Classification of complications of epilepsy surgery and invasive diagnostic procedures: A proposed protocol and feasibility study

Objective: In epilepsy surgery, which aims to treat seizures and thereby to improve the lives of persons with drug-resistant epilepsy, the chances of attaining seizure relief must be carefully weighed against the risks of complications and expected adverse events. The interpretation of data regarding complications of epilepsy surgery and invasive diagnostic procedures is hampered by a lack of uniform definitions and method of data collection. Methods: Based on a review of previous definitions and classifications of complications, we developed a proposal for a new classification. This proposal was then subject to revisions after expert opinion within E-pilepsy, an EU-funded European pilot network of reference centers in refractory epilepsy and epilepsy surgery, later incorporated into the ERN (European Reference Network) EpiCARE. This version was discussed with recognized experts, and a final protocol was agreed to after further revision. The final protocol was evaluated in practical use over 1 year in three of the participating centers. One hundred seventy-four consecutive procedures were included with 35 reported complications. Results: This report presents a multidimensional classification of complications in epilepsy surgery and invasive diagnostic procedures, where complications are characterized in terms of their immediate effects, resulting permanent symptoms, and consequences on activities of daily living. Significance: We propose that the protocol will be helpful in the work to promote safety in epilepsy surgery and for future studies designed to identify risk factors for complications. Further work is needed to address the reporting of outcomes as regards neuropsychological function, activities of daily living, and quality of life

Early-Stage Contactin-Associated Protein-like 2 Limbic Encephalitis: Clues for Diagnosis

BACKGROUND AND OBJECTIVES: Previous studies suggested that autoimmune limbic encephalitis with antibodies against contactin-associated protein-like 2 (CASPR2-encephalitis) is clinically heterogeneous and progresses slowly, preventing its early recognition. We aimed to describe the onset and progression of CASPR2-encephalitis and to assess long-term outcomes. METHODS: We retrospectively analyzed the medical records of all patients whose CSF tested positive for anti-CASPR2 antibodies in our center between 2006 and 2020. Standardized telephone interviews of all available patients and relatives were conducted, assessing long-term functional independence using the Functional Activity Questionnaire (FAQ) and quality of life using the 36-Item Short-Form Survey (SF36). RESULTS: Forty-eight patients were included (98% males; median age 64 years), and 35 participated in telephone interviews (73%). At onset, 81% had at least 1 neurologic symptom among the following: limbic (54%), peripheral nerve hyperexcitability (PNH; 21%), and/or cerebellar symptoms (17%). Most of the patients (75%) had initially symptoms of only one of these categories. Limbic symptoms at onset included mostly seizures (33%), while memory disturbances were less frequent (10%). PNH signs were mostly neuropathic pain (9/10 patients). Other symptoms seen at onset included asthenia (33%), mood disorders (25%), and insomnia (21%); 19% of patients did not show any limbic, peripheral, or cerebellar symptom at onset but only asthenia (15%), mood disorders (6%), weight loss (8%), dysautonomia (4%), and/or insomnia (2%). The peak of the disease was attained in median 16.7 months after onset. Over the study period (median follow-up, 58.8 months, range 10.6-189.1), 77% of patients developed ≥3 core CASPR2 symptoms and 42% fulfilled the diagnostic criteria for autoimmune limbic encephalitis, although all patients ultimately developed limbic symptoms. At the last visit, most interviewed patients (28/35 patients, 80%; median, 5 years after onset) had recovered functional independence (FAQ <9) while only the vitality subscore of the SF36 was lower than normative data (mean 49.9 vs 58.0, p = 0.0369). DISCUSSION: CASPR2-encephalitis has a progressive course and is highly heterogeneous at the early stage. In men older than 50 years, otherwise unexplained seizures, cerebellar ataxia, and/or neuropathic pain are suggestive of early-stage CASPR2-encephalitis, especially if they coincide with recent asthenia, mood disorders, or insomnia

Predatoroonops.

68 p. : ill., maps ; 26 cm.The new endemic goblin spider genus Predatoroonops is erected for 17 new soft-bodied oonopid species from Brazil: Predatoroonops schwarzeneggeri, sp. nov., is the type species of the genus, P. poncho, sp. nov., P. billy, sp. nov., P. valverde, sp. nov., P. blain, sp. nov., P. maceliot, sp. nov., P. anna, sp. nov., P. rickhawkins, sp. nov., P. dutch, sp. nov., P. dillon, sp. nov., P. vallarta, sp. nov., P. phillips, sp. nov., P. yautja, sp. nov., P. peterharlli, sp. nov., P. mctiernani, sp. nov., P. chicano, sp. nov., and P. olddemon, sp. nov. Males of this new genus are easily diagnosed and separated from other Oonopinae genera by the extremely modified male chelicerae that frontally have median furrows and accentuated projections. The females can be recognized by the genitalia, which have a conspicuous posterior receptaculum, usually exposed between the epigastric folds. An auxiliary character for both sexes could be the presence of very long pairs of ventral spines with pronounced bases on the legs I and II tibiae and metatarsi. The genus is considered endemic and the species are recorded mainly from the Brazilian Atlantic Forest. An identification key is provided for all Predatoroonops species known to date

Guaraguaoonops.

13 p. : ill., map ; 26 cm.A new endemic goblin spider genus Guaraguaoonops is erected to include two new soft-bodied oonopid species from Brazil: the type species, G. hemhem, distributed in the states of Maranhão, Piauí, and Ceará, and G. humbom, known only from Piauí. These spiders are unique among oonopids and easily diagnosed by the flattened carapace with a porrect clypeus, modified lateral setae on the carapace in both sexes, and male with a sinuous, flattened distal cheliceral projection and palp with ventral conical tegular projection. These species probably occupy a soil cryptic habit and are found in dry sand of "cerrado" areas in northeastern Brazil

Arachnida at "Reserva Ducke", Central Amazonia/Brazil

The class Arachnida contains 11 recent orders: Acari, Amblypygi, Araneae, Opiliones, Palpigradi, Pseudoscorpiones, Ricinulei, Schizomida, Scorpiones, Solifugae and Uropygi (Thelyphonida). In total, >570 families, >9165 genera and >93455 species are known world-wide. More than 136 families, >482 genera and >1547 described species occur in Amazonia. Data show, that almost one-fourth of the families presently known in the Arachnida and about 2% of the worlds described species are represented in Amazonia. In the forest reserve 'Reserva Ducke' near Manaus, the Acari-Oribatida represent 45 families, 72 genera and 35 described species, the Aranea 30 families, 143 genera and 295 described species, the Opiliones 5 families, 7 genera and 8 decribed species, the Scorpiones 2 families, 4 genera and 5 described species, the Pseudoscorpiones 6 families, 11 genera, and 15 described species, the Schizomida, 1 family, 2 genera and 2 described species, and the Amblypygi, Palpigradi, Solifugae and Uropygi (Thelyphonida) one species each. Most names are liste

Goblin spider genus Neoxyphinus.

75 p. : ill., maps ; 26 cm.The Neotropical spider genus Neoxyphinus Birabén, 1953, is revised, comprising 10 species found from the West Indies to northern Argentina. The genus is characterized by a unique combination of characters, which include the presence of a set of low tubercles or large spikes on the posterior surface of carapace; male endites with an apical, retrolateral excavation bearing a subapical toothlike apophysis; palpal bulb strongly inflated; embolus compact, S-shaped, with large, round ejaculatory opening; epigynal atrium large, with angular lateral corners. The large, round ejaculatory duct may be a synapomorphy of the genus. The genus Hawkeswoodoonops Makhan and Ezzatpanah, 2011, is synonymized with Neoxyphinus and the two species included in that genus are considered as nomina dubia. The monotypic genus Decuana Dumitrescu and Georgescu, 1987, is also synonymized with Neoxyphinus and its type species, D. hispida Dumitrescu and Georgescu, 1987, is transferred to the genus and redescribed. Confirming a hypothesis raised in the literature, Dysderina termitophila Bristowe, 1938, is transferred to Neoxyphinus and recognized as the senior synonym of the type species N. ogloblini Birabén, 1953. Two other species are transferred from Dysderina to Neoxyphinus: D. keyserlingi Simon, 1907, here recognized as the senior synonym of D. rugosa Bristowe, 1938, and D. furtiva Chickering, 1968, of which the male is described for the first time. In addition to the redescription of N. termitophilus, n. comb., N. hispidus, n. comb., N. xyphinoides (Chamberlin and Ivie, 1942), N. keyserlingi, n. comb., and N. furtivus, n. comb., five new species are described: N. petrogoblin Abrahim and Ott, from the Amazon basin in Brazil, Colombia, Ecuador, and Peru; N. gregoblin Abrahim and Santos, from Venezuela; N. axe Abrahim and Brescovit, from Bahia, Brazil; N. boibumba Abrahim and Rheims, from Pará, Brazil; and N. barreirosi Abrahim and Bonaldo, from Brazil, Colombia, Guyana, and Venezuela. With the exception of N. boibumba, known only from males, all new species are described from both sexes

Current practices in long-term video-EEG monitoring services: A survey among partners of the E-PILEPSY pilot network of reference for refractory epilepsy and epilepsy surgery.

The European Union-funded E-PILEPSY network aims to improve awareness of, and accessibility to, epilepsy surgery across Europe. In this study we assessed current clinical practices in epilepsy monitoring units (EMUs) in the participating centers. A 60-item web-based survey was distributed to 25 centers (27 EMUs) of the E-PILEPSY network across 22 European countries. The questionnaire was designed to evaluate the characteristics of EMUs, including organizational aspects, admission, and observation of patients, procedures performed, safety issues, cost, and reimbursement. Complete responses were received from all (100%) EMUs surveyed. Continuous observation of patients was performed in 22 (81%) EMUs during regular working hours, and in 17 EMUs (63%) outside of regular working hours. Fifteen (56%) EMUs requested a signed informed consent before admission. All EMUs performed tapering/withdrawal of antiepileptic drugs, 14 (52%) prior to admission to an EMU. Specific protocols on antiepileptic drugs (AED) tapering were available in four (15%) EMUs. Standardized Operating Procedures (SOP) for the treatment of seizure clusters and status epilepticus were available in 16 (59%). Safety measures implemented by EMUs were: alarm seizure buttons in 21 (78%), restricted patient's ambulation in 19 (70%), guard rails in 16 (59%), and specially designated bathrooms in 7 (26%). Average costs for one inpatient day in EMU ranged between 100 and 2200 Euros. This study shows a considerable diversity in the organization and practice patterns across European epilepsy monitoring units. The collected data may contribute to the development and implementation of evidence-based recommended practices in LTM services across Europe

Contribution of the Microbial Communities Detected on an Oil Painting on Canvas to Its Biodeterioration

In this study, we investigated the microbial community (bacteria and fungi) colonising an oil painting on canvas, which showed visible signs of biodeterioration. A combined strategy, comprising culture-dependent and -independent techniques, was selected. The results derived from the two techniques were disparate. Most of the isolated bacterial strains belonged to related species of the phylum Firmicutes, as Bacillus sp. and Paenisporosarcina sp., whereas the majority of the non-cultivable members of the bacterial community were shown to be related to species of the phylum Proteobacteria, as Stenotrophomonas sp. Fungal communities also showed discrepancies: the isolated fungal strains belonged to different genera of the order Eurotiales, as Penicillium and Eurotium, and the non-cultivable belonged to species of the order Pleosporales and Saccharomycetales. The cultivable microorganisms, which exhibited enzymatic activities related to the deterioration processes, were selected to evaluate their biodeteriorative potential on canvas paintings; namely Arthrobacter sp. as the representative bacterium and Penicillium sp. as the representative fungus. With this aim, a sample taken from the painting studied in this work was examined to determine the stratigraphic sequence of its cross-section. From this information, “mock paintings,” simulating the structure of the original painting, were prepared, inoculated with the selected bacterial and fungal strains, and subsequently examined by micro-Fourier Transform Infrared spectroscopy, in order to determine their potential susceptibility to microbial degradation. The FTIR-spectra revealed that neither Arthrobacter sp. nor Penicillium sp. alone, were able to induce chemical changes on the various materials used to prepare “mock paintings.” Only when inoculated together, could a synergistic effect on the FTIR-spectra be observed, in the form of a variation in band position on the spectrum.The FTIR analyses performed in this study were financed by the Junta de Andalucía (RNM-325 group). The molecular analyses performed in this study were financed by the Austrian Science Fund (FWF) project ‘Hertha-Firnberg T137’ and the Spanish Ministry of Science and Innovation (Project CTQ2008-06727-C03-03). G. Piñar also thanks the “Elise-Richter V194-B20” projects

Rhodium nanoparticles for ultraviolet plasmonics

The nonoxidizing catalytic noble metal rhodium is introduced for ultraviolet plasmonics. Planar tripods of 8 nm Rh nanoparticles, synthesized by a modified polyol reduction method, have a calculated local surface plasmon resonance near 330 nm. By attaching p-aminothiophenol, local field-enhanced Raman spectra and accelerated photodamage were observed under near-resonant ultraviolet illumination, while charge transfer simultaneously increased fluorescence for up to 13 min. The combined local field enhancement and charge transfer demonstrate essential steps toward plasmonically enhanced ultraviolet photocatalysis.This work has been supported by NSF-ECCS-12-32239. This work was partially supported by the Army’s In-house Laboratory Innovative Research program. Financial support from USAITCA (project no. W911NF-13-1-0245) and MICINN (Spanish Ministry of Science and Innovation, project no. FIS2013- 45854-P) is also acknowledged

A survey of the European Reference Network EpiCARE on clinical practice for selected rare epilepsies

Objective: Clinical care of rare and complex epilepsies is challenging, because evidence-based treatment guidelines are scarce, the experience of many physicians is limited, and interdisciplinary treatment of comorbidities is required. The pathomechanisms of rare epilepsies are, however, increasingly understood, which potentially fosters novel targeted therapies. The objectives of our survey were to obtain an overview of the clinical practice in European tertiary epilepsy centers treating patients with 5 arbitrarily selected rare epilepsies and to get an estimate of potentially available patients for future studies. Methods: Members of the European Reference Network for rare and complex epilepsies (EpiCARE) were invited to participate in a web-based survey on clinical practice of patients with Dravet syndrome, tuberous sclerosis complex (TSC), autoimmune encephalitis, and progressive myoclonic epilepsies including Unverricht Lundborg and Unverricht-like diseases. A consensus-based questionnaire was generated for each disease. Results: Twenty-six of 30 invited epilepsy centers participated. Cohorts were present in most responding centers for TSC (87%), Dravet syndrome (85%), and autoimmune encephalitis (71%). Patients with TSC and Dravet syndrome represented the largest cohorts in these centers. The antiseizure drug treatments were rather consistent across the centers especially with regard to Dravet syndrome, infantile spasms in TSC, and Unverricht Lundborg / Unverricht-like disease. Available, widely used targeted therapies included everolimus in TSC and immunosuppressive therapies in autoimmune encephalitis. Screening for comorbidities was routinely done, but specific treatment protocols were lacking in most centers. Significance: The survey summarizes the current clinical practice for selected rare epilepsies in tertiary European epilepsy centers and demonstrates consistency as well as heterogeneity in the treatment, underscoring the need for controlled trials and recommendations. The survey also provides estimates for potential participants of clinical trials recruited via EpiCARE, emphasizing the great potential of Reference Networks for future studies to evaluate new targeted therapies and to identify novel biomarkers.info:eu-repo/semantics/publishedVersio