Prevalence of childhood epilepsy in Canada.

Few data exist on the frequency and burden of childhood epilepsy in Canada and on the impact in the general population. We have assessed the point prevalence of childhood epilepsy in Canada. We analyzed data from the National Longitudinal Survey of Children and Youth (N=20 025 for Cycle 2, and N= 31 960 for cycle 3). Each cycle was collected over a two year period (2: 1996-1997, 3: 1998-1999). In the survey the following specific question was asked to the person most knowledgeable in the household: Does the child have any of the following long-term conditions that have been diagnosed by a health professional? The list of responses included Epilepsy and certain co-morbid conditions. In addition, a subsequent question identified whether the condition was treated by means of a specific anticonvulsant medication. (anticonvulsants or anti-epileptic pills?). Prevalence was based on the national standard population at the time of each survey. In Cycle 2, 80 of 20 025 subjects from 0 to 13 years old were described to have the diagnosis of epilepsy, yielding a weighted point prevalence of 4.03 per 1 000. In Cycle 3 161 of 31 960 children from 0 to 15 were described as having epilepsy, yielding a weighted point prevalence of 5.26 per 1 000. The rate of epilepsy was higher for males and increases with age. The overall rates for this age cohort are consistent with those obtained in other developed countries and seem to coincide with rates for youth and adults in Canada

Epilepsia mioclónica juvenil

La epilepsia mioclónica juvenil (EMJ) es un trastorno generalizado que se inicia usualmente en la pubertad o adolescencia y se caracteriza por la presencia de mioclonías y, con menor frecuencia, crisis tónico-clónica generalizadas y ausencias. A nivel internacional, se estima que anualmente tiene lugar un nuevo caso de EMJ por cada 1000-2000 personas. El diagnóstico es fundamentalmente de naturaleza clínica, corroborado por información electroencefalográfica. El fármaco de primera elección para el tratamiento de la EMJ sigue siendo el ácido valpróico; sin embargo, se han reportado resultados eficaces con lamotrigina y levetiracetam para el control de EMJ en monoterapia o politerapia, con topiramato como terapia coadyuvante para el control de las crisis tónico-clónicas generalizadas

Epilepsias mioclónicas progresivas

Progressive myoclonus epilepsies (PME) are infrequent neurodegenerative disorders clinically and genetically heterogeneous cause, characterized by action myoclonus, seizures and progressive neurologic disability. They mainly affect children and teenagers. Its early clinical features make the differential diagnosis difficult with other, more frequent neurogenetic diseases such as juvenile myoclonic epilepsy. The majority of genetic mutations that lead to these diseases are known to be autosomal-recessive inheritance, with autosomal-dominant or mitochondrial inheritance being of exceptional frequency. The diagnosis is made when the mutations are identified in a patient with characteristic clinical features (like in the Univerritch-Lundborg disease or North Sea PME). On the other hand, in some cases pathological (vgr., for Lafora body disease or for Myoclonic epilepsy with ragged-red fibers) or specific laboratory test (such as sialic acid in urine for Sialidosis), are more useful. It is important to make as specific a diagnosis as possible because there are some genetically defined therapies for some of these diseases. The management of the seizures in these diseases includes the use of valproic acid as a first-line drug treatment, and other drugs like zonisamide and levetiracetam as second-line. However, the lack of response to antiepileptic drugs is not uncommon. Although the prognosis varies within diseases, it is generally unfavorable and may lead to disability or early death.Las epilepsias mioclónicas progresivas (EMP) son enfermedades neurodegenerativas infrecuentes, clínica y genéticamente heterogéneas, caracterizadas por presentar mioclonías de acción, crisis epilépticas y deterioro neurológico progresivo. Afectan principalmente a niños y adolescentes. Su cuadro clínico inicial dificulta un adecuado diagnóstico diferencial con otras enfermedades neurológicas genéticas más frecuentes como la epilepsia mioclónica juvenil. Se sabe que la mayoría de mutaciones genéticas que causan estas enfermedades reflejan una herencia autosómica recesiva, con variantes dominante o mitocondrial de excepcional frecuencia. El diagnóstico tiene lugar cuando se identifican las mutaciones en un paciente con un cuadro clínico característico (como es el caso de la enfermedad de Unverritch-Lundborg o la EMP del Mar del Norte). Por otro lado, en algunos casos son más útiles la anatomía patológica (para la enfermedad de cuerpos de Lafora o la epilepsia mioclónica con fibras rojas rasgadas) o exámenes auxiliares específicos (vgr., ácido siálico en orina para Sialidosis). Es importante hacer el diagnóstico específico ya que ello permite un tratamiento genético definido para algunas de estas enfermedades. El manejo de las crisis epilépticas incluye el uso de valproato como fármaco de primera línea, en tanto que otros como zonisamida y levetiracetam constituyen una segunda línea; sin embargo, la falta de respuesta al tratamiento médico antiepiléptico es relativamente común. El pronóstico puede variar entre una enfermedad y otra, pero, por lo general, suele ser desfavorable conduciendo a discapacidad severa o muerte temprana

Unlocking Andean sigmodontine diversity: five new species of Chilomys (Rodentia: Cricetidae) from the montane forests of Ecuador

The Andean cloud forests of Ecuador are home to several endemic mammals. Members of the Thomasomyini rodents are well represented in the Andes, with Thomasomys being the largest genus (47 species) of the subfamily Sigmodontinae. Within this tribe, however, there are genera that have escaped a taxonomic revision, and Chilomys Thomas, 1897, constitutes a paradigmatic example of these “forgotten” Andean cricetids. Described more than a century ago, current knowledge of this externally unmistakable montane rodent is very limited, and doubts persist as to whether or not it is monotypic. After several years of field efforts in Ecuador, a considerable quantity of specimens of Chilomys were collected from various localities representing both Andean chains. Based on an extensive genetic survey of the obtained material, we can demonstrate that what is currently treated as C. instans in Ecuador is a complex comprising at least five new species which are described in this paper. In addition, based on these noteworthy new evidence, we amend the generic diagnosis in detail, adding several key craniodental traits such as incisor procumbency and microdonty. These results indicate that Chilomys probably has a hidden additional diversity in large parts of the Colombian and Peruvian territories, inviting a necessary revision of the entire genus.Fil: Brito, Jorge. Instituto Nacional de Biodiversidad; EcuadorFil: Tinoco, Nicolás. Pontificia Universidad Católica del Ecuador; EcuadorFil: Pinto, C. Miguel. Observatorio de Biodiversidad Ambiente y Salud; EcuadorFil: García, Rubí. Instituto Nacional de Biodiversidad; EcuadorFil: Koch, Claudia. Leibniz Institute for the Analysis of Biodiversity Chang; AlemaniaFil: Fernandez, Vincent. Natural History Museum; Reino UnidoFil: Burneo, Santiago. Pontificia Universidad Católica del Ecuador; EcuadorFil: Pardiñas, Ulises Francisco J.. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Centro Nacional Patagónico. Instituto de Diversidad y Evolución Austral; Argentin

The Impact of Manuscript Learning vs. Video Learning on a Surgeon's Confidence in Performing a Difficult Procedure

Introduction: Operative surgical videos are a popular educational resource, not commonly a part of a peer-reviewed article. We wanted to evaluate the impact of either reading a peer-reviewed manuscript or watching an operative video on a surgeon's confidence in performing a complex case.Methods: Pediatric surgeons and fellows were asked to complete an initial questionnaire to assess their confidence (formulated as a score) in the diagnosis and operative repair of anal stenosis and rectal atresia.Results: Of 101 pediatric surgeons and fellows, 52 (51%) were randomized into a “manuscript” group and 49 (49%) into a “video” group. The mean confidence before the intervention was the same in the two groups (6.4 vs. 6.6). Attending surgeons started with more confidence than trainees (7.1 vs. 5.3, p < 0.001). In the manuscript group, the average confidence increased to 7.7 (p = 0.005), and in the video group the average confidence increased to 7.9 (p = 0.001) globally. Trainees in the video group significantly improved their confidence to a score of 6.6 (p = 0.035), as did attending surgeons to 8.5 (p = 0.01). In the manuscript group, only attendings significantly improved their confidence by 1.5–8.3 (p < 0.001), whereas trainees did not with a difference of 1.3 (p = 0.194). When considering experience level, physicians who reported never having performed this surgery improved only by reading the manuscript (3.9–6.2) (p = 0.004), not by watching the video (5.4–6.6) (p = 0.106). Surgeons with experience doing this operation (>5 times) did not improve their confidence by reading the manuscript (p = 0.10), nor by watching the video (p = 0.112).Conclusion: Reviewing either a detailed manuscript or operative video on the surgical management of rectal atresia and anal stenosis demonstrated a significant increase in self-reported confidence. Trainees benefitted the most from operative videos, whereas experienced surgeons did not improve their confidence by reading the manuscript nor watching the video

Leveraging natural history biorepositories as a global, decentralized, pathogen surveillance network

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic reveals a major gap in global biosecurity infrastructure: a lack of publicly available biological samples representative across space, time, and taxonomic diversity. The shortfall, in this case for vertebrates, prevents accurate and rapid identification and monitoring of emerging pathogens and their reservoir host(s) and precludes extended investigation of ecological, evolutionary, and environmental associations that lead to human infection or spillover. Natural history museum biorepositories form the backbone of a critically needed, decentralized, global network for zoonotic pathogen surveillance, yet this infrastructure remains marginally developed, underutilized, underfunded, and disconnected from public health initiatives. Proactive detection and mitigation for emerging infectious diseases (EIDs) requires expanded biodiversity infrastructure and training (particularly in biodiverse and lower income countries) and new communication pipelines that connect biorepositories and biomedical communities. To this end, we highlight a novel adaptation of Project ECHO’s virtual community of practice model: Museums and Emerging Pathogens in the Americas (MEPA). MEPA is a virtual network aimed at fostering communication, coordination, and collaborative problem-solving among pathogen researchers, public health officials, and biorepositories in the Americas. MEPA now acts as a model of effective international, interdisciplinary collaboration that can and should be replicated in other biodiversity hotspots. We encourage deposition of wildlife specimens and associated data with public biorepositories, regardless of original collection purpose, and urge biorepositories to embrace new specimen sources, types, and uses to maximize strategic growth and utility for EID research. Taxonomically, geographically, and temporally deep biorepository archives serve as the foundation of a proactive and increasingly predictive approach to zoonotic spillover, risk assessment, and threat mitigation

An empirical evaluation of camera trap study design: How many, how long and when?

Abstract Camera traps deployed in grids or stratified random designs are a well‐established survey tool for wildlife but there has been little evaluation of study design parameters. We used an empirical subsampling approach involving 2,225 camera deployments run at 41 study areas around the world to evaluate three aspects of camera trap study design (number of sites, duration and season of sampling) and their influence on the estimation of three ecological metrics (species richness, occupancy and detection rate) for mammals. We found that 25–35 camera sites were needed for precise estimates of species richness, depending on scale of the study. The precision of species‐level estimates of occupancy (ψ) was highly sensitive to occupancy level, with 0.75) species, but more than 150 camera sites likely needed for rare (ψ < 0.25) species. Species detection rates were more difficult to estimate precisely at the grid level due to spatial heterogeneity, presumably driven by unaccounted habitat variability factors within the study area. Running a camera at a site for 2 weeks was most efficient for detecting new species, but 3–4 weeks were needed for precise estimates of local detection rate, with no gains in precision observed after 1 month. Metrics for all mammal communities were sensitive to seasonality, with 37%–50% of the species at the sites we examined fluctuating significantly in their occupancy or detection rates over the year. This effect was more pronounced in temperate sites, where seasonally sensitive species varied in relative abundance by an average factor of 4–5, and some species were completely absent in one season due to hibernation or migration. We recommend the following guidelines to efficiently obtain precise estimates of species richness, occupancy and detection rates with camera trap arrays: run each camera for 3–5 weeks across 40–60 sites per array. We recommend comparisons of detection rates be model based and include local covariates to help account for small‐scale variation. Furthermore, comparisons across study areas or times must account for seasonality, which could have strong impacts on mammal communities in both tropical and temperate sites

Epidemiology of nausea and vomiting of pregnancy: prevalence, severity, determinants, and the importance of race/ethnicity

<p>Abstract</p> <p>Background</p> <p>Studies that contributed to the epidemiology of nausea and vomiting of pregnancy have reported conflicting findings, and often failed to account for all possible co-variables necessary to evaluate the multidimensional associations. The objectives of this study were to: 1) Estimate the prevalence and the severity of nausea and vomiting of pregnancy during the 1^stand the 2^ndtrimester of pregnancy, and 2) Identify determinants of presence and severity of nausea and vomiting of pregnancy during the 1^stand 2^ndtrimesters separately, with a special emphasis on the impact of race/ethnicity.</p> <p>Methods</p> <p>A prospective study including pregnant women attending the Centre Hospitalier Universitaire (CHU) Sainte-Justine or René-Laennec clinics for their prenatal care was conducted from 2004 to 2006. Women were eligible if they were ≥ 18 years of age, and ≤ 16 weeks of gestation. Women were asked to fill out a 1^sttrimester self-administered questionnaire and were interviewed over the telephone during their 2^ndtrimester of pregnancy. Presence of nausea and vomiting of pregnancy was based on the reporting of pregnant women (yes/no); severity of symptoms was measured by the validated modified-PUQE index.</p> <p>Results</p> <p>Of the 367 women included in the study, 81.2% were Caucasians, 10.1% Blacks, 4.6% Hispanics, and 4.1% Asians. Multivariate analyses showed that race/ethnicity was significantly associated with a decreased likelihood of reporting nausea and vomiting of pregnancy (Asians vs. Caucasians OR: 0.13; 95%CI 0.02–0.73; and Blacks vs. Caucasians OR: 0.29; 95%CI 0.09–0.99).</p> <p>Conclusion</p> <p>Our study showed that race/ethnicity was associated with the reporting of nausea and vomiting of pregnancy in the 1^sttrimester of pregnancy.</p

Deep brain stimulation of the anterior nucleus of the thalamus in drug-resistant epilepsy in the MORE multicenter patient registry

Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology. This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background and objectives: The efficacy of deep brain stimulation of the anterior nucleus of the thalamus (ANT DBS) in patients with drug-resistant epilepsy (DRE) was demonstrated in the double-blind Stimulation of the Anterior Nucleus of the Thalamus for Epilepsy randomized controlled trial. The Medtronic Registry for Epilepsy (MORE) aims to understand the safety and longer-term effectiveness of ANT DBS therapy in routine clinical practice. Methods: MORE is an observational registry collecting prospective and retrospective clinical data. Participants were at least 18 years old, with focal DRE recruited across 25 centers from 13 countries. They were followed for at least 2 years in terms of seizure frequency (SF), responder rate (RR), health-related quality of life (Quality of Life in Epilepsy Inventory 31), depression, and safety outcomes. Results: Of the 191 patients recruited, 170 (mean [SD] age of 35.6 [10.7] years, 43% female) were implanted with DBS therapy and met all eligibility criteria. At baseline, 38% of patients reported cognitive impairment. The median monthly SF decreased by 33.1% from 15.8 at baseline to 8.8 at 2 years (p 10 implantations) had 42.8% reduction in median monthly SF by 2 years in comparison with 25.8% in low-volume center. In patients with cognitive impairment, the reduction in median monthly SF was 26.0% by 2 years compared with 36.1% in patients without cognitive impairment. The most frequently reported adverse events were changes (e.g., increased frequency/severity) in seizure (16%), memory impairment (patient-reported complaint, 15%), depressive mood (patient-reported complaint, 13%), and epilepsy (12%). One definite sudden unexpected death in epilepsy case was reported. Discussion: The MORE registry supports the effectiveness and safety of ANT DBS therapy in a real-world setting in the 2 years following implantation. Classification of evidence: This study provides Class IV evidence that ANT DBS reduces the frequency of seizures in patients with drug-resistant focal epilepsy.The MORE registry was sponsored and funded by Medtronic, plc.info:eu-repo/semantics/publishedVersio