Individual neuropsychological characteristics in patients with juvenile myoclonic epilepsy

Background. An association between juvenile myoclonic epilepsy (JME) and nonpsychotic psychiatric and cognitive disorders has been described in recent years. Scientists are trying to link JME with certain personality traits marked by emotional instability. Objective. The goal of our research was to assess the state of cognitive functions in young adult patients with JME–excluding the adverse side effects (ASEs) of antiepileptic drugs (AEDs)–and analyze the level of personality and situational anxiety, neuroticism, and depression in young adult patients with JME. Design. We tested 26 patients with JME and 26 healthy adults with the computer program NS-PsychoTest (Neurosoft Company, RF), a program which is aimed at studying and evaluating neuropsychological characteristics. Results. Our study showed that the frequency of depressive symptoms, according to the cognitive-affective subscale (Beck’s Depression Inventory), in patients with JME was statistically significantly higher than among people without epilepsy. Comorbid personality and nonpsychotic psychiatric disorders are common interdisciplinary problems in JME management. Most practitioners pay attention only to the treatment of seizures caused by JME, and their patients, accordingly, do not receive adequate psychotherapeutic help. Conclusion. Cognitive disorders are often associated with epilepsy, and are a result of a combination of factors. According to our study, in the presence of statistically significant differences in short-term memory and mental performance in patients with JME, compared to healthy young adults, the main indicators of cognitive function in patients with JME generally correspond to the norm. Our findings highlight the etiological heterogeneity of cognitive disorders in JME and the importance of early screening for them

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Nonpsychotic Psychiatric Disorders in Juvenile Myoclonic Epilepsy

The association of epilepsy with mental illness has been described in recent years. Scientists are trying to relate certain epilepsies, such as juvenile myoclonic epilepsy (JME), with certain personality traits marked by emotional instability. The goal of this review is to evaluate the scientific literature about nonpsychotic psychiatric disorders in JME patients, the most common form of idiopathic generalized epilepsy (IGE). Data in this review were collected through an extensive literature search of available full-text publications in PubMed, Springer, Clinical Keys and eLIBRARY.RU databases. Comorbid personality and nonpsychotic psychiatric disorders are a common and interdisciplinary problem in JME management. The disorders in patients with JME often go undiagnosed and hence untreated. Therefore, this problem requires further and extensive investigation

Influence of anxiety on wrist tapping parameters and individual perception of one minute in healthy adults and in patients with juvenile myoclonic epilepsy

Aim ― To study the influence of anxiety on parameters of wrist tapping in normal conditions and in juvenile myoclonic epilepsy (JME). Material and Methods ― We evaluated 105 people aged 16 to 55 years old (average: 31.6±10.2 years). The sample was comprised of two groups: first (I) group – healthy volunteers (n=60); second (II) group – patients with JME (n=45). Every group was stratified into two subgroups: subgroup Ia (n=33) – healthy volunteers without symptoms of anxiety; subgroup Ib (n=27) – healthy volunteers with subclinical anxiety; subgroup IIa (n=19) – patients with JME without symptoms of anxiety; subgroup IIb (n=26) – patients with JME with subclinical anxiety. Wrist tapping parameters were studied using method of our authorship named «Method of influencing a person’s individual rhythm through exogenous rhythmic stimulation». We studied reference ranges of basic characteristics of wrist tapping. Results ― Comparison of basic parameters of wrist tapping in subgroups Ia and IIa revealed a trend towards an increase in rhythm stability in patients with JME when compared to healthy volunteers. At the same time, subclinical anxiety led to a pronounced increase in frequency of individual rhythm in subgroup IIb when compared to subgroup Ia. Conclusion ― Influence of anxiety on wrist tapping parameters is more pronounced in patients with JME when compared to healthy volunteers

Process of Personalized Prescription of Valproic Acid as the Main Element of the Management of Epilepsy

The purpose of this study was to develop a sequential process of personalized valproic acid (VPA) prescription in patients with epilepsy. Materials and Methods: We randomly selected 167 patients with epilepsy receiving VPA, based on carriage of CYP2C9*2 and/or CYP2C9*3 and therapeutic drug monitoring. The patients’ CYP2C9 status was determined by CYP2C9 genotyping before the beginning of anticonvulsant therapy. Results: The sequence of personalized valproic acid prescription has been developed. Conclusion: Using the sequential process of personalized VPA prescription will allow neurologists, psychiatrists and general practitioners to select starting and maintenance dosages of VPA with respect to the individual patient’s pharmacogenetic profile and thereby, significantly improve the safety of pharmacotherapy in epilepsy patients

Effect of Elevated Storage Temperatures on the Physicochemical and Sensory Properties of Apple Puree

Food products change their quality during storage not only under the external impact, but also because they are complex in composition. As a result, food scientists look for new methods to control these internal changes. The research objective was to describe the changes in the physicochemical properties of apple puree during storage at elevated temperatures (40–60°C) and link them with the changes in the sensory profile. The study featured homogenized apple puree packaged in composite material and heated up to 40, 50, and 60°C. The colorimetric studies were conducted at 45°/0°, light source D65. The proton relaxation time and the water diffusion coefficient (impulse gradient method) were studied at a frequency of 20 MHz. The analysis of molecular dynamics involved the method of electron paramagnetic resonance of spin probes. The samples were cooled down to –70°C to measure the content of non-crystallizing water by the method of differential scanning calorimetry. The color change rate was constant and followed the zero-order kinetic reaction equation with an activation energy of 92 kJ/mol. The changes in color, proton relaxation, and sensory properties correlated when the samples were stored at 50 and 60°C. The analysis of the magnetic relaxation time, the diffusion coefficient of water, and the content of non-crystallizing water indicated that the main changes in the physical structure of the puree during heat treatment occurred as a result of the aggregation of apple cell fragments. These findings were confirmed by the optical microscopy. A prolonged exposure to 40–60°C affected the color, the relaxation of water protons, and the size of aggregates of apple cell fragments. It also affected the amount of water that did not crystallize at –70°C. The correspondence between the values of the activation energies was determined by the methods of colorimetry and proton relaxation. Therefore, the coloration and the water changes depended on the same processes. These physical and chemical properties can be used for quantitative assessment of apple puree under thermal treatment

New Trends in Management of Epilepsy in Patients with Cerebral Venous Malformations: Our Experience

Background: Venous vascular malformations, also known as venous angiomas or, more exactly, developmental venous anomalies (DVAs), represent congenital, anatomically variant pathways in the normal venous drainage of the brain area. In general neurological practice, DVAs are not considered epileptogenic, therefore, in conducting neuroimaging as a rule, not taken into account. A positive correlation, however, between the location of the DVAs and the electroencephalographic seizure focus is debated. Materials and Methods: The present study provides a complete analysis of clinical and MRI characteristics of symptomatic epilepsies associated with cerebral venous malformations in children and adults. Patients were selected after a retrospective search through the database of the Neurological Center of Epileptology, Neurogenetics and Brain Research of the University Clinic into which, since 2016, patients were prospectively entered. To date (February 2016), there is a total of 5,856 patients with epilepsy of which there are 105 patients with congenital malformations of the brain, and 32 of them were found to have principal diagnosis of DVA. Results: Cavernous angiomas prevailed among venous anomalies (53.1%); DVAs were registered in 46.9% of cases. The associated analysis of DVA localization and the epileptic seizure types showed a direct relationship in 60.0% cases. Conclusion: DVAs as a cause of seizures are important to consider when examining patients with epileptic seizures

Nonpsychotic Psychiatric Disorders in Juvenile Myoclonic Epilepsy

The association of epilepsy with mental illness has been described in recent years. Scientists are trying to relate certain epilepsies, such as juvenile myoclonic epilepsy (JME), with certain personality traits marked by emotional instability. The goal of this review is to evaluate the scientific literature about nonpsychotic psychiatric disorders in JME patients, the most common form of idiopathic generalized epilepsy (IGE). Data in this review were collected through an extensive literature search of available full-text publications in PubMed, Springer, Clinical Keys and eLIBRARY.RU databases. Comorbid personality and nonpsychotic psychiatric disorders are a common and interdisciplinary problem in JME management. The disorders in patients with JME often go undiagnosed and hence untreated. Therefore, this problem requires further and extensive investigation

Rationale, design, and baseline characteristics in Evaluation of LIXisenatide in Acute Coronary Syndrome, a long-term cardiovascular end point trial of lixisenatide versus placebo

BACKGROUND: Cardiovascular (CV) disease is the leading cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). Furthermore, patients with T2DM and acute coronary syndrome (ACS) have a particularly high risk of CV events. The glucagon-like peptide 1 receptor agonist, lixisenatide, improves glycemia, but its effects on CV events have not been thoroughly evaluated. METHODS: ELIXA (www.clinicaltrials.gov no. NCT01147250) is a randomized, double-blind, placebo-controlled, parallel-group, multicenter study of lixisenatide in patients with T2DM and a recent ACS event. The primary aim is to evaluate the effects of lixisenatide on CV morbidity and mortality in a population at high CV risk. The primary efficacy end point is a composite of time to CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. Data are systematically collected for safety outcomes, including hypoglycemia, pancreatitis, and malignancy. RESULTS: Enrollment began in July 2010 and ended in August 2013; 6,068 patients from 49 countries were randomized. Of these, 69% are men and 75% are white; at baseline, the mean ± SD age was 60.3 ± 9.7 years, body mass index was 30.2 ± 5.7 kg/m(2), and duration of T2DM was 9.3 ± 8.2 years. The qualifying ACS was a myocardial infarction in 83% and unstable angina in 17%. The study will continue until the positive adjudication of the protocol-specified number of primary CV events. CONCLUSION: ELIXA will be the first trial to report the safety and efficacy of a glucagon-like peptide 1 receptor agonist in people with T2DM and high CV event risk