Drug-responsive versus drug-refractory mesial temporal lobe epilepsy: a single-center prospective outcome study

Objectives: To evaluate clinical, electrophysiological, and neuroradiological factors which correlate with the prognosis in patients with mesial temporal lobe epilepsy (MTLE). Methods: This was a single-center prospective outcome study in patients with MTLE. The patients’ family history, clinical characteristics, neurophysiological data (electroencephalography–EEG), neuroimaging, antiepileptic therapy, and outcome were collected and analyzed. The population was divided into four groups depending on the frequency of the seizures when they attended their last follow up. All variables and outcome measures were compared between the four groups. Results: In total 83 consecutive patients were included within the four groups. Group 1 (seizure-free) consisted of 7 patients, (9%), Group 2 (rare seizures) consisted of 15 patients (18%), Group 3 (often seizures) consisted of 30 patients (36%), and Group 4 (very often seizures) consisted of 31 patients (37%). The groups did not differ significantly in demographic characteristics. There was a strong positive correlation between resistance to therapy and sleep activation on EEG (p = 0.005), occurrence of focal to bilateral seizures (p = 0.007), automatisms (p = 0.004), and the number of previously used antiepileptic drugs (AEDs) (p = 0.002). There was no association between febrile convulsions (FC), hippocampal sclerosis (HS), and the outcome that was found. Conclusion: MTLE is a heterogeneous syndrome. Establishing the factors responsible for, and associated with, drug resistance is important for optimal management and treatment, as early identification of drug resistance should then ensure a timely referral for surgical treatment is made. This prospective study shows that sleep activation on EEG, ictal automatisms, occurrence of focal to bilateral tonic-clonic seizures, and increased number of tried AEDs are negative prognostic factors. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group

Development and validation of the Schedule for the Assessment of Insight in Alcohol Dependence (SAI-AD): Dimensions and correlates of insight in alcohol use disorder

Introduction: The objectives of this study were to develop a multidimensional, clinician-rated scale that assess impaired insight into illness in patients with alcohol use disorder (AUD) and to examine its reliability, validity and internal structure. Moreover, we investigated the relationships of overall insight and its dimensions with demographic and clinical characteristics in AUD. Methods: We developed the Schedule for the Assessment of Insight in Alcohol Dependence (SAI-AD), based on scales that has already been used in psychosis and other mental disorders. Sixty-four patients with AUD were assessed with SAI-AD. Hierarchical cluster analysis and multidimensional scaling were used to identify insight components and assess their inter-relationships. Results: The SAI-AD demonstrated good convergent validity (r = −0.73, p < 0.001) and internal consistency (Cronbach's alpha = 0.72). Inter-rater and test-retest reliabilities were high (intra-class correlations 0.90 and 0.88, respectively). Three subscales of SAI-AD were identified which measure major insight components: awareness of illness, recognition of symptoms and need for treatment, and treatment engagement. Higher levels of depression, anxiety and AUD symptom severity were associated with overall insight impairment but not with recognition of symptoms and need for treatment, or with treatment engagement. Illness duration was specifically and positively associated with the treatment engagement component of insight. Conclusions: Insight is a multidimensional construct in AUD and its major components appear to be associated with different clinical aspects of the disorder. The SAI-AD is a valid and reliable tool for the assessment of insight in AUD patients

The Pharmacokinetics of Levetiracetam in Critically Ill Adult Patients: An Intensive Care Unit Clinical Study

The aim of this study was to investigate levetiracetam pharmacokinetics in critically ill adult intensive care patients and to identify pathophysiological factors affecting its kinetics. Fourteen critically ill patients in an intensive care unit were enrolled in the study and received intravenous levetiracetam. Blood samples were collected at specific time points to determine the levetiracetam pharmacokinetics. Patient characteristics such as renal function, demographics, disease severity, organ dysfunction, and biochemical laboratory tests were evaluated for their influence on the kinetics of levetiracetam. Estimated glomerular filtration rate (eGFR) had a statistically significant (p = 0.001) effect on levetiracetam clearance. None of the other patient characteristics had a statistically significant effect on the pharmacokinetics. Simulations of dosing regimens revealed that even typically administered doses of levetiracetam may result in significantly increased concentrations and risk of drug toxicity in patients with impaired renal function. The Acute Physiology and Chronic Health Evaluation II (APACHE II) score differed significantly among the three groups with different epileptic activity (p = 0.034). The same groups also differed in terms of renal function (p = 0.031). Renal dysfunction should be considered when designing levetiracetam dosage. Patients with a low APACHE II score had the lowest risk of experiencing epileptic seizures. © 2022 by the authors. Licensee MDPI, Basel, Switzerland

Brain abscess following intracerebral haemorrhage

A 79-year old male patient developed a brain abscess as infective transformation of a preceding intracerebral haemorrhage after urinary tract infection. The awareness of brain abscess formation at the site of intracerebral haemorrhage is crucial for early diagnosis and treatment of this rare but potentially fatal complication. (c) 2006 Elsevier Ltd. All rights reserved

Adaptive immersive Virtual Environments as a treatment for depersonalization disorder

Depersonalization is a dissociative disorder associated to a profound disruption of self-awareness in the form of emotional numbing and feelings of disembodiment. The salient feature of depersonalization is a breakdown in the familiarity of one&apos;s psychological and somatic self (and surroundings when derealization is also present), in spite of being aware of the unreality of the change. At an early stage of research it was realized that people inclined to dissociation find it harder to tolerate discontinuity in perceptual environments, possibly due to a rigid perceptual attitude. Consequently, perceptual discontinuity experienced during momentary immersion into a VE would be expected to increase symptoms of dissociation among individuals prone to develop them. It has been put forward that a tendency toward immersion or absorption, linking to imaginative processes underlying the dissociative experience, significantly relates to the level of change in virtual reality-induced dissociative symptoms. Consequently, it has been implied that increased tolerability of perceptual discontinuities and a more flexible perceptual attitude in people suffering depersonalization/derealization disorder may be of help. We propose the use of adaptive immersive virtual environments to the treatment of depersonalization. In particular, we propose that implementation of biofeedback electrical stimulation to detect somato-sensory processing bias may contribute to selectively targeting deranged neurocognitive processing components, and as an indirect consequence promote, to some extent, the diagnostic process. Psychophysiological approaches may be of help in the treatment of depersonalization via additional series of afferent inputs - virtual reality (VR) stimuli - to alter the receptive fields of the affected proprioceptive systems and reorganize them. The aim of this paper is to stimulate future research towards the development of potential virtual rehabilitation programs based on biofeedback, electrical stimulation and concurrent measurement of galvanic skin response and EEG targeting selective somatosensory stimulation in patients with depersonalization. Our research hypotheses might constitute a starting point for the development of new treatment tools for depersonalization in particular and depersonalization/derealization disorder in general

Traumatic brain injury in Greece: Report of a countrywide registry

Introduction: The purpose of this study was to evaluate the incidence of TBI in Greece and to provide evidence on the epidemiologic characteristics of the disease. Patients and methods: This is a prospective observational study initiated by the Hellenic Society of Trauma and Emergency Surgery. Thirty hospitals participated in the registry. All trauma patients requiring admission transfer to a higher level centre and those who arrived dead were included in the study. This report evaluated the epidemiologic characteristics of patients with brain trauma, the cause and the severity of the injury and the final outcome. Results: Eight thousand eight hundred and sixty-two patients were included in the registry. Of them, 3383 had at least one brain injury. There were 2451 males and 932 females. Traffic accidents were the leading cause of TBI (54.1%), followed by falls (27.7%). The most affected age group was the 15-44 year olds (48.0%), but TBIs were more lethal in the 45-64 age group (17.8%). Interestingly, a 3.4% mortality was recorded if a TBI was present, even if ISS was relatively low (0-9 ISS group). Conclusion: TBI is a major element of trauma. Knowledge of the epidemiologic characteristics of the disease is imperative for adequate planning and future quality assessment. © 2010 Informa UK Ltd All rights reserved

Long-term neuropsychological outcomes following temporal lobe epilepsy surgery: An update of the literature

We present an update of the literature concerning long-term neuropsychological outcomes following surgery for refractory temporal lobe epilepsy (TLE). A thorough search was conducted through the PubMed and Medline electronic databases for studies investigating neu-ropsychological function in adult patients undergoing resective TLE surgery and followed for a mean/median &gt; five years period. Two independent reviewers screened citations for eligibility and assessed relevant studies for the risk of bias. We found eleven studies fulfilling the above requirements. Cognitive function remained stable through long-term follow up despite immedi-ate post-surgery decline; a negative relation between seizure control and memory impairment has emerged and a possible role of more selective surgery procedures is highlighted. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

Resting respiratory variables and exercise capacity in adult patients with cystic fibrosis

Introduction: Cystic fibrosis (CF) is the most common life-limiting, recessively inherited disease in the white population, associated with significantly high morbidity and mortality rates; CF pulmonary disease, assessed by pulmonary function tests, arterial blood gases and the Schwachman score, remains the most prevalent in terms of morbidity in the adult CF population. Objectives: The aim of the present study was to evaluate the relationship between resting respiratory variables and exercise capacity in adult patients with CF. Results: Study investigations undertaken in 18 CF patients and 11 healthy volunteers showed that among the resting lung function parameters, inspiratory capacity (IC) at rest was the only significant predictor of VO 2 peak (r = 0.67, p &amp;lt; 0.007) and VO2/t-slope (r = 0.86, p &amp;lt; 0.0001). The percentage of predicted FEV1 in adult CF patients was 77 ± 33% pred. vs 104 ± 16% pred. in healthy subjects (p &amp;lt; 0.006); the corresponding percentage of IC at rest was 82 ± 36% pred. in patients vs 116 ± 20% pred. in healthy (p &amp;lt; 0.003). CF patients presented with a significantly prolonged rapid breathing after exercise (32br per minute at recovery for CF vs 22 for healthy; p &amp;lt; 0.001), as well as a shortened inspiratory time. Conclusion: Adult patients with CF show a limited exercise capacity with lower peak oxygen consumption and prolonged oxygen kinetics. Interestingly, decreased IC qualified as the only significant predictor of exercise capacity in our study. © 2010 Published by Elsevier Ltd

Fear of COVID-19 Impact on Professional Quality of Life among Mental Health Workers

Several studies have examined the impact of the COVID-19 pandemic on healthcare workers&rsquo; mental health, but only a few have investigated its detrimental effect on the mental well-being of mental health workers (MHWs). Background: The current study aimed to explore the effect of the fear of COVID-19 (FCV-19) on professional quality of life dimensions, namely compassion satisfaction (CS), burnout (BO), and secondary traumatic stress (STS) in MHWs above and beyond sociodemographic and professional factors. Methods: Hierarchical linear regression models were employed to examine the relationship of extreme FCV-19 with CS, BO, and STS in MHWs (n = 224), after considering sociodemographic variables as potential confounding factors. Extreme FCV-19 was operationalized as a binary variable with a cut-off score of &ge;16.5 considered as extreme fear. Results: We found that extreme FCV-19 in MHWs is linked with increased compassion fatigue (BO and STS), and this relationship is exacerbated by younger age in regard to BO and by female gender concerning STS. CS remains unaffected by severe FCV-19, and it is higher in older participants. Conclusion: Organizational support is required to protect MHWs&rsquo; mental well-being and ensure the quality of care they provide during prolonged crises, such as the COVID-19 pandemic. Measures that intensify a sense of safety, protection, and control against COVID-19 infections in mental health services should be included in the recommendations that may reduce BO and STS among MHWs

Α multicenter retrospective study evaluating brivaracetam in the treatment of epilepsies in clinical practice

Brivaracetam (BRV) is the latest approved antiepileptic drug. The aim of the study was to evaluate the efficacy and tolerability of BRV in everyday clinical practice. In this retrospective, observational, multicenter study, data from epilepsy patients receiving BRV from January 2018 to July 2019 were analyzed. Patients with age ≥16 suffering from any type of epilepsy and having at least one follow up encounter after dose titration were included. 156 consecutive patients were included in the study. The mean age was 40 (16–84 years) and the mean duration of epilepsy was 21 years. Of the 156 patients, 81% were diagnosed with focal-onset seizures, 16% with generalized seizures, while 3% suffered from unclassified seizures. Nine patients received BRV as monother-apy as a switching therapy. At the first follow up visit, seizure cessation was achieved in 56 (36%) patients and the rate of ≥50% responders was 36%. Twenty four patients (15%) remained un-changed; six patients (4%) were recorded with increased seizure frequency, while the remaining 9% had a response of less than 50%. Twenty-six patients (17%) showed clinically significant adverse events, but none were life threatening. Brivaracetam seems to be an effective, easy to use and safe antiepileptic drug in the clinical setting. © 2021 by the authors. Licensee MDPI, Basel, Switzerland