Management of refractory complex partial seizures: current state of the art

Diagnosis of complex partial epilepsy is based on the clinical history, and laboratory tests, including EEG and neuroimaging studies, corroborate the diagnosis. The goal of epilepsy management is to make the patient completely seizure-free without drug-induced side effects, even in the patient with refractory complex partial seizures. Frequently this can be accomplished by choice of the optimal antiepileptic drug (AED) or a combination of drugs, the use of strategies to maximize the effectiveness of drug treatment, or by surgical removal of the seizure focus. Currently there are five “classical” first-line AEDs and 11 new AEDs available in the US and in many other countries for the treatment of localization-related epilepsy. The current state of the evidence is that no AED is clearly superior to other AEDs in the management of refractory complex partial seizures. Therefore the choice of which drug to use in an individual patient has to be based on other considerations, including the potential adverse reactions that may occur in that patient. There are a number of strategies for optimal use of AEDs in the management of refractory complex partial seizures. These include verification of the diagnosis of epilepsy and classification of specific seizure types, use of monotherapy if possible but polytherapy if necessary, starting with a low dose and raising it slowly but, until complete seizure control is achieved, pushing to the maximum tolerated dose, changing timing of dosing to reduce toxicity, using pharmacokinetic principles to fine-tune AED doses, adjusting dose for drug–drug interactions, and never giving up in the pursuit of better seizure control. Resection of the seizure focus can be curative in the majority of patients with seizures localized to one mesial temporal lobe. Success rates for resection of extratemporal seizure foci are lower. Vagus nerve stimulation (VNS) devices result in a significant reduction of seizure frequency in many patients, but patients rarely become completely seizure-free as a result of VNS device implantation. Management of refractory complex partial seizures continues to improve with the identification of new drugs and the development of new approaches to their control and cure

Trace Element Geochemistry of Martian Iddingsite in the Lafayette Meteorite

The Lafayette meteorite contains abundant iddingsite, a fine-grained intergrowth of smectite clay, ferrihydrite, and ionic salt minerals. Both the meteorite and iddingsite formed on Mars. Samples of iddingsite, olivine, and augite pyroxene were extracted from Lafayette and analyzed for trace elements by instrumental neutron activation. Our results are comparable to independent analyses by electron and ion microbeam methods. Abundances of most elements in the iddingsite do not covary significantly. The iddingsite is extremely rich in Hg, which is probably terrestrial contamination. For the elements Si, Al, Fe, Mn, Ni, Co, and Zn, the composition of the iddingsite is close to a mixture of approximately 50% Lafayette olivine + approximately 40% Lafayette siliceous glass + approximately 1O% water. Concordant behavior among these elements is not compatible with element fractionations between smectite and water, but the hydrous nature and petrographic setting of the iddingsite clearly suggest an aqueous origin. These inferences are both consistent, however, with deposition of the iddingsite originally as a silicate gel, which then crystallized (neoformed) nearly isochemically. The iddingsite contains significantly more magnesium than implied by the model, which may suggest that the altering solutions were rich in Mg(2+)

Groundbreaking Mars Sample Return for Science and Human Exploration

Partnerships between science and human exploration have recent heritage for the Moon (Lunar Precursor Robotics Program, LPRP) and nearearth objects (Exploration Precursor Robotics Program, xPRP). Both programs spent appreciable time and effort determining measurements needed or desired before human missions to these destinations. These measurements may be crucial to human health or spacecraft design, or may be desired to better optimize systems designs such as spacesuits or operations. Both LPRP and xPRP recommended measurements from orbit, by landed missions and by sample return. LPRP conducted the Lunar Reconnaissance Orbiter (LRO) and Lunar Crater Observation and Sensing Satellite (LCROSS) missions, providing high-resolution visible imagery, surface and subsurface temperatures, global topography, mapping of possible water ice deposits, and the biological effects of radiation [1]. LPRP also initiated a landed mission to provide dust and regolith properties, local lighting conditions, assessment of resources, and demonstration of precision landing [2]. This mission was canceled in 2006 due to funding shortfalls. For the Moon, adequate samples of rocks and regolith were returned by the Apollo and Luna programs to conduct needed investigations. Many near-earth asteroids (NEAs) have been observed from the Earth and several have been more extensively characterized by close-flying missions and landings (NEAR, Hayabusa, Rosetta). The current Joint Robotic Precursor Activity program is considering activities such as partnering with the New Frontiers mission OSIRIS-Rex to visit a NEA and return a sample to the Earth. However, a strong consensus of the NEO User Team within xPRP was that a dedicated mission to the asteroid targeted by humans is required [3], ideally including regolith sample return for more extensive characterization and testing on the Earth

The parent magma of xenoliths in shergottite EETA79001: Bulk and trace element composition inferred from magmatic inclusions

The SNC meteorites are samples of the Martian crust, so inferences about their origins and parent magmas are of wide planetologic significance. The EETA79001 shergottite, a basalt, contains xenoliths of pyroxene-olivine cumulate rocks which are possibly related to the ALHA77005 and LEW88516 SNC lherzolites. Olivines in the xenoliths contain magmatic inclusions, relics of magma trapped within the growing crystals. The magmatic inclusions allow a parent magma composition to be retrieved; it is similar to the composition reconstructed from xenolith pyroxenes by element distribution coefficients. The xenolith parent magma is similar but not identical to parent magmas for the shergottite lherzolites

Gender Differences in Human Single Neuron Responses to Male Emotional Faces

Well-documented differences in the psychology and behavior of men and women have spurred extensive exploration of gender€™s role within the brain, particularly regarding emotional processing. While neuroanatomical studies clearly show differences between the sexes, the functional effects of these differences are less understood. Neuroimaging studies have shown inconsistent locations and magnitudes of gender differences in brain hemodynamic responses to emotion. To better understand the neurophysiology of these gender differences, we analyzed recordings of single neuron activity in the human brain as subjects of both genders viewed emotional expressions. This study included recordings of single-neuron activity of 14 (6 male) epileptic patients in four brain areas: amygdala (236 neurons), hippocampus (n = 270), anterior cingulate cortex (n = 256), and ventromedial prefrontal cortex (n = 174). Neural activity was recorded while participants viewed a series of avatar male faces portraying positive, negative or neutral expressions. Significant gender differences were found in the left amygdala, where 23% (n = 15/66) of neurons in men were significantly affected by facial emotion, vs. 8% (n = 6/76) of neurons in women. A Fisher€™s exact test comparing the two ratios found a highly significant difference between the two (p \u3c 0.01). These results show specific differences between genders at the single-neuron level in the human amygdala. These differences may reflect gender-based distinctions in evolved capacities for emotional processing and also demonstrate the importance of including subject gender as an independent factor in future studies of emotional processing by single neurons in the human amygdala

Psychometric Evaluation and Design of Patient-Centered Communication Measures for Cancer Care Settings

Objective To evaluate the psychometric properties of questions that assess patient perceptions of patient-provider communication and design measures of patient-centered communication (PCC). Methods Participants (adults with colon or rectal cancer living in North Carolina) completed a survey at 2 to 3 months post-diagnosis. The survey included 87 questions in six PCC Functions: Exchanging Information, Fostering Health Relationships, Making Decisions, Responding to Emotions, Enabling Patient Self-Management, and Managing Uncertainty. For each Function we conducted factor analyses, item response theory modeling, and tests for differential item functioning, and assessed reliability and construct validity. Results Participants included 501 respondents; 46% had a high school education or less. Reliability within each Function ranged from 0.90 to 0.96. The PCC-Ca-36 (36-question survey; reliability=0.94) and PCC-Ca-6 (6-question survey; reliability=0.92) measures differentiated between individuals with poor and good health (i.e., known-groups validity) and were highly correlated with the HINTS communication scale (i.e., convergent validity). Conclusion This study provides theory-grounded PCC measures found to be reliable and valid in colorectal cancer patients in North Carolina. Future work should evaluate measure validity over time and in other cancer populations. Practice implications The PCC-Ca-36 and PCC-Ca-6 measures may be used for surveillance, intervention research, and quality improvement initiatives

Screening vs. Confinement in 1+1 Dimensions

We show that, in 1+1 dimensional gauge theories, a heavy probe charge is screened by dynamical massless fermions both in the case when the source and the dynamical fermions belong to the same representation of the gauge group and, unexpectedly, in the case when the representation of the probe charge is smaller than the representation of the massless fermions. Thus, a fractionally charged heavy probe is screened by dynamical fermions of integer charge in the massless Schwinger model, and a colored probe in the fundamental representation is screened in $QCD_2$ with adjoint massless Majorana fermions. The screening disappears and confinement is restored as soon as the dynamical fermions are given a non-zero mass. For small masses, the string tension is given by the product of the light fermion mass and the fermion condensate with a known numerical coefficient. Parallels with 3+1 dimensional $QCD$ and supersymmetric gauge theories are discussed.Comment: 29 pages, latex, no figures. slight change in the wording on page 2, references adde

Precise Chemical Analyses of Planetary Surfaces

We identify the chemical elements and element ratios that should be analyzed to address many of the issues identified by the Committee on Planetary and Lunar Exploration (COMPLEX). We determined that most of these issues require two sensitive instruments to analyze the necessary complement of elements. In addition, it is useful in many cases to use one instrument to analyze the outermost planetary surface (e.g. to determine weathering effects), while a second is used to analyze a subsurface volume of material (e.g., to determine the composition of unaltered planetary surface material). This dual approach to chemical analyses will also facilitate the calibration of orbital and/or Earth-based spectral observations of the planetary body. We determined that in many cases the scientific issues defined by COMPLEX can only be fully addressed with combined packages of instruments that would supplement the chemical data with mineralogic or visual information