Optimizing epilepsy treatment in children, adults and elderly: clinical perspectives

Epilepsy is a common neurological condition among all age groups. Its diagnosis depends on clinical history and is supported by investigations like electroencephalograph and magnetic resonance imaging. In children, febrile seizures and juvenile myoclonic seizures are common. In adults and elderly, epilepsy could be new onset or present since childhood. Several antiseizure medications (ASMs) are available for treatment of epilepsy. Each of these drugs has different advantages as well as limitations. Several factors including patient related factors (e. g. age, comorbidities, and gender), seizure characteristics and epilepsy type, and drug related factors (namely, pharmacokinetics, pharmacodynamics, efficacy, side effects, and risk of drug-drug interactions) are considered while selecting drug therapy. There are concerns related to teratogenicity due to pharmacotherapy in females of child-bearing potential. Elderly patients also need special considerations while selecting an appropriate treatment option for epilepsy. Advisory board meetings with a group of expert neurologists were conducted at eight cities across India to gain clinical insights on management of epilepsy in different age groups. Consensus was supported by relevant literature obtained from PubMed and Google scholar using the keywords ‘epilepsy’, ‘diagnosis’, ‘children’, ‘adults’, ‘elderly’, and ‘management’. According to the experts, choice of appropriate ASM is driven by patient- and drug-related factors and seizure characteristics. In India, valproate remains a commonly prescribed agent except in females of childbearing age. Levetiracetam is preferred because of its safety profile whereas clobazam is an effective initial add-on therapy. Newer drugs are largely useful as adjuvants

Impact of Laboratory Practices on Interlaboratory Variability in Therapeutic Drug Monitoring of Immunosuppressive Drugs

The immunosuppressants cyclosporine, tacrolimus, sirolimus, everolimus, and probably also mycophenolic acid require therapeutic drug monitoring (TDM)-guided dosing to ensure that blood concentrations are kept within the target range in transplant patients. Reliable, accurate, and precise test methods are therefore essential to effectively monitor levels and to make proper dose adjustments. Data from proficiency testing programs have shown substantial interlaboratory variability. Only few attempts have been made to study the underlying causes. The aim of this study was to systematically document current practices used for immunosuppressant drug TDM in clinical laboratories and identify methodological and practice differences, which may cause the variability observed among laboratories. Data collection was primarily conducted by a structured Web-based survey. Invitations to participate in the survey were distributed to clinical laboratories providing immunosuppressant drug TDM. Surveys were completed by 76 laboratories in 14 countries. The results of our survey suggest that there are 3 main reasons for interlaboratory variability: (1) lack of standardization of laboratory procedures and workflows starting with sample collection and handling, (2) lack of use of appropriate reference materials (eg, isotope-labeled internal standards for liquid chromatography-tandem mass spectroscopy), and (3) poor compliance with internationally accepted good laboratory practice guidelines (eg, related to quality control, quality assurance, validation, training of personnel). The results of the survey also suggest that interlaboratory variability is a multifactorial problem. Technical-level consensus on laboratory operational procedures, quality systems, and personnel training will be of great importance to improve quality and interlaboratory comparability

Nanowires in electronics packaging

In the light of continuous miniaturization of traditional microelectronic components, the demand for decreasing wire diameters becomes immediately evident. The observation of metallic conductor properties for certain configurations of carbon nanotubes (CNT) and their current-carrying capability [1] sets the minimal diameter of a “true” wire to about 3 nm (compare Chap. 18). Investigations are in progress even below that diameter on nanocontacts, formed by single metal atoms, i.e. quantum wires. Quantum wires can be produced by mechanical wire breaking [2] or its combination with etching and deposition [3] or other techniques. The properties of quantum wires are only about to be understood theoretically [4]. Doubtless, they are worth considering for packaging solutions in molecular electronics to come [5]. In this chapter we focus on metal wires and rods in the size range above 10 nm up to submicron diameters, evaluated already to be attractive for microelectronic packaging purposes. Techniques to generate, to characterize and to handle them, as well as their interaction with electromagnetic fields will be useful for packaging applications in the age of nanotechnology. With the wealth of information available, this review focuses on general trends and starting points for deeper study. Although the cited references are representative, they cannot be complete, since numerous activities are still ongoing to produce and to characterize new kinds of wire-like geometries from different materials