Potential efficacy of zonisamide in refractory juvenile myoclonic epilepsy: retrospective evidence from an Irish compassionate-use case series.

To retrospectively evaluate the efficacy of zonisamide as adjunctive therapy in the treatment of refractory juvenile myoclonic epilepsy. We retrospectively reviewed the records of seven patients with refractory juvenile myoclonic epilepsy, commenced on a compassionate-use basis on zonisamide as adjunctive treatment between October 2001 and September 2004. We found significant response rates (>50% reduction in seizure frequency) of 83.3%, 100% and 100% for generalised convulsions, myoclonus, and absence seizures respectively. These results were sustained over more prolonged follow-up in five of seven patients, with one patient improving further over time. Two patients became seizure free with the introduction of zonisamide. Two patients were able to reduce the number of anti-epileptic medications and maintain >75% and 100% reduction in seizure frequency respectively. Four patients initially had minor side-effects that resolved during the maintenance period. In this retrospective study, zonisamide was effective and well-tolerated as adjunctive therapy in patients with refractory juvenile myoclonic epilepsy

Attitudes and perceptions of Irish health care professionals regarding functional neurological disorder: A national survey

Abstract Background Functional neurological disorder (FND) is a common and often disabling condition. Limited access to services for FND poses challenges both for patients and their health care providers. This survey explored the attitudes, experiences, support needs and training needs of health care professionals (HCPs) who provide care to individuals with FND in Ireland. Methods A broad range of HCPs working with patients with FND in Ireland partook in an anonymous online 12‐item survey. Participants were recruited via professional bodies and snowball convenience sampling utilising social media and email invitation. Descriptive and inferential statistics were employed to analyze data. Results A total of 314 HCPs working in Ireland completed the survey. 80% were female and over half worked in their current role for more than 10 years.   75% of the sample encountered three or less individuals with FND per month. Identified service‐related challenges to effective patient care included insufficient clinic time, lack of confidence explaining the diagnosis, and the need for greater access to specialist support.  Data revealed persisting negative attitudes toward FND patients among a proportion of respondents. The majority of respondents did not feel they received adequate education on FND, with the exception of neurologists, of whom 65% felt adequately trained.  The majority of respondents (85%) also felt that people with FND did not have access to appropriate FND services in Ireland. Conclusion This study indicates that there is a significant need to improve FND education among HCPs in Ireland, in addition to developing appropriately resourced, integrated, multidisciplinary care pathways for the FND patient group

Development of a new thrombectomy technical difficulty index: TTDI

Aim: Multiple recent trials have proven the efficacy of thrombectomy in large vessel occlusive stroke and earlier reperfusion correlates with improved outcomes. We developed a thrombectomy technical difficulty index (TTDI) to predict the expected procedural difficulty as an aid to operator decision making for the achievement of a fast and successful recanalization.Materials and Methods: Key thrombectomy factors were used to grade predicted difficulty of thrombectomy on a 3-point scale, from minimal, mild to moderate to severe. Thirty patients that underwent thrombectomy had their computed tomography angiograms scans analysed by seven neurointerventionists using the TTDI to predict level of difficulty to establish its reliability (intra-class correlation, ICC) and validity.Results: An almost perfect level of agreement on TTDI scores between the 7 neurointerventionists was reported (ICC = 0.89, 95 CI = 0.81 to 0.94), and an expert INR opinion of case difficulty using the TTDI (ICC = 0.861, 95 CI = 0.77 to 0.93). Validity analysis showed that that length of procedure was shorter for minimal compared to mild to moderate difficultly cases as assessed with TTDI.Conclusion: The TTDI is a promising tool to assess predicted thrombectomy case difficulty, allowing operator to consider potential problems and inform decisions about whether a modification to technique, including access, equipment and anaesthesia, should be considered. Larger prospective studies evaluating the TTDI are warranted

Is the child pornography a substitute or a complement for child intercourse?

This thesis analyzes the change in quantity demanded of sexual intercourse with minors in dependence on the cost of child pornography. Using this method it examines the type of the good, whether it is a substitute or a complement. Usage possibilities are discussed for child pornography as a complement or a substitute for child intercourse. Thereafter, regression analysis using first-differences and fixed-effects methods follows, which confirms inverse relationship between quantity demanded of sexual intercourse with minors and the cost of child pornography finding child pornography being a substitute for the demand for underage intercourse. This regression analysis is conducted based on the data from the years 2001-2008 from the USA and from the Czech Republic by using internet development as an proxy variable to measure the decline in the cost of child pornography. USA's proxy being assigned IP addresses. As an instrument IP address are used in the USA, and number of households with the internet accession Czech Republic. Estimated results served as a basis for formulating suggestions as to how to lower the number of sexual violence victims. The recommendation is reducing repression for holding child pornography

Clinical experience with adjunctive perampanel in adult patients with uncontrolled epilepsy: A UK and Ireland multicentre study

Purpose: To derive clinically useful information about the efficacy and tolerability of adjunctive treatment with perampanel for refractory epilepsy in an outpatient setting. Method: We pooled retrospective casenotes data of adult patients with refractory epilepsy prescribed perampanel from 18 hospitals throughout UK and Ireland. Results: Three hundred and ten patients were included (mean age 40.9 [SD = 12.0], 50% women, 27.7% with learning disability). The mean duration of epilepsy was 26.7 years (range 2–67 years, SD = 13.5) and 91.9% were taking two or more anti-epileptic drugs at the time of perampanel initiation. Mean retention was 6.9 months (range 1 day–22.3 months, SD = 4.5). The retention was 86% at 3 months, 71% at 6 months, 47.6% at 12 months and 27% at 18 months. At final follow-up a >50% reduction in seizure frequency was reached in 57.5% of tonic–clonic seizures, 57.4% of complex partial seizures and 43.8% of simple partial seizures. Eleven patients (3.5%) became seizure free. Two hundred and nine patients (67.4%) experienced adverse effects and of these 67% withdrew treatment due to their effects. The most common were sedation, behaviour/mood disturbance, dizziness, and unsteadiness. Conclusion: Perampanel appears a safe and effective antiepileptic drug when used as adjunctive therapy in patients with uncontrolled partial epilepsy (including those with learning disability), although few patients achieved complete seizure control. Long-term retention was slightly lower than reported rates for other anti-epileptic drugs, potentially due to the highly refractory population. Monitoring for adverse effects on energy levels, mood and behaviour is recommended

Quantifying Nitrous Acid Formation Mechanisms Using Measured Vertical Profiles During the CalNex 2010 Campaign and 1D Column Modeling

International audienceNitrous acid (HONO) is an important radical precursor that can impact secondary pollutant levels, especially in urban environments. Due to uncertainties in its heterogeneous formation mechanisms, models often under predict HONO concentrations. A number of heterogeneous sources at the ground have been proposed but there is no consensus about which play a significant role in the urban boundary layer. We present a new one-dimensional chemistry and transport model which performs surface chemistry based on molecular collisions and chemical conversion, allowing us to add detailed HONO formation chemistry at the ground. We conducted model runs for the 2010 CalNex campaign, finding good agreement with observations for key species such as O3, NOx, and HOx. With the ground sources implemented, the model captures the diurnal and vertical profile of the HONO observations. Primary HOx production from HONO photolysis is 2–3 times more important than O3 or HCHO photolysis at mid-day, below 10 m. The HONO concentration, and its contribution to HOx, decreases quickly with altitude. Heterogeneous chemistry at the ground provided a HONO source of 2.5 × 1011 molecules cm−2 s−1 during the day and 5 × 1010 molecules cm−2 s−1 at night. The night time source was dominated by NO2 hydrolysis. During the day, photolysis of surface HNO3/nitrate contributed 45%–60% and photo-enhanced conversion of NO2 contributed 20%–45%. Sensitivity studies addressing the uncertainties in both photolytic mechanisms show that, while the relative contribution of either source can vary, HNO3/nitrate is required to produce a surface HONO source that is strong enough to explain observations