy with the time to post-stroke epilepsy or the risk of acute symptomatic seizures. Interpretation Post-stroke seizures are related to stroke severity, etiology, and location, whereas an early electroencephalogram was not predictive of epilepsy. We did not find an association of reperfusion treatment with risks of acute symptomatic seizures or post-stroke epilepsy

Blood Biomarkers to Predict Long-Term Mortality after Ischemic Stroke

Altres ajuts: This work has been funded by La Fundació La Marató (Reg. 84/240 proj. 201702).Stroke is a major cause of disability and death globally, and prediction of mortality represents a crucial challenge. We aimed to identify blood biomarkers measured during acute ischemic stroke that could predict long-term mortality. Nine hundred and forty-one ischemic stroke patients were prospectively recruited in the Stroke-Chip study. Post-stroke mortality was evaluated during a median 4.8-year follow-up. A 14-biomarker panel was analyzed by immunoassays in blood samples obtained at hospital admission. Biomarkers were normalized and standardized using Z -scores. Multiple Cox regression models were used to identify clinical variables and biomarkers independently associated with long-term mortality and mortality due to stroke. In the multivariate analysis, the independent predictors of long-term mortality were age, female sex, hypertension, glycemia, and baseline National Institutes of Health Stroke Scale (NIHSS) score. Independent blood biomarkers predictive of long-term mortality were endostatin > quartile 2, tumor necrosis factor receptor-1 (TNF-R1) > quartile 2, and interleukin (IL)-6 > quartile 2. The risk of mortality when these three biomarkers were combined increased up to 69%. The addition of the biomarkers to clinical predictors improved the discrimination (integrative discriminative improvement (IDI) 0.022 (0.007-0.048), p quartile 3 was an independent predictor of mortality due to stroke. Altogether, endostatin, TNF-R1, and IL-6 circulating levels may aid in long-term mortality prediction after stroke

Real-Life Effectiveness and Tolerability of Brivaracetam in Focal to Bilateral and Primary Generalized Tonic-Clonic Seizures

Effectiveness; Brivaracetam; Tonic-clonic seizuresEfectividad; Brivaracetam; Convulsiones tónico-clónicasEfectivitat; Brivaracetam; Convulsions tònic-clòniquesPurpose. Brivaracetam (BRV), an antiseizure medication indicated for focal-onset seizures, has shown efficacy in the treatment of focal to bilateral tonic-clonic seizures (FBTCS). We aimed to determine the effectiveness and safety of BRV in patients with FBTCS and generalized tonic-clonic seizures (GTCS). Methods. We performed a multicenter, retrospective, longitudinal study in adult patients with epilepsy who experienced at least one FBTCS or GTCS before starting BRV (baseline visit). Data were collected from consecutive outpatient visits over a 4-year period. All patients had been followed for at least 3 months before the baseline visit and completed a minimum follow-up of 3 months after starting BRV. Response (≥50% reduction in FBTCS/GTCS frequency) and retention rates, as well as seizure freedom and presence of adverse events at 3, 6, and 12 months, were recorded as outcome measures. Results. 114 patients were included (mean age years, 52% male, 36.6% genetic generalized epilepsy); 94 had a 12-month follow-up period. At 12 months’ follow-up, the response rate was 83%, and 73.4% of patients were FBTCS/GTCS-free. Retention was 79% at 12 months. Adverse events occurred in 29.8% of patients, the most common being drowsiness (14.9%). No significant differences were found in response rates between FBTCS and GTCS. Drug resistance was independently associated with lower response and seizure freedom rates at follow-up. The absence of a titration period predicted seizure freedom and response at 3 months. Conclusions. BRV is an effective and well-tolerated treatment in patients with focal to bilateral tonic-clonic seizures and generalized tonic-clonic seizures.E. Fonseca declares research funding and honoraria from UCB Pharma, Esteve Laboratorios, Eisai Inc., Bial Pharmaceutical, GW Pharmaceuticals, Angelini Pharma, and Sanofi Genzyme. A. Gifreu declares research funding from UCB Pharma and Bial Pharmaceutical. Manuel Quintana has received honoraria from UCB Pharma, Eisai Inc., Sanofi, GW Pharmaceuticals, Neuraxpharm Spain, and Pierre Fabre Ibérica. S. Lallana has received travel support and research funding from UCB Pharma and Bial Pharmaceutical. S. López-Maza declares travel support and research funding from Eisai Inc., UCB Pharma, and Neuraxpharm Spain. L. Abraira has received research funding and speaker fees from UCB Pharma, Bial Pharmaceutical, Eisai Inc., Sanofi Genzyme, and Esteve Laboratorios. D. Campos-Fernández has received research funding from UCB Pharma. E. Santamarina has received research funding and speaker fees from UCB Pharma, Bial Pharmaceutical, Eisai Inc., Arvelle, and Esteve Laboratorios. J. Rodríguez Uranga declares honoraria from Arvelle, Angelini Pharma, Bial Pharmaceutical, Eisai Inc., Esteve Laboratorios, UCB Pharma, and Pfizer Inc. M. Toledo declares research funding and speaker fees from UCB Pharma, GW Pharmaceuticals, Bial Pharmaceutical, Eisai Inc., Sanofi, Arvelle, and Esteve Laboratorios. J Abril Jaramillo and L. Redondo Vergé have no conflict of interest to declare

Perampanel: A therapeutic alternative in refractory status epilepticus associated with MELAS syndrome

MELAS; Perampanel; Status epilepticusMELAS; Perampanel; Estatus epilèpticMELAS; Perampanel; Status epilépticoTo our knowledge, there are no reports of status epilepticus (SE) associated with mitochondrial diseases and treated with perampanel (PER). We present three cases of patients with refractory SE associated with MELAS syndrome who responded favorably to PER. All cases were diagnosed as non-convulsive SE (focal without impairment of level of consciousness). After an initial treatment with other anti-seizure drugs, PER was added in all cases (8, 16 and 12 mg) and cessation of SE was observed within the next 4-8 hours. All the cases involved a stroke-like lesion present on brain MRI. In our patients, PER was an effective option in SE associated with MELAS syndrome

The cellular and synaptic architecture of the mechanosensory dorsal horn

The deep dorsal horn is a poorly characterized spinal cord region implicated in processing low-threshold mechanoreceptor (LTMR) information. We report an array of mouse genetic tools for defining neuronal components and functions of the dorsal horn LTMR-recipient zone (LTMR-RZ), a role for LTMR-RZ processing in tactile perception, and the basic logic of LTMR-RZ organization. We found an unexpectedly high degree of neuronal diversity in the LTMR-RZ: seven excitatory and four inhibitory subtypes of interneurons exhibiting unique morphological, physiological, and synaptic properties. Remarkably, LTMRs form synapses on between four and 11 LTMR-RZ interneuron subtypes, while each LTMR-RZ interneuron subtype samples inputs from at least one to three LTMR classes, as well as spinal cord interneurons and corticospinal neurons. Thus, the LTMR-RZ is a somatosensory processing region endowed with a neuronal complexity that rivals the retina and functions to pattern the activity of ascending touch pathways that underlie tactile perception

Association of Mortality and Risk of Epilepsy With Type of Acute Symptomatic Seizure After Ischemic Stroke and an Updated Prognostic Model

IMPORTANCE: Acute symptomatic seizures occurring within 7 days after ischemic stroke may be associated with an increased mortality and risk of epilepsy. It is unknown whether the type of acute symptomatic seizure influences this risk. OBJECTIVE: To compare mortality and risk of epilepsy following different types of acute symptomatic seizures. DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed data acquired from 2002 to 2019 from 9 tertiary referral centers. The derivation cohort included adults from 7 cohorts and 2 case-control studies with neuroimaging-confirmed ischemic stroke and without a history of seizures. Replication in 3 separate cohorts included adults with acute symptomatic status epilepticus after neuroimaging-confirmed ischemic stroke. The final data analysis was performed in July 2022. EXPOSURES: Type of acute symptomatic seizure. MAIN OUTCOMES AND MEASURES: All-cause mortality and epilepsy (at least 1 unprovoked seizure presenting >7 days after stroke). RESULTS: A total of 4552 adults were included in the derivation cohort (2547 male participants [56%]; 2005 female [44%]; median age, 73 years [IQR, 62-81]). Acute symptomatic seizures occurred in 226 individuals (5%), of whom 8 (0.2%) presented with status epilepticus. In patients with acute symptomatic status epilepticus, 10-year mortality was 79% compared with 30% in those with short acute symptomatic seizures and 11% in those without seizures. The 10-year risk of epilepsy in stroke survivors with acute symptomatic status epilepticus was 81%, compared with 40% in survivors with short acute symptomatic seizures and 13% in survivors without seizures. In a replication cohort of 39 individuals with acute symptomatic status epilepticus after ischemic stroke (24 female; median age, 78 years), the 10-year risk of mortality and epilepsy was 76% and 88%, respectively. We updated a previously described prognostic model (SeLECT 2.0) with the type of acute symptomatic seizures as a covariate. SeLECT 2.0 successfully captured cases at high risk of poststroke epilepsy. CONCLUSIONS AND RELEVANCE: In this study, individuals with stroke and acute symptomatic seizures presenting as status epilepticus had a higher mortality and risk of epilepsy compared with those with short acute symptomatic seizures or no seizures. The SeLECT 2.0 prognostic model adequately reflected the risk of epilepsy in high-risk cases and may inform decisions on the continuation of antiseizure medication treatment and the methods and frequency of follow-up