Cause of death and predictors of mortality in a community-based cohort of people with epilepsy.

OBJECTIVE: The risk of premature mortality is increased in people with epilepsy. The reasons for this and how it may relate to epilepsy etiology remain unclear. METHODS: The National General Practice Study of Epilepsy is a prospective, community-based cohort that includes 558 people with recurrent unprovoked seizures of whom 34% died during almost 25 years of follow-up. We assessed the underlying and immediate causes of death and their relationship to epilepsy etiology. Psychiatric and somatic comorbidities of epilepsy as predictors of mortality were scrutinized using adjusted Cox proportional hazards models. RESULTS: The 3 most common underlying causes of death were noncerebral neoplasm, cardiovascular, and cerebrovascular disease, accounting for 59% (111/189) of deaths, while epilepsy-related causes (e.g., sudden unexplained death in epilepsy) accounted for 3% (6/189) of deaths. In 23% (43/189) of individuals, the underlying cause of death was directly related to the epilepsy etiology; this was significantly more likely if death occurred within 2 years of the index seizure (percent ratio 4.28 [95% confidence interval 2.63-6.97]). Specific comorbidities independently associated with increased risk of mortality were neoplasms (primary cerebral and noncerebral neoplasm), certain neurologic diseases, and substance abuse. CONCLUSIONS: Comorbid diseases are important causes of death, as well as predictors of premature mortality in epilepsy. There is an especially strong relationship between cause of death and epilepsy etiology in the first 2 years after the index seizure. Addressing these issues may help stem the tide of premature mortality in epilepsy

Premature mortality in refractory partial epilepsy: does surgical treatment make a difference?

Background: Epilepsy carries an increased risk of premature death. For some people with intractable focal epilepsy, surgery offers hope for a seizure-free life. The authors aimed to see whether epilepsy surgery influenced mortality in people with intractable epilepsy. Methods: The authors audited survival status in two cohorts (those who had surgery and those who had presurgical assessment but did not have surgery). Results: There were 40 known deaths in the non-surgical group (3365 person years of follow-up) and 19 in the surgical group (3905 person-years of follow-up). Non-operated patients were 2.4 times (95% CI 1.4 to 4.2) as likely to die as those who had surgery. They were 4.5 times (95% CI 1.9 to 10.9) as likely to die a probable epilepsy-related death. In the surgical group, those with ongoing seizures 1 year after surgery were 4.0 (95% CI 1.2 to 13.7) times as likely to die as those who were seizure-free or who had only simple partial seizures. Time-dependent Cox analysis showed that the yearly outcome group did not significantly affect mortality (HR 1.3, 95% CI 0.9 to 1.8). Conclusion: Successful epilepsy surgery was associated with a reduced risk of premature mortality, compared with those with refractory focal epilepsy who did not have surgical treatment. To some extent, the reduced mortality is likely to be conferred by inducing freedom from seizures. It is not certain whether better survival is attributable only to surgery, as treatment decisions were not randomised, and there may be inherent differences between the groups.<br/

\Lambda-buildings and base change functors

We prove an analog of the base change functor of \Lambda-trees in the setting of generalized affine buildings. The proof is mainly based on local and global combinatorics of the associated spherical buildings. As an application we obtain that the class of generalized affine building is closed under ultracones and asymptotic cones. Other applications involve a complex of groups decompositions and fixed point theorems for certain classes of generalized affine buildings.Comment: revised version, 29 pages, to appear in Geom. Dedicat

Evidence that the Bursting Component of the X-ray Radiation From 3C 111 Originates in the PC-Scale Jet

Evidence is presented indicating that the bursting component of the X-ray radiation detected in the nuclear region of the active radio galaxy 3C 111 comes from the blobs ejected in the pc-scale jet and not from the accretion disc. After each new outburst the radio flux density associated with it increases to a peak in ~1 year and then subsides over a period of 1-2 years with the flux falling off exponentially as the blob moves outward and dissipates. Similar peaks (bursts) are seen in the X-ray light curve and a cross-correlation between the two shows a very high correlation with the X-ray peaks leading the radio peaks by ~100 days. A second cross-correlation, this time between the radio event start times and the X-ray light curve, also shows a significant correlation. When this is taken together with the long (~1 yr) delay between the start of each ejection event and its associated X-ray peak it indicates that this bursting component of the X-ray flux must be associated with the ejected blobs in the pc-scale jet and not with the accretion disc. Because X-ray telescopes do not have the resolution required to resolve the accretion disc area from the pc-scale jet, this paper is the first to present observational evidence that can pinpoint the point of origin of at least those long-timescale X-ray bursts with durations of 1-3 yrs.Comment: 11 pages, 8 Figures. Accepted for publication in Astrophysics and Space Scienc

Greenberger-Horne-Zeilinger nonlocality for continuous variable systems

As a development of our previous work, this paper is concerned with the Greenberger-Horne-Zeilinger (GHZ) nonlocality for continuous variable cases. The discussion is based on the introduction of a pseudospin operator, which has the same algebra as the Pauli operator, for each of the $N$ modes of a light field. Then the Bell-CHSH (Clauser, Horne, Shimony and Holt) inequality is presented for the $N$ modes, each of which has a continuous degree of freedom. Following Mermin's argument, it is demonstrated that for $N$-mode parity-entangled GHZ states (in an infinite-dimensional Hilbert space) of the light field, the contradictions between quantum mechanics and local realism grow exponentially with $N$, similarly to the usual $N$-spin cases.Comment: RevTEX; comments are welcomed; new version with minor change

Model for the hydration of non-polar compounds and polymers

We introduce an exactly solvable statistical-mechanical model of the hydration of non-polar compounds, based on grouping water molecules in clusters where hydrogen bonds and isotropic interactions occur; interactions between clusters are neglected. Analytical results show that an effective strengthening of hydrogen bonds in the presence of the solute, together with a geometric reorganization of water molecules, are enough to yield hydrophobic behavior. We extend our model to describe a non-polar homopolymer in aqueous solution, obtaining a clear evidence of both ``cold'' and ``warm'' swelling transitions. This suggests that our model could be relevant to describe some features of protein folding.Comment: REVTeX, 6 pages, 3 figure

Outcome of seizures in the general population after 25 years: a prospective follow-up, observational cohort study.

We investigated long-term (to 25 years) seizure prognosis and survival in people with newly diagnosed epilepsy in the community. We explored whether prognosis is different in those with epilepsy (&gt;2 unprovoked seizures) and those with a single seizure at presentation. This is a prospective observational cohort study of people with newly diagnosed seizures. We investigated seizure outcome and survival in people presenting with a single seizure and in those presenting with &gt;2 seizures (epilepsy). 695 people (median follow-up 23.6 years) had unprovoked epileptic seizures. For seizure analysis we excluded 38 people with missing data leaving 657 (309 male, and 249 aged &lt;18 years). Seizures recurred in 67%. The 354 people with epilepsy were only slightly more likely to have further seizure recurrence than the 302 people with a single seizure at presentation (HR 1.32, 95% CI 1.09 to 1.59). In 327 people with complete follow-up, 268 (82%, 95% CI 77% to 86%) were in terminal remission; (80%, (95% CI 73% to 85%) in those with epilepsy at presentation). Premature mortality was increased in people with epilepsy (standardised mortality ratio 1.67; 95% CI 1.40 to 1.99) and those with a single seizure at presentation (standardised mortality ratio 2.65; 95% CI 2.23 to 3.15). It is also high in those with early remission. People with epilepsy and with single seizures at presentation in the community generally have good prognosis for seizure control with prolonged follow-up. The risk of premature mortality is significantly increased in both groups

Discrete Symmetries and Generalized Fields of Dyons

We have studied the different symmetric properties of the generalized Maxwell's - Dirac equation along with their quantum properties. Applying the parity (\mathcal{P}), time reversal (\mathcal{T}), charge conjugation (\mathcal{C}) and their combined effect like parity time reversal (\mathcal{PT}), charge conjugation and parity (\mathcal{CP}) and \mathcal{CP}T transformations to varius equations of generalized fields of dyons, it is shown that the corresponding dynamical quantities and equations of dyons are invariant under these discrete symmetries. Abstract Key words- parity, time reversal, charge-conjugation, dyons Abstract PACS No.- 14.80 Hv

Vacuum structure of Toroidal Carbon Nanotubes

Low energy excitations in carbon nanotubes can be described by an effective field theory of two components spinor. It is pointed out that the chiral anomaly in 1+1 dimensions should be observed in a metallic toroidal carbon nanotube on a planar geometry with varying magnetic field. We propose an experimental setup for studying this quantum effect. We also analyze the vacuum structure of the metallic toroidal carbon nanotube including the Coulomb interactions and discuss some effects of external charges on the vacuum.Comment: 10 pages, 11 figure