Treating patients with medically resistant epilepsy.

Recent evidence suggests that medically resistant epilepsy can be identified if seizures persist despite adequate doses of 2 appropriate first-line antiepileptic drugs (AEDs). Patients with medically resistant epilepsy should have their seizures carefully characterized in order to confirm their diagnosis, select treatment, and assist in determining prognosis. Patients should be counseled about factors that aggravate epilepsy and the importance of adhering to treatments. Physicians should carefully inquire about side effects and alter therapy to eliminate or minimize these symptoms. Uncontrolled seizures cause injuries, disability, and increased mortality, so surgery should be considered as soon as seizures are proven to be medically resistant. Patients with incomplete response to AEDs and who are not surgical candidates may benefit from additional medication trials or from palliative nonmedical therapies, such as vagal nerve stimulation

Stressful life event appraisal and coping in patients with psychogenic seizures and those with epilepsy

AbstractUnderstanding stress and coping among individuals with psychogenic nonepileptic seizures (PNES) may have important treatment implications. 40 patients with PNES, 20 with epilepsy (EPIL), and 40 healthy control (HC) participants reported the frequency of various stressful life events (both positive and negative) and appraised the distress these events induced. They also described their habitual coping behaviors. PNES patients reported no more frequent stressful life events than EPIL patients or HC. In addition, the stressors they experienced are not objectively more severe. However, they reported more severe distress due to negative life events, especially in the domains of work, social functioning, legal matters, and health. PNES patients also engaged in less planning and active coping than HC. Neither of these two coping behaviors was associated with distress ratings. The PNES group did not engage in more denial than either group. However, greater denial among PNES patients was associated with greater perceived distress. Coping in PNES is characterized by elevated levels of perceived distress and fewer action strategies than are normally employed to reduce the impact of a stressor. These findings may inform cognitive behavioral therapy of PNES patients

Quantum Fermion Hair

It is shown that the Dirac operator in the background of a magnetic %Reissner-Nordstr\"om black hole and a Euclidean vortex possesses normalizable zero modes in theories containing superconducting cosmic strings. One consequence of these zero modes is the presence of a fermion condensate around magnetically charged black holes which violates global quantum numbers.Comment: 16pp (harvmac (l)) and 2 figs.(not included

Euclidean Black Hole Vortices

We argue the existence of solutions of the Euclidean Einstein equations that correspond to a vortex sitting at the horizon of a black hole. We find the asymptotic behaviours, at the horizon and at infinity, of vortex solutions for the gauge and scalar fields in an abelian Higgs model on a Euclidean Schwarzschild background and interpolate between them by integrating the equations numerically. Calculating the backreaction shows that the effect of the vortex is to cut a slice out of the Euclidean Schwarzschild geometry. Consequences of these solutions for black hole thermodynamics are discussed.Comment: 24 page

final safety tolerability and seizure outcomes in patients with focal epilepsy treated with adjunctive perampanel for up to 4 years in an open label extension of phase iii randomized trials study 307

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Abelian Higgs Hair for Black Holes

We find evidence for the existence of solutions of the Einstein and Abelian Higgs field equations describing a black hole pierced by a Nielsen-Olesen vortex. This situation falls outside the scope of the usual no-hair arguments due to the non-trivial topology of the vortex configuration and the special properties of its energy-momentum tensor. By a combination of numerical and perturbative techniques we conclude that the black hole horizon has no difficulty in supporting the long range fields of the Nielsen Olesen string. Moreover, the effect of the vortex can in principle be measured from infinity, thus justifying its characterization as black hole ``hair".Comment: 31 pages, plain tex, 7 figures included. minor corrections and references adde

CMBPol Mission Concept Study: Foreground Science Knowledge and Prospects

We report on our knowledge of Galactic foregrounds, as well as on how a CMB satellite mission aiming at detecting a primordial B-mode signal (CMBPol) will contribute to improving it. We review the observational and analysis techniques used to constrain the structure of the Galactic magnetic field, whose presence is responsible for the polarization of Galactic emissions. Although our current understanding of the magnetized interstellar medium is somewhat limited, dramatic improvements in our knowledge of its properties are expected by the time CMBPol flies. Thanks to high resolution and high sensitivity instruments observing the whole sky at frequencies between 30 GHz and 850 GHz, CMBPol will not only improve this picture by observing the synchrotron emission from our galaxy, but also help constrain dust models. Polarized emission from interstellar dust indeed dominates over any other signal in CMBPol's highest frequency channels. Observations at these wavelengths, combined with ground-based studies of starlight polarization, will therefore enable us to improve our understanding of dust properties and of the mechanism(s) responsible for the alignment of dust grains with the Galactic magnetic field. CMBPol will also shed new light on observations that are presently not well understood. Morphological studies of anomalous dust and synchrotron emissions will indeed constrain their natures and properties, while searching for fluctuations in the emission from heliospheric dust will test our understanding of the circumheliospheric interstellar medium. Finally, acquiring more information on the properties of extra-Galactic sources will be necessary in order to maximize the cosmological constraints extracted from CMBPol's observations of CMB lensing. (abridged)Comment: 43 pages, 7 figures, 2 table

Future Opportunities for Research in Rescue Treatments

Clinical studies of rescue medications for seizure clusters are limited and are designed to satisfy regulatory requirements, which may not fully consider the needs of the diverse patient population that experiences seizure clusters or utilize rescue medication. The purpose of this narrative review is to examine the factors that contribute to, or may influence the quality of, seizure cluster research with a goal of improving clinical practice. We address five areas of unmet needs and provide advice for how they could enhance future trials of seizure cluster treatments. The topics addressed in this article are: (1) unaddressed end points to pursue in future studies, (2) roles for devices to enhance rescue medication clinical development programs, (3) tools to study seizure cluster prediction and prevention, (4) the value of other designs for seizure cluster studies, and (5) unique challenges of future trial paradigms for seizure clusters. By focusing on novel end points and technologies with value to patients, caregivers, and clinicians, data obtained from future studies can benefit the diverse patient population that experiences seizure clusters, providing more effective, appropriate care as well as alleviating demands on health care resources

Hairy Black Holes in String Theory

Solutions of bosonic string theory are constructed which correspond to four-dimensional black holes with axionic quantum hair. The basic building blocks are the renormalization group flows of the CP1 model with a theta term and the SU(1,1)/U(1) WZW coset conformal field theory. However the solutions are also found to have negative energy excitations, and are accordingly expected to decay to the vacuum.Comment: 14 pages (References added

The cosmic web for density perturbations of various scales

We follow the evolution of galaxy systems in numerical simulation. Our goal is to understand the role of density perturbations of various scales in the formation and evolution of the cosmic web. We perform numerical simulations with the full power spectrum of perturbations, and with spectrum cut at long wavelengths. Additionally, we have one model, where we cut the intermediate waves. We analyze the density field and study the void sizes and density field clusters in different models. Our analysis shows that the fine structure (groups and clusters of galaxies) is created by small-scale density perturbations of scale $\leq 8$ \Mpc. Filaments of galaxies and clusters are created by perturbations of intermediate scale from $\sim 8$ to $\sim 32$ \Mpc, superclusters of galaxies by larger perturbations. We conclude that the scale of the pattern of the cosmic web is determined by density perturbations of scale up to $\sim 100$ \Mpc. Larger perturbations do not change the pattern of the web, but modulate the richness of galaxy systems, and make voids emptier. The stop of the increase of the scale of the pattern of the cosmic web with increasing scale of density perturbations can probably be explained as the freezing of the web at redshift $z\simeq 0.7$.Comment: 12 pages, 7 figures, accepted for publication in Astronomy and Astrophysic