Efficacy of Perampanel in Nocturnal Seizures in Adult Patients with Epilepsy

Perampanel; Nocturnal seizures; EpilepsyPerampanel; Convulsiones nocturnas; EpilepsiaPerampanel; Convulsions nocturnes; EpilèpsiaObjective. Nocturnal seizures are usually underestimated and represent a major problem in adult patients with epilepsy. Our aim was to study the effectiveness of perampanel for the treatment of nocturnal seizures in adult patients with epilepsy. Methods. Observational study of a prospectively acquired sample of adult patients with focal and generalized epilepsy in which perampanel was started from January to October 2021 in a specialized epilepsy unit in a tertiary hospital. Demographic and clinical characteristics were recorded. All patients completed a follow-up period of at least 3 months. Seizure frequency during the 6-month period before the patient started treatment was obtained from medical records. Retention and responder rates (considered as a nocturnal seizure frequency reduction of ≥50%) and improvement of subjective sleep disturbances were analyzed as outcome measures. Results. Forty-eight patients were included (mean age 39 8 ± 17 4; 60.4% men), and 38 of them had a 6-month follow-up. Focal epilepsy was the most common diagnosis (81.3%), and most patients had a structural etiology (56.3%). Thirty-four (70.8%) patients had drug-resistant epilepsy. The mean nocturnal seizure frequency per month at baseline was 13 2 ± 35 9. Fifteen (31.3%) patients had subjective sleep disturbances at baseline, of which insomnia was the most frequent complaint (16.7%). Perampanel was started at a median dose of 4 mg/day (range = 2-14). At 3-month followup, the retention rate was 74.6%; 64.6% were considered responders (54.2% were seizure-free). Monthly nocturnal seizures decreased significantly at 3 months (8 2 ± 26 7 vs. 13 2 ± 35 9 seizures/month; p = 0 044) and 6 months (5 3 ± 18 2 vs. 13 2 ± 35 9 seizures/month; p = 0 006). Subjective sleep disturbances improved at 3-month follow-up (10.4% vs. 31.3%; p = 0 002) and 6-month follow-up (10.5% vs. 31.3%; p = 0 022). Significance. Perampanel can be a suitable treatment option in adult patients with both focal and generalized epilepsy with nocturnal seizures and can reduce the presence of sleep complaints.This study was funded by Eisai Inc

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

Headache : A striking prodromal and persistent symptom, predictive of COVID-19 clinical evolution

To define headache characteristics and evolution in relation to COVID-19 and its inflammatory response. This is a prospective study, comparing clinical data and inflammatory biomarkers of COVID-19 patients with and without headache, recruited at the Emergency Room. We compared baseline with 6-week follow-up to evaluate disease evolution. Of 130 patients, 74.6% (97/130) had headache. In all, 24.7% (24/97) of patients had severe pain with migraine-like features. Patients with headache had more anosmia/ageusia (54.6% vs. 18.2%; p < 0.0001). Clinical duration of COVID-19 was shorter in the headache group (23.9 ± 11.6 vs. 31.2 ± 12.0 days; p = 0.028). In the headache group, IL-6 levels were lower at the ER (22.9 (57.5) vs. 57.0 (78.6) pg/mL; p = 0.036) and more stable during hospitalisation. After 6 weeks, of 74 followed-up patients with headache, 37.8% (28/74) had ongoing headache. Of these, 50% (14/28) had no previous headache history. Headache was the prodromal symptom of COVID-19 in 21.4% (6/28) of patients with persistent headache (p = 0.010). Headache associated with COVID-19 is a frequent symptom, predictive of a shorter COVID-19 clinical course. Disabling headache can persist after COVID-19 resolution. Pathophysiologically, its migraine-like features may reflect an activation of the trigeminovascular system by inflammation or direct involvement of SARS-CoV-2, a hypothesis supported by concomitant anosmia

Skull fractures by glass bottles tested on cadaveric heads

Head trauma is frequently related to the misuse of drinking vessels as weapons. Forensic reports usually evaluate these blunt injuries as having occurred in scenarios where the alcohol intake is high. Fatal consequences are seen in blows with glass bottles aiming at the head. To prove the outcome that a glass bottle thrown to the head could cause, three intact human cadaver heads were impacted with 1-liter glass bottles at 9.5 m/s using a drop-tower. The impact location covered the left temporal bone, sphenoid bone, and zygomatic arch. The contact between the head and the bottle was produced at an angle of 90° with (1) the valve of the bottle, (2) the bottom of the bottle, and (3) with the head rotated 20° in the frontal plane touching again with the bottom of the bottle. The three bottles remained intact after the impact, and the injury outcomes were determined by computed tomography (CT). The alterations were highly dependent on the impact orientation. The outcome varied from no injury to severe bone fractures. In the most injurious case (#3), fractures were identified in the cranial base, sphenoid bone, and zygomatic bone. These testing conditions were selected to replicate one specific legal case, as required by the plaintiff. Physical disputes with bar glassware can lead to complex combinations of blunt and sharp-force injuries. Controlled biomechanical studies can benefit forensic analyses of violence involving glassware by providing a better understanding of the underlying injury mechanisms

Visiones de la educación financiera: Análisis y perspectivas

"Visiones de la educación financiera: análisis y perspectivas es una obra que enmarca la importancia de la educación financiera en la sociedad en el contexto actual. Las decisiones que en este tema realiza un individuo pueden impactar positiva o negativamente su estabilidad económica por un periodo indeterminado, es aquí cuando la educación financiera actúa como una herramienta trascendental en su bienestar personal. Además de tener la función de armadura ante las batallas que se libran en los mercados —como la crisis financiera de 2008— funge como dinamizador de las economías al potenciar los proyectos de inversión con el aumento del emprendedurismo, impactando así en las variables macroeconómicas. Esta área del conocimiento ha adquirido importancia y popularidad a nivel internacional a raíz de las crisis económicas de los últimos años, sin embargo, aún existen, entre otras, brechas sociodemográficas, culturales, económicas, que no permiten el acceso a estas enseñanzas, excluyendo parte de la población del proceso del bienestar económico. Para ejemplificar esta desigualdad, en los capítulos se plasma un panorama internacional de la educación financiera, considerando las implicaciones y retos que han tenido las estrategias nacionales de educación financiera a nivel mundial"

Humoral and Cellular Responses to SARS-CoV-2 in Convalescent COVID-19 Patients With Multiple Sclerosis

Information about humoral and cellular responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and antibody persistence in convalescent (COVID-19) patients with multiple sclerosis (PwMS) is scarce. The objectives of this study were to investigate factors influencing humoral and cellular responses to SARS-CoV-2 and its persistence in convalescent COVID-19 PwMS. This is a retrospective study of confirmed COVID-19 convalescent PwMS identified between February 2020 and May 2021 by SARS-CoV-2 antibody testing. We examined relationships between demographics, MS characteristics, disease-modifying therapy (DMT), and humoral (immunoglobulin G against spike and nucleocapsid proteins) and cellular (interferon-gamma [IFN-γ]) responses to SARS-CoV-2. A total of 121 (83.45%) of 145 PwMS were seropositive, and 25/42 (59.5%) presented a cellular response up to 13.1 months after COVID-19. Anti-CD20-treated patients had lower antibody titers than those under other DMTs (p < 0.001), but severe COVID-19 and a longer time from last infusion increased the likelihood of producing a humoral response. IFN-γ levels did not differ among DMT. Five of 7 (71.4%) anti--CD20-treated seronegative patients had a cellular response. The humoral response persisted for more than 6 months in 41/56(81.13%) PwMS. In multivariate analysis, seropositivity decreased due to anti-CD20 therapy (OR 0.08 [95% CI 0.01-0.55]) and increased in males (OR 3.59 [1.02-12.68]), whereas the cellular response decreased in those with progressive disease (OR 0.04 [0.001-0.88]). No factors were associated with antibody persistence. Humoral and cellular responses to SARS-CoV-2 are present in COVID-19 convalescent PwMS up to 13.10 months after COVID-19. The humoral response decreases under anti-CD20 treatment, although the cellular response can be detected in anti-CD20-treated patients, even in the absence of antibodie

Design and implementation of support and planning for 360º recording. Recording techniques (video and audio) and problem solving: application to the recording of institutional and popular science videos. Part III

Proyecto de Innovación Docente que se ha traducido en empleabiliad de alguno de los alumnos participantesLa grabación 360º está introduciendo variaciones sustanciales en la forma de narrar y producir contenidos audiovisuales. La posibilidad de sumergir al espectador en un entorno totalmente inmersivo en el que cada punto de vista de atención es seleccionado por el propio espectador, implica un cambio de paradigma en el papel que ejerce el director o realizador como creador y narrador de los acontecimientos. Pero, en todo lo relacionado con la producción audiovisual, el dominio de la tecnología es fundamental para llegar a la excelencia. Resulta fundamental profundizar e investigar en todas las posibilidades técnicas antes de aplicarlo al mundo profesional. Llevamos trabajando desde el curso 2018-2019 en diseñar un protocolo que permita planificar creaciones de grabación 360º tanto en lo relacionado con el vídeo como con el audio. En el curso anterior, establecimos un protocolo y empezamos a colaborar con el proyecto nº 262 Innova-Docencia, “liderado por la profesora Dña. Teresa García Nieto, en el proyecto ‘Científic@s en prácticas’ mediante un convenio con el CSIC. El objetivo es crear producciones audiovisuales en 360º que divulguen la labor desarrollada en el organismo, integrando a los alumnos del Grado de Comunicación Audiovisual, con el objetivo de que aprendan esta técnica de grabación e implementen nuevas fórmulas narrativas asociadas a la misma. El proyecto ‘Científic@s en prácticas’ consiste en tratar de captar científicos entre alumnos preuniversitarios, por lo que creemos que la producción audiovisual puede servir de estímulo para que estos alumnos de la ESO puedan comprender la naturaleza de los objetivos del proyecto en el que participan. El proyecto resulta innovador por dos motivos principales: a) el alumnado aprende directamente sobre un proyecto real la aplicación de nuevas tecnologías de producción audiovisual y b) aprenden a elaborar protocolos mediante el aprendizaje de metodologías de investigación derivadas de aplicaciones y estudios sobre el proceso. Además, dada la novedad de esta tecnología 360º, ninguna asignatura del Grado de Comunicación Audiovisual aborda esta materia entre sus contenidos.360º filming is introducing substantial variations in the way audiovisual content is narrated and produced. The possibility of immersing the viewer in a totally immersive environment in which each point of view is selected by the viewer, implies a paradigm shift in the role of the director or producer as the creator and narrator of events. But, in everything related to audiovisual production, the mastery of technology is fundamental in order to achieve excellence. It is essential to delve into and investigate all the technical possibilities before applying it to the professional world. Since the 2018-2019 academic year, we have been working on designing a protocol that allows us to plan 360º recording creations both in terms of video and audio. In the previous academic year, we established a protocol and began to collaborate with project no. 262 Innova-Docencia, "led by the teacher Ms. Teresa García Nieto, in the project 'Científic@s en prácticas' through an agreement with the CSIC. The aim is to create 360º audiovisual productions that disseminate the work carried out in the organisation, integrating the students of the Audiovisual Communication Degree, with the objective that they learn this recording technique and implement new narrative formulas associated with it. The 'Scientists in practice' project consists of trying to recruit scientists among pre-university students, so we believe that audiovisual production can serve as a stimulus for these ESO students to understand the nature of the objectives of the project in which they are participating. The project is innovative for two main reasons: a) the students learn directly on a real project the application of new audiovisual production technologies and b) they learn to develop protocols by learning research methodologies derived from applications and studies on the process. Moreover, given the novelty of this 360º technology, no other subject in the Audiovisual Communication Degree includes this subject among its contents.Depto. de Ciencias de la Comunicación AplicadaFac. de Bellas ArtesFac. de Ciencias de la InformaciónFALSEsubmitte

Risk of recurrence after discontinuing anticoagulation in patients with COVID-19- associated venous thromboembolism: a prospective multicentre cohort studyResearch in context

Background: The clinical relevance of recurrent venous thromboembolism (VTE) after discontinuing anticoagulation in patients with COVID-19-associated VTE remains uncertain. We estimated the incidence rates and mortality of VTE recurrences developing after discontinuing anticoagulation in patients with COVID-19-associated VTE. Methods: A prospective, multicenter, non-interventional study was conducted between March 25, 2020, and July 26, 2023, including patients who had discontinued anticoagulation after at least 3 months of therapy. All patients from the registry were analyzed during the study period to verify inclusion criteria. Patients with superficial vein thrombosis, those who did not receive at least 3 months of anticoagulant therapy, and those who were followed for less than 15 days after discontinuing anticoagulation were excluded. Outcomes were: 1) Incidence rates of symptomatic VTE recurrences, and 2) fatal PE. The rate of VTE recurrences was defined as the number of patients with recurrent VTE divided by the patient-years at risk of recurrent VTE during the period when anticoagulation was discontinued. Findings: Among 1106 patients with COVID-19-associated VTE (age 62.3 ± 14.4 years; 62.9% male) followed-up for 12.5 months (p25-75, 6.3–20.1) after discontinuing anticoagulation, there were 38 VTE recurrences (3.5%, 95% confidence interval [CI]: 2.5–4.7%), with a rate of 3.1 per 100 patient-years (95% CI: 2.2–4.2). No patient died of recurrent PE (0%, 95% CI: 0–7.6%). Subgroup analyses showed that patients with diagnosis in 2021–2022 (vs. 2020) (Hazard ratio [HR] 2.86; 95% CI 1.45–5.68) or those with isolated deep vein thrombosis (vs. pulmonary embolism) (HR 2.31; 95% CI 1.19–4.49) had significantly higher rates of VTE recurrences. Interpretation: In patients with COVID-19-associated VTE who discontinued anticoagulation after at least 3 months of treatment, the incidence rate of recurrent VTE and the case-fatality rate was low. Therefore, it conceivable that long-term anticoagulation may not be required for many patients with COVID-19-associated VTE, although further research is needed to confirm these findings. Funding: Sanofi and Rovi, Sanofi Spain

Risk of recurrence after discontinuing anticoagulation in patients with COVID-19- associated venous thromboembolism: a prospective multicentre cohort studyResearch in context

Summary: Background: The clinical relevance of recurrent venous thromboembolism (VTE) after discontinuing anticoagulation in patients with COVID-19-associated VTE remains uncertain. We estimated the incidence rates and mortality of VTE recurrences developing after discontinuing anticoagulation in patients with COVID-19-associated VTE. Methods: A prospective, multicenter, non-interventional study was conducted between March 25, 2020, and July 26, 2023, including patients who had discontinued anticoagulation after at least 3 months of therapy. All patients from the registry were analyzed during the study period to verify inclusion criteria. Patients with superficial vein thrombosis, those who did not receive at least 3 months of anticoagulant therapy, and those who were followed for less than 15 days after discontinuing anticoagulation were excluded. Outcomes were: 1) Incidence rates of symptomatic VTE recurrences, and 2) fatal PE. The rate of VTE recurrences was defined as the number of patients with recurrent VTE divided by the patient-years at risk of recurrent VTE during the period when anticoagulation was discontinued. Findings: Among 1106 patients with COVID-19-associated VTE (age 62.3 ± 14.4 years; 62.9% male) followed-up for 12.5 months (p25-75, 6.3–20.1) after discontinuing anticoagulation, there were 38 VTE recurrences (3.5%, 95% confidence interval [CI]: 2.5–4.7%), with a rate of 3.1 per 100 patient-years (95% CI: 2.2–4.2). No patient died of recurrent PE (0%, 95% CI: 0–7.6%). Subgroup analyses showed that patients with diagnosis in 2021–2022 (vs. 2020) (Hazard ratio [HR] 2.86; 95% CI 1.45–5.68) or those with isolated deep vein thrombosis (vs. pulmonary embolism) (HR 2.31; 95% CI 1.19–4.49) had significantly higher rates of VTE recurrences. Interpretation: In patients with COVID-19-associated VTE who discontinued anticoagulation after at least 3 months of treatment, the incidence rate of recurrent VTE and the case-fatality rate was low. Therefore, it conceivable that long-term anticoagulation may not be required for many patients with COVID-19-associated VTE, although further research is needed to confirm these findings. Funding: Sanofi and Rovi, Sanofi Spain