Pregnancy outcomes in women with epilepsy and MTHFR mutations supplemented with methylated folate and methylcobalamin (methylated B12).

Antiseizure medications (ASM) may contribute to adverse fetal outcomes in pregnant women with epilepsy (WWE). Folate processing (Methylenetetrahydrofolate reductase, MTHFR) gene abnormalities are common in women with epilepsy and depression. L-methylfolate supplements may bypass MTHFR deficiencies, yet their use in WWE during gestation or on fetal development is not well studied. We examine pregnancy histories of three WWE who supplemented with either folate or L-methylfolate and methylcobalamin (methylated B12) during pregnancies. Their pregnancy outcomes improved with L-methylfolate and methylcobalamin supplementation. L-methylfolate and methylcobalamin supplementation merits further study in WWE who have MTHFR mutations, fertility, recurrent miscarriage and or depression histories

Individualizing therapies with responsive epilepsy neurostimulation — A mirtazapine case study of hippocampal excitability

AbstractObjectivesThis study aimed to investigate mirtazapine-induced changes in responsive neurostimulator (RNS) recordings in a patient with epilepsy.Materials and methodsCortical detection/stimulation counts from an RNS implanted in a patient with bitemporal epilepsy were matched to mirtazapine use to see if that drug altered hippocampal excitability.ResultsMirtazapine decreased hippocampal stability; when mirtazapine was held after a washout period, DSC counts declined, but when it was retrialed, DSC counts increased. Responsive epilepsy neurostimulator system data helped design an optimal and individualized medication regimen for our patient with drug-resistant focal epilepsy.ConclusionsResponsive neurostimulator systems in epilepsy may assess a medication's effect on hippocampal excitability. Mirtazapine worsened hippocampal excitability in a patient with bitemporal epilepsy

Pilot data on responsive epilepsy neurostimulation, measures of sleep apnea and continuous glucose measurements.

Objectives: To match responsive neurostimulator (RNS) and polysomnographic data to determine if RNS detections and stimulations correlate with measurements of sleep disordered breathing and continuous glucose measurements (CGM). Materials and methods: In a patient with an RNS with detection/stimulation leads implanted bi-temporally detection-stimulation counts were matched by time with coinciding polysomnogram and CGM data. Results: Temporal dispersion of RNS DSC were independent of measures of sleep apnea, hypopnea or glucose. Conclusion: Hippocampal nighttime responsive neurostimulation therapies did not appear to worsen measures of normal or abnormal sleep

Continuous monitoring devices and seizure patterns by glucose, time and lateralized seizure onset.

Objectives: To investigate if glucose levels influence seizure patterns. Materials and methods: In a patient with RNS/NeuroPace implanted bi-temporally and type 1 diabetes mellitus, seizure event times and onset locations were matched to continuous tissue glucose. Results: Left focal seizure (LFS, n = 22) glucoses averaged 169 mg/dL, while right focal seizure (RFS, n = 23) glucoses averaged 131 mg/dL (p = 0.03). LFS occurred at mean time 17:02 while RFS occurred at 04:23. LFS spread to the contralateral side (n = 19) more than RFS (n = 2). Conclusion: Seizure onset laterality and spread vary with glucose and time of seizure

Bidirectional association between disturbed sleep and neuropathic pain symptoms : a prospective cohort study in post-total joint replacement participants

Background Disturbed sleep is strongly correlated with chronic pain. The aim of this study was to examine the association between sleep disturbance and incident joint pain focusing on neuropathic-like pain symptoms. Methods A total of 423 individuals who had undergone total joint replacement (TJR) for osteoarthritis were assessed at the mean time of 3.6 years post-surgery and again at 5.9 years post-TJR, using the Medical Outcomes Survey sleep subscale, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and painDETECT questionnaire instruments. Cox hazard ratios (HRs) and 95% confidence intervals (CIs) were computed adjusting for age, body mass index, sex, and use of hypnotic and analgesic medication. Results The presence of neuropathic pain symptoms predicted incidence of disturbed sleep after adjustment for covariates and pain severity (adjusted HR [aHR] 2.01, 95% CI: 1.00–4.10; p<0.05). There was no association between joint pain and incidence of disturbed sleep when individuals with neuropathic pain symptoms at the baseline visit were excluded (aHR 1.11, 95% CI: 0.47–2.67). Disturbed sleep at baseline predicted incident neuropathic joint pain symptoms (aHR 2.75, 95% CI: 1.21–6.26; p<0.016) but had no effect on incidence of joint pain when all types of pain were considered together (aHR 0.63, 95% CI: 0.30–1.39). Conclusion These data suggest a causal bidirectional link between sleep disturbance and joint pain with neuropathic features but not with other types of joint pain

Fecal Coliform Bacteria TMDL Implementation on Cane Creek and Little Cane Creek in Oconee County, South Carolina

2008 S.C. Water Resources Conference - Addressing Water Challenges Facing the State and Regio

K-Band Spectroscopy of (Pre-)Cataclysmic Variables: Are Some Donor Stars Really Carbon Poor?

We present a new sample of $K$-band spectral observations for CVs: non-magnetic and magnetic as well as present day and pre CVs. The purpose of this diverse sample is to address the recent claim that the secondary stars in dwarf novae are carbon deficient, having become so through a far more evolved evolution than the current paradigm predicts. Our new observations, along with previous literature results, span a wide range of orbital period and CV type. In general, dwarf novae in which the secondary star is seen show weak to no CO absorption while polar and pre-CV donor stars appear to have normal CO absorption for their spectral type. However, this is not universal. The presence of normal looking CO absorption in the dwarf nova SS Aur and the hibernating CV QS Vir and a complete lack of CO absorption in the long period polar V1309 Ori cloud the issue. A summary of the literature pointing to non-solar abundances including enhanced NV/CIV ratios is presented. It appears that some CVs have non-solar abundance material accreting onto the white dwarf suggesting an evolved secondary star while for others CO emission in the accretion disk may play a role. However, the exact mechanism or combination of factors causing the CO absorption anomaly in CVs is not yet clear.Comment: Accepted in A

Bidirectional association between disturbed sleep and neuropathic pain symptoms: a prospective cohort study in post-total joint replacement participants

Disturbed sleep is strongly correlated with chronic pain. The aim of this study was to examine the association between sleep disturbance and incident joint pain focusing on neuropathic pain-like symptoms. 423 individuals who had undergone total joint replacement (TJR) for osteoarthritis (OA) were assessed 3.6 years post-surgery, using the Medical Outcomes Survey sleep subscale, the WOMAC and PainDETECT instruments, and again 5.9 years post-TJR. Cox hazards ratios (HR) and 95% confidence intervals (CIs) were computed adjusting for age, BMI, sex, use of hypnotic and analgesic medication. The presence of neuropathic pain symptoms predicted incidence of disturbed sleep after adjustment for covariates and pain severity (aHR 2.01, 95% CI: 1.00-4.10 p<0.05). There was no association between joint pain and incidence of disturbed sleep when individuals with neuropathic pain symptoms at baseline visit were excluded (aHR 1.11, 95% CI: 0.47-2.67). Disturbed sleep at baseline predicted incident neuropathic joint pain symptoms (aHR 2.75, 95% CI: 1.21-6.26; p<0.016) but had no effect on incidence of joint pain when all types of pain were considered together (aHR 0.63, 95%CI: 0.30-1.39). These data suggest a causal bidirectional link between sleep disturbance and joint pain with neuropathic features, but not with other types of joint pain