Clinical characteristics associated with psychosocial functioning among patients with uncomplicated epilepsy in Spain

Objective To identify the clinical characteristics associated with poor psychosocial functioning among Spanish patients with epilepsy but no other neurological or psychiatric disorder. Methods Between May and September 2001 a survey among patients with epilepsy was carried out in 32 Spanish health care centres. The selection criteria of patients were attendance to a routine neurologist visit, to be aged between 25 and 64 and not having another additional neurological handicap (n = 812). Psychosocial function was elicited through six indicators: educational level, marital status, unemployment status, restricted car driving, self-perception of epilepsy as an important limiting factor in the educational level achieved and, among unemployed, as the cause of their unemployment. Multiple logistic regression models were fitted in order to calculate adjusted odds ratios (aOR) and their 95% confidence intervals. Results After simultaneously adjusting for socio-demographic variables and clinical characteristics, the six outcomes analysed increased with seizure frequency. Moreover, all the outcomes except low educational level were also related to early age at onset of epilepsy. Although no relation with objective educational level was found, there was a strong association between early age at onset of symptoms and self-perception of epilepsy as an important limiting factor of educational achievement. Conclusion These findings emphasize the need for more effective treatment of epilepsy and also highlight the importance of a psychosocial approach to management of epilepsy for patients with an early onset of symptoms in order to prevent social limitations in adult lif

Detección de nuevas estructuras arqueológicas a partir de LIDAR aéreo en El Shincal de Quimivil

Con el objetivo de profundizar estudios sobre la existencia de nuevos restos arqueológicos en las inmediaciones del sitio El Shincal de Quimivil (Londres, Catamarca, Argentina), se utilizó por primera vez en Argentina tecnología LIDAR aérea. Este importante yacimiento arqueológico es conocido como la capital regional Inka del Noroeste argentino; considerado por algunos investigadores como un “Nuevo Cusco”. El vuelo LIDAR cubrió el pie de monte de las sierras de Zapata, del Shincal y Belén, entre los sitios de El Shincal de Quimivil, Paraje La Aguada y los Tambillos de Zapata. Las 3000 ha relevadas están cubiertas casi completamente por vegetación densa que impide la detección visual de lo que hay por debajo de la misma.Facultad de Ciencias Astronómicas y Geofísica

Detección de nuevas estructuras arqueológicas a partir de LIDAR aéreo en El Shincal de Quimivil

Con el objetivo de profundizar estudios sobre la existencia de nuevos restos arqueológicos en las inmediaciones del sitio El Shincal de Quimivil (Londres, Catamarca, Argentina), se utilizó por primera vez en Argentina tecnología LIDAR aérea. Este importante yacimiento arqueológico es conocido como la capital regional Inka del Noroeste argentino; considerado por algunos investigadores como un “Nuevo Cusco”. El vuelo LIDAR cubrió el pie de monte de las sierras de Zapata, del Shincal y Belén, entre los sitios de El Shincal de Quimivil, Paraje La Aguada y los Tambillos de Zapata. Las 3000 ha relevadas están cubiertas casi completamente por vegetación densa que impide la detección visual de lo que hay por debajo de la misma.Facultad de Ciencias Astronómicas y Geofísica

Add-on cannabidiol treatment for drug-resistant seizures in tuberous sclerosis complex

Importance Efficacy of cannabidiol has been demonstrated in seizures associated with Lennox-Gastaut and Dravet syndromes but appears not yet to have been established in conditions with primarily focal seizures, such as tuberous sclerosis complex (TSC).Objective To evaluate efficacy and safety of 25-mg/kg/day and 50-mg/kg/day cannabidiol dosages vs placebo against seizures associated with TSC.Design, Setting, and Participants This double-blind, placebo-controlled randomized clinical trial (GWPCARE6) enrolled patients between April 6, 2016, and October 4, 2018; follow-up was completed on February 15, 2019. The trial was conducted at 46 sites in Australia, Poland, Spain, the Netherlands, United Kingdom, and United States. Eligible patients (aged 1-65 years) were those with a clinical diagnosis of TSC and medication-resistant epilepsy who had had at least 8 TSC-associated seizures during the 4-week baseline period, with at least 1 seizure occurring in at least 3 of the 4 weeks, and were currently taking at least 1 antiepileptic medication.Interventions Patients received oral cannabidiol at 25 mg/kg/day (CBD25) or 50 mg/kg/day (CBD50) or a matched placebo for 16 weeks.Main Outcomes and Measures The prespecified primary outcome was the change from baseline in number of TSC-associated seizures for cannabidiol vs placebo during the treatment period.Results Of 255 patients screened for eligibility, 31 were excluded and 224 were randomized. Of the 224 included patients (median [range] age, 11.4 [1.1-56.8] years; 93 female patients [41.5%]), 75 were randomized to CBD25, 73 to CBD50, and 76 to placebo, with 201 completing treatment. The percentage reduction from baseline in the type of seizures considered the primary end point was 48.6% (95% CI, 40.4%-55.8%) for the CBD25 group, 47.5% (95% CI, 39.0%-54.8%) for the CBD50 group, and 26.5% (95% CI, 14.9%-36.5%) for the placebo group; the percentage reduction from placebo was 30.1% (95% CI, 13.9%-43.3%; P < .001) for the CBD25 group and 28.5% (95% CI, 11.9%-42.0%; nominal P = .002) for the CBD50 group. The most common adverse events were diarrhea (placebo group, 19 [25%]; CBD25 group, 23 [31%]; CBD50 group, 41 [56%]) and somnolence (placebo group, 7 [9%]; CBD25 group, 10 [13%]; CBD50 group, 19 [26%]), which occurred more frequently with cannabidiol than placebo. Eight patients in CBD25 group, 10 in CBD50 group, and 2 in the placebo group discontinued treatment because of adverse events. Twenty-eight patients taking cannabidiol (18.9%) had elevated liver transaminase levels vs none taking placebo.Conclusions and Relevance Cannabidiol significantly reduced TSC-associated seizures compared with placebo. The 25-mg/kg/day dosage had a better safety profile than the 50-mg/kg/day dosage

Rufinamide for the treatment of Lennox-Gastaut syndrome: evidence from clinical trials and clinical practice

Rufinamide was granted orphan drug status in 2004 for the adjunctive treatment of seizures associated with Lennox-Gastaut syndrome in patients aged 654 years, and was subsequently approved for this indication in several countries, including Europe and the United States. Structurally unrelated to other antiepileptic drugs, rufinamide is thought to act primarily by prolonging the inactivation phase of voltage-gated sodium channels. Rufinamide was approved on the basis of an international, randomised, placebo-controlled Phase III trial, conducted in 138 patients with Lennox-Gastaut syndrome, which demonstrated its favourable tolerability profile and efficacy in significantly reducing the frequency of drop attacks and total seizures, compared with placebo. The effectiveness and safety/tolerability of rufinamide in treating seizures associated with Lennox-Gastaut syndrome have subsequently been confirmed in several other clinical trials and long-term extension studies. These findings are supported by \u2018real-world\u2019 data from a series of clinical practice studies conducted in Europe, the United States, and Korea. Rufinamide has been shown to be effective and generally well tolerated in children as young as one year and in adults. It is particularly effective as treatment for drop attacks and generalised tonic-clonic seizures, and it has been suggested that it might be preferred over other antiepileptic drugs as a second-line treatment for Lennox-Gastaut syndrome when drop attacks are frequent. The most common side effects of rufinamide treatment include somnolence, headache, dizziness, nausea, vomiting, and fatigue. No new or unexpected safety signals have emerged following long-term treatment with rufinamide, either in clinical trials or in clinical practice

First case of delayed ivermectin peripheral neuropathy

Résumé de la communication accessible dans le Fundamental & Clinical Pharmacology, n°19 issue 2 (2005), p.234International audienc

Autobiographical memory in epileptic patients after temporal lobe resection or bitemporal hippocampal sclerosis

Contains fulltext : 219449.pdf (Publisher’s version ) (Closed access)The human hippocampus is believed to be a crucial node in the neural network supporting autobiographical memory retrieval. Structural mesial temporal damage associated with temporal lobe epilepsy (TLE) provides an opportunity to systematically investigate and better understand the local and distal functional consequences of mesial temporal damage in the engagement of the autobiographical memory network. We examined 19 TLE patients (49.21 ± 11.55 years; 12 females) with unilateral mesial TLE (MTLE; 12 with anterior temporal lobe resection: 6 right MTLE, 6 left MTLE) or bilateral mesial TLE (7 BMTLE) and 18 matched healthy subjects. We used functional MRI (fMRI) with an adapted autobiographical memory paradigm and a specific neuropsychological test (Autobiographical Memory Interview, AMI). While engaged in the fMRI autobiographical memory paradigm, all groups activated a large fronto-temporo-parietal network. However, while this network was left lateralized for healthy participants and right MTLE patients, left MTLE and patients with BMTLE also showed strong activation in right temporal and frontal regions. Moreover, BMTLE and left MTLE patients also showed significant mild deficits in episodic autobiographical memory performance measured with the AMI test. The right temporal and extra-temporal fMRI activation, along with the impairment in autobiographical memory retrieval found in left MTLE and BMTLE patients suggest that alternate brain areas - other than the hippocampus - may also support this process, possibly due to neuroplastic effects.15 p

Cortical laminar necrosis related to prolonged focal status epilepticus

Cortical laminar necrosis (CLN) is radiologically defined as high intensity cortical lesions on T1 weighted MRI images following a gyral distribution. Histopathologically, CLN is characterised by pannecrosis of the cortex involving neurones, glial cells, and blood vessels. It has been reported to be associated with hypoxia, metabolic disturbances, drugs, and infections. We present two patients who developed CLN and permanent neurological deficits after prolonged and repeated focal status epilepticus. The possible mechanisms leading to CLN in these patients are discussed, together with the implications of prompt and aggressive treatment in similar cases