factors underlying the development of chronic temporal lobe epilepsy in autoimmune encephalitis

Abstract Purpose Limbic encephalitis (LE) is an autoimmune condition characterized by amnestic syndrome, psychiatric features and seizures. Early diagnosis and prompt treatment are crucial to avoid long-term sequelae, including psycho-cognitive deficits and persisting seizures. The aim of our study was to analyze the characteristics of 33 LE patients in order to identify possible prognostic factors associated with the development of chronic epilepsy. Methods This is a retrospective cohort study including adult patients diagnosed with LE in the period 2010–2017 and followed up for ≥12 months. Demographics, seizure semiology, EEG pattern, MRI features, CSF/serum findings were reviewed. Results All 33 LE patients (19 M/14F, mean age 61.2 years) presented seizures. Thirty subjects had memory deficits; 22 presented behavioural/mood disorders. Serum and/or CSF auto-antibodies were detected in 12 patients. In 31 subjects brain MRI at onset showed typical alterations involving temporal lobes. All patients received immunotherapy. At follow-up, 13/33 had developed chronic epilepsy; predisposing factors included delay in diagnosis (p = .009), low seizure frequency at onset (p = .02), absence of amnestic syndrome (p = .02) and absence/rarity of inter-ictal epileptic discharges on EEG (p = .06). Conclusions LE with paucisymptomatic electro-clinical presentation seemed to be associated to chronic epilepsy more than LE presenting with definite and severe "limbic syndrome"

Tenerezza della carne in relazione al collagene e alle modalità di cottura

Il grado di tenerezza della carne dipende dalla struttura delle proteine miofibrillari (tessitura), dal contenuto di collagene e dalla sua struttura, e dal contenuto di grasso intramuscolare (marbling). Il collagene è la proteina più abbondante negli organismi viventi e si ritrova abbondantemente anche nei muscoli scheletrici. E’ noto che un elevato contenuto di collagene provoca una perdita di tenerezza della carne; tuttavia, è ancora solo parzialmente stato chiarito il ruolo dai legami che si formano fra le fibre di collagene (cross-linking) durante il processo di crescita degli animali. Dal punto di vista strutturale è costituito da tre catene polipeptidiche disposte a tripla elica (catene-α). A livello muscolare sono presenti principalmente il collagene di tipo I e III che costituiscono rispettivamente l’epimisio ed il perimisio. Il fattore che determina il comportamento e la resistenza al trattamento con calore del collagene nella carne non sottoposta a cottura è essenzialmente rappresentato dall’entità e della tipologia di legami crociati presenti. Essi possono essere infatti sia termolabili che termostabili. I primi vengono rimossi velocemente dai trattamenti termici (es. 70°C per 10 minuti), mentre i secondi resistono anche a temperature di 80°C per 45 minuti. La quantità residua dei legami crociati termostabili in diverse speci animali dopo il trattamento termico, è uno dei fattori che incide significativamente sulla tenerezza della carne cotta. Altri fattori sono tuttavia coinvolti, quali ad esempio il tenore di grasso di marezzatura o la tipologia di trattamento termico. In particolare i diversi metodi di cottura e la combinazione tempo/temperatura possono modificare la quantità residua della frazione solubile ed insolubile di collagene, le perdite di cottura (cooking loss), e il grado di contrazione (shrinkage) delle miofibrille in corrispondenza di temperature maggiori di 65-70°C

Deep brain stimulation for intractabile epilepsy

Deep brain stimulation (DBS) is currently considered a promising neuromodulation therapy for refractory epilepsy not suitable for resective surgery. Several anatomical targets and different stimulation approaches have been proposed in order to obtain satisfactory seizures reduction. As expected, according with different patterns of neural pathways involvement, the efficacy of each anatomical target stimulation in reducing seizure frequency varies among the different epileptic syndromes

Levetiracetam vs Lamotrigine as First-Line Antiseizure Medication in Female Patients With Idiopathic Generalized Epilepsy

ImportanceAfter the recent limitations to prescribing valproate, many studies have highlighted the challenging management of female patients of reproductive age with idiopathic generalized epilepsy (IGE). However, no study, to the authors' knowledge, has addressed the comparative effectiveness of alternative antiseizure medications (ASMs) in these patients.ObjectiveTo compare the effectiveness and safety of levetiracetam and lamotrigine as initial monotherapy in female patients of childbearing age with IGE.Design, Setting, and ParticipantsThis was a multicenter, retrospective, comparative effectiveness cohort study analyzing data from patients followed up from 1994 to 2022. Patients were recruited from 22 primary, secondary, and tertiary adult and child epilepsy centers from 4 countries. Eligible patients were female individuals of childbearing age, diagnosed with IGE according to International League Against Epilepsy (2022) criteria and who initiated levetiracetam or lamotrigine as initial monotherapy. Patients were excluded due to insufficient follow-up after ASM prescription.ExposuresLevetiracetam or lamotrigine as initial monotherapy.Main Outcomes and MeasuresInverse probability of treatment weighting (IPTW)-adjusted Cox proportional hazards regression was performed to compare treatment failure (TF) among patients who received levetiracetam or lamotrigine as initial monotherapy.ResultsA total of 543 patients were included in the study, with a median (IQR) age at ASM prescription of 17 (15-21) years and a median (IQR) follow-up of 60 (24-108) months. Of the study population, 312 patients (57.5%) were prescribed levetiracetam, and 231 (42.5%) were prescribed lamotrigine. An IPTW-adjusted Cox model showed that levetiracetam was associated with a reduced risk of treatment failure after adjustment for all baseline variables (IPTW-adjusted hazard ratio [HR], 0.77; 95% CI, 0.59-0.99; P = .04). However, after stratification according to different IGE syndromes, the higher effectiveness of levetiracetam was confirmed only in patients with juvenile myoclonic epilepsy (JME; IPTW-adjusted HR, 0.47; 95% CI, 0.32-0.68; P < .001), whereas no significant differences were found in other syndromes. Patients treated with levetiracetam experienced adverse effects more frequently compared with those treated with lamotrigine (88 of 312 [28.2%] vs 42 of 231 [18.1%]), whereas the 2 ASMs had similar retention rates during follow-up (IPTW-adjusted HR, 0.91; 95% CI, 0.65-1.23; P = .60).Conclusions and RelevanceResults of this comparative effectiveness research study suggest the use of levetiracetam as initial alternative monotherapy in female patients with JME. Further studies are needed to identify the most effective ASM alternative in other IGE syndromes