Long-term Effectiveness and Tolerability of Topiramate in Children with Epilepsy under the Age of 2 Years: 4-Year Follow-up

This is a long-term, open label, observational study aimed to broaden our clinical experiences in managing infants and toddlers with epilepsy. The long-term retention rate and side effects of topiramate (TPM) in them were evaluated and compared with carbamazepine (CBZ). A total of 146 children were involved in the study (TPM=41, CBZ=105). The retention rates at 24 , 36, and 48 months were 46.3%, 34.1%, 26.8% for TPM and 36.2%, 23.8%, 13.3% for CBZ, respectively. At 6 months after starting antiepileptic drugs (AED), the seizure freedom or clinical efficacy (seizure reduction rate more than 50 percent) were 73.2% for TPM and 62.9% for CBZ. The major side effects led to discontinuation included psychomotor slowing, poor oral intake from TPM and sleepiness and skin rash from CBZ. TPM was discontinued due to side effects in one case (2.4%) and lack of efficacy in five cases (12.2%), whereas CBZ was discontinued due to lack of efficacy (22.9%) and side effects (6.7%). As compared with CBZ, TPM showed the same long-term retention rate in children under the age of 2 yr, and no serious side effects. It is therefore concluded that TPM can be considered as a major AED for treating children with epilepsy under the age of 2 yr

Perceiving What Is Reachable Depends on Motor Representations: Evidence from a Transcranial Magnetic Stimulation Study

Background: Visually determining what is reachable in peripersonal space requires information about the egocentric location of objects but also information about the possibilities of action with the body, which are context dependent. The aim of the present study was to test the role of motor representations in the visual perception of peripersonal space. Methodology: Seven healthy participants underwent a TMS study while performing a right-left decision (control) task or perceptually judging whether a visual target was reachable or not with their right hand. An actual grasping movement task was also included. Single pulse TMS was delivered 80 % of the trials on the left motor and premotor cortex and on a control site (the temporo-occipital area), at 90 % of the resting motor threshold and at different SOA conditions (50ms, 100ms, 200ms or 300ms). Principal Findings: Results showed a facilitation effect of the TMS on reaction times in all tasks, whatever the site stimulated and until 200ms after stimulus presentation. However, the facilitation effect was on average 34ms lower when stimulating the motor cortex in the perceptual judgement task, especially for stimuli located at the boundary of peripersonal space. Conclusion: This study provides the first evidence that brain motor area participate in the visual determination of what is reachable. We discuss how motor representations may feed the perceptual system with information about possibl

Physiological and autonomic stress responses after prolonged sleep restriction and subsequent recovery sleep in healthy young men

Purpose Sleep restriction is increasingly common and associated with the development of health problems. We investigated how the neuroendocrine stress systems respond to prolonged sleep restriction and subsequent recovery sleep in healthy young men. Methods After two baseline (BL) nights of 8 h time in bed (TIB), TIB was restricted to 4 h per night for five nights (sleep restriction, SR, n = 15), followed by three recovery nights (REC) of 8 h TIB, representing a busy workweek and a recovery weekend. The control group (n = 8) had 8 h TIB throughout the experiment. A variety of autonomic cardiovascular parameters, together with salivary neuropeptide Y (NPY) and cortisol levels, were assessed. Results In the control group, none of the parameters changed. In the experimental group, heart rate increased from 60 +/- 1.8 beats per minute (bpm) at BL, to 63 +/- 1.1 bpm after SR and further to 65 +/- 1.8 bpm after REC. In addition, whole day low-frequency to-high frequency (LF/HF) power ratio of heart rate variability increased from 4.6 +/- 0.4 at BL to 6.0 +/- 0.6 after SR. Other parameters, including salivary NPY and cortisol levels, remained unaffected. Conclusions Increased heart rate and LF/HF power ratio are early signs of an increased sympathetic activity after prolonged sleep restriction. To reliably interpret the clinical significance of these early signs of physiological stress, a follow-up study would be needed to evaluate if the stress responses escalate and lead to more unfavourable reactions, such as elevated blood pressure and a subsequent elevated risk for cardiovascular health problems.Peer reviewe

Can cognitive enhancers reduce the risk of falls in older people with Mild Cognitive Impairment? A protocol for a randomised controlled double blind trial

<p>Abstract</p> <p>Background</p> <p>Older adults with cognitive problems have a higher risk of falls, at least twice that of cognitively normal older adults. The consequences of falls in this population are very serious: fallers with cognitive problems suffer more injuries due to falls and are approximately five times more likely to be admitted to institutional care. Although the mechanisms of increased fall risk in cognitively impaired people are not completely understood, it is known that impaired cognitive abilities can reduce attentional resource allocation while walking. Since cognitive enhancers, such as cholinesterase inhibitors, improve attention and executive function, we hypothesise that cognitive enhancers may reduce fall risk in elderly people in the early stages of cognitive decline by improving their gait and balance performance due to an enhancement in attention and executive function.</p> <p>Method/Design</p> <p>Double blinded randomized controlled trial with 6 months follow-up in 140 older individuals with Mild Cognitive Impairment (MCI). Participants will be randomized to the intervention group, receiving donepezil, and to the control group, receiving placebo. A block randomization by four and stratification based on fall history will be performed. Primary outcomes are improvements in gait velocity and reduction in gait variability. Secondary outcomes are changes in the balance confidence, balance sway, attention, executive function, and number of falls.</p> <p>Discussion</p> <p>By characterizing and understanding the effects of cognitive enhancers on fall risk in older adults with cognitive impairments, we will be able to pave the way for a new approach to fall prevention in this population. This RCT study will provide, for the first time, information regarding the effect of a medication designed to augment cognitive functioning have on the risk of falls in older adults with Mild Cognitive Impairment. We expect a significant reduction in the risk of falls in this vulnerable population as a function of the reduced gait variability achieved by treatment with cognitive enhancers. This study may contribute to a new approach to prevent and treat fall risk in seniors in early stages of dementia.</p> <p>Trial Registration</p> <p>The protocol for this study is registered with the Clinical Trials Registry, identifier number: NCT00934531 <url>http://www.clinicaltrials.gov</url></p

Send more data: a systematic review of mathematical models of antimicrobial resistance

Abstract Background Antimicrobial resistance is a global health problem that demands all possible means to control it. Mathematical modelling is a valuable tool for understanding the mechanisms of AMR development and spread, and can help us to investigate and propose novel control strategies. However, it is of vital importance that mathematical models have a broad utility, which can be assured if good modelling practice is followed. Objective The objective of this study was to provide a comprehensive systematic review of published models of AMR development and spread. Furthermore, the study aimed to identify gaps in the knowledge required to develop useful models. Methods The review comprised a comprehensive literature search with 38 selected studies. Information was extracted from the selected papers using an adaptation of previously published frameworks, and was evaluated using the TRACE good modelling practice guidelines. Results None of the selected papers fulfilled the TRACE guidelines. We recommend that future mathematical models should: a) model the biological processes mechanistically, b) incorporate uncertainty and variability in the system using stochastic modelling, c) include a sensitivity analysis and model external and internal validation. Conclusion Many mathematical models of AMR development and spread exist. There is still a lack of knowledge about antimicrobial resistance, which restricts the development of useful mathematical models

Wit-Russisch-Nederlands Gezondheids Informatie Centrum, Gomel, Wit-Rusland. Wit-Russisch-Nederlands Humanitair Hulp Project &apos;Gomel project&apos;

In het kader van het Wit-Russisch-Nederlands Humanitair Hulpproject, naar aanleiding van het ongeval met de kernreactor van Tsjernobyl in 1986 werd een Gezondheidsinformatie- centrum opgericht in Gomel. Hier werd een nieuw communicatieconcept gelanceerd. Preventieve gezondheidszorg programma's werden gestart ; het centrum vervult een kernfunctie bij de gezondheidscommunicatie voor de bevolking en voor werkers in het beroepsveld. Gedurende 1993 werden de bevolkingsvragen zorgvuldig genoteerd en geanalyseerd. De resultaten van de analyse gaven aan dat het Centrum een belangrijke functie bekleedt bij het verwijzen van patienten naar de juiste specialisten of ziekenhuizen en als laag-drempelige informatiebron dient voor degenen die een "second opinion" verlangen. Tevens functioneert het als informatiebron met betrekking tot j vragen van sociale, psycho-sociale en sociaal-economische aard. Verder dient het centrum als informatiebank voor het publiek en de beroepsgroepen voor vragen met betrekking tot straling. Het nieuwe communicatieconcept (met als belangrijke component het persoonlijk contact) is goed ontvangen door de bevolking van Gomel goed ontvangen. Het ontwikkelen van preventieve gezondheidszorg programma's voor specifieke doelgroepen werd een hoeksteen van het beleid van het Centrum. Aanbevelingen voor de toekomst besluiten dit rapport.This report describes the launching and the implementation of the Belarussian-Dutch Health Information Centre, an objective in a project aimed to alleviate the negative consequences of the Chernobyl nuclear power plant accident on April 26, 1986. In a newly established Health Information Centre in Gomel a new communication strategy was introduced in which trainings on health care programmes for professionals were performed concerning health communication with the population. During 1993 questions put to the medical consultants were extensively analysed and it was concluded that the Centre is developing a pivotal function in referring people to the relevant medical specialists or hospitals. It serves as a low-barrier source of information for patients who seek a second opinion and for questions on general health care and health education and it is developing towards a main centre for questions on social, psycho-social and socio-economic problems of the population. Furthermore, the Centre serves as a centre for information about radiation matters for the general public and professionals. Recommendations for the future management strategy conclude this report.VW

Overzicht van klachten en diagnoses van patienten van de Witrussisch-Nederlandse polikliniek te Gomel (Oktober 1991 - September 1993)

Het rapport geeft een overzicht van de medische consumptie van 4500 personen welke gezien werden op de Witrussische-Nederlandse polikliniek te Gomel in Wit-Rusland van oktober 1991 tot september 1993. Dit Witrussisch-Nederlands samenwerkingsverband werd opgezet in het kader van een Nederlands Humanitair Hulpproject ten gevolge van het reactorongeval te Tsjernobyl in 1986. In een nieuw computersysteem voor patientenregistratie werden personalia, klachtenpatroon, diagnose, behandelingsstrategie en voorgeschreven therapie of medicatie geregistreerd. Met name werd gekeken naar klachten welke verband houden met blootstelling aan ioniserende straling. De populatie bestond voor 75% uit liquidatoren, mensen met een (beroepsmatige) mogelijk verhoogde blootstelling. Cardiovasculaire, gastro-intestinale of neurologische klachten, en klachten van het bewegingsapparaat waren het meest frequent, evenals het aantal diagnoses in deze subgroepen. Het patroon van klachten en diagnoses was vergelijkbaar met dat van een Nederlandse polikliniek interne geneeskunde, verhoogd waren struma, gastritis, maag- en dunnedarmzweren. Diagnoses welke gerelateerd kunnen zijn aan blootstelling aan ioniserende straling werden geanalyseerd. Een maligniteit werd 23x vastgesteld. Een groot aantal schildklieraandoeningen werd gediagnostiseerd. In 54 gevallen werd een haematologische ziekte vastgesteld, waarvan 5 maligniteiten. Cataract werd in 19 gevallen gediagnostiseerd. In alle gevallen liggen de getallen lager dan in een Nederlandse populatie van dezelfde grootte. Bij de behandelingsplannen werd het hoge aantal voorschrijvingen van homeopathische middelen (50%) geweten aan schaarste en onbekendheid met voorschrijven van westerse geneesmiddelen.This report provides a survey of the medical consumption of 4500 patients seen at the Belarussian-Dutch Outpatient Clinic in Gomel, Belarus during 1991-1993. This clinic was established in the framework of Dutch humanitarian aid following the Chernobyl reactor accident in 1986. A computerized patient registration programme was introduced. Special attention was paid to complaints that could be related to possible enhanced radiation exposure of the patients. The patient population consisted approximately 75% of liquidators, persons who may have been exposed to higher doses of radiation than the general public. Complaints affecting cardiovascular, gastro-intestinal, neurological and locomotor systems were uttered most frequently, consequently most diagnoses were related to these disciplines. The quantity of types of complaints and diagnoses were in agreement with each other, except for thyroid disease. The pattern of complaints and diagnoses was roughly comparable to the situation in a general outpatient clinic internal medicine in the Netherlands and the number of goitre, gastritis, gastric and duodenal ulcers was higher. Diagnoses that could be attributed to increased radiation exposure were analyzed. A large number of cases of thyroid disease were diagnosed. Haematologic disease was registered in 54 cases, five of these concerned malignant disease. Cataract was diagnosed in 19 cases, both lower than in a Dutch population of similar size. The same accounted for malignant disease (23x). Treatment plans consisted of different therapies and medication. The high percentage of prescriptions of homeopathic remedies (50%) may be due to scarcity of and unfamiliarity with prescribing western medication.VW