Vagus Nerve Stimulation in Refractory Epilepsy: Effects on Pro- and Anti-Inflammatory Cytokines in Peripheral Blood

Objective: The vagus nerve has important immunological functions that may be relevant for its anticonvulsive action. We postulate that this anticonvulsive action is activated by a shift in the immune system resulting in a reduction of neurotoxic and an increase of neuroprotective tryptophan metabolites. Methods: Eleven patients with refractory epilepsy and 11 controls matched for age and gender were included in this study. The primary outcome measure was a 50% seizure reduction. Other variables were pro-inflammatory cytokines IL-6 and TNF-alpha, anti-inflammatory cytokine IL-10, cortisol, and the tryptophan metabolites 3-hydroxykynurenine (3-OH-KYN), kynurenic acid (KYNA), kynurenine, serotonin (5-HT) and 5-hydroxyindol acetic acid (5-HIAA). Blood samples were scheduled during baseline, and in week 28 of add-on treatment. Results: IL-6 levels were higher in the responders than in the control group, and decreased after vagus nerve stimulation (VNS), whereas IL-10 was low and increased after VNS. In nonresponders, VNS resulted in an increase of IL-6 plasma levels and in a decrease of IL-10. Cortisol concentrations are higher in the epilepsy group than in the control group. After VNS, these concentrations decreased. The concentrations of the tryptophan metabolites were lower in the epilepsy group than in the control group. The KYNA ratios are defined as the ratio of neuroprotective KYNA versus neurotoxic 3-OH-KYN and KYNA versus neurotoxic kynurenine: these ratios were lower in epilepsy patients than in controls, and they both moderately increased after VNS. Conclusion: The outcome of this preliminary study indicates that VNS causes a rebalancing of the immune system. This results in: (1) a reduction of neurotoxic and an increase of neuroprotective kynurenine metabolites and (2) in the normalization of cortisol levels. Copyright (C) 2010 S. Karger AG, Base

Interplays of psychometric abilities on learning gross anatomy

In recent years, there has been international debate concerning how students learn anatomy. The rapid increase in scientific knowledge has put pressure on the place of anatomy within the medical and allied health professional curricula, as well as the design and structure of anatomy courses. In this regard, relatively little is known about what medical and allied health professions students want from an anatomy course or how they learn it. To assess students’ learning approaches and perceptions of anatomy, a series of psychometric tests were administered to Medical (n=82), Podiatry (n=21), and Pharmacy (n=74) students in the United Kingdom. Analysis of the Anatomy Learning Experience (ALE) questionnaire revealed a predominantly positive attitude towards anatomy and the dissection room, with most valuing cadaveric dissection and not regarding it as a daunting environment. Further to this, analysis of the Approaches to Studying Inventory for Students (ASSIST) revealed predominant preferences for strategic and deep approaches. Personality traits were associated with certain learning approaches; neuroticism with surface (p=0.038), conscientiousness with both a deep and strategic approach (p=0.000 and p=0.060 respectively). Certain personality traits were also found to be associated with anatomy experience e.g. neuroticism and achievement striving felt the most effective way to learn was to get their hands in and feel for structures (p=0.044 and p=0.012 respectively). This study concludes that undergraduate students of medicine, podiatry and pharmacy learn anatomy in slightly different ways. Preparation for classroom activities should centre on the promotion of an optimum learning environment and teaching strategies which promote a deep approach to learning. Understanding students’ personality and learning experiences should help teachers improve the students’ learning of anatomy for effective application to clinical practice

Bone mineral density and fractures in institutionalised children with epilepsy and intellectual disability

Background Long-term use of antiseizure drugs is associated with a low bone mineral density (BMD) and an increased fracture risk. The literature regarding institutionalised children on chronic antiseizure drugs is limited. Therefore, the aim of this cross-sectional study is to evaluate the prevalence of low BMD and the history of fractures in institutionalised children with epilepsy and intellectual disability (ID). Methods A dual-energy X-ray absorptiometry of lumbar spine (L1-L4) and hip was performed in 24 children, residing in a long-stay care facility in the Netherlands. Additionally, serum concentrations of albumin, calcium and 25-hydroxyvitamin D were determined. Data on fractures were retrospectively extracted from the medical files. Results Ages of the children (14 male and 10 female) ranged from 5 to 17 years with a mean age of 13.0 (+/- 3.2). The criteria of the International Society for Clinical Densitometry (ISCD) were used for classification of bone mineral disorders. Eight (33.3%) children had a normal BMD (Z-score > - 2.0). Of the 16 children with a low BMD (Z-score <= - 2.0), three were diagnosed as osteoporotic, based on their fracture history. Ten children (41.7%) were reported to have at least one fracture in their medical history. Serum concentrations of albumin-corrected calcium (2.28-2.50 mmol/L) and (supplemented) vitamin D (16-137 nmol/L) were within the normal range. Conclusions This study demonstrated that 67% of institutionalised children with epilepsy and ID had low BMD and 42% had a history of at least one fracture, despite supplementation of calcium and vitamin D in accordance with the Dutch guidelines