1.
Epilepsy Behav. 2019 Nov 22;102:106681. doi: 10.1016/j.yebeh.2019.106681. [
Author information
- 1
- Providence VA Medical Center, Providence, RI, United States of America; Center for Neurorestoration and Neurotechnology, Providence, RI, United States of America; Brown University, Providence, RI, United States of America; Rhode Island Hospital, Providence, RI, United States of America. Electronic address: william_lafrance_jr@brown.edu.
- 2
- Brown University, Providence, RI, United States of America.
- 3
- Providence VA Medical Center, Providence, RI, United States of America; Brown University, Providence, RI, United States of America; Rhode Island Hospital, Providence, RI, United States of America.
- 4
- Providence VA Medical Center, Providence, RI, United States of America.
- 5
- Providence VA Medical Center, Providence, RI, United States of America; Brown University, Providence, RI, United States of America.
Abstract
OBJECTIVE:
Over 40% of combat Veterans report exposure to at least one type of morally injurious experience (MIE). While moral injury (MI) is described among Veterans with posttraumatic stress disorder (PTSD), MI has not been studied in Veterans with psychogenic nonepileptic seizures (PNES). We sought to identify MI in a clinical sample of Veterans with PNES and describe differences between those with MI and those without.
METHODS:
We conducted a retrospective cross-sectional study of 82 male and female Veterans with video-electroencephalography (EEG)-confirmed PNES consecutively seen in a Veterans Administration neuropsychiatry clinic. Identification of MI (witnessed or experienced events that conflict with one's moral compass) was made based by an independent observer using a survey of MIEs. Comorbidities, trauma history, and symptom scales were compared among those with and without MI.
RESULTS:
Twelve of 82 Veterans with PNES had MI. Those with MI reported higher guilt, depression symptoms and were of younger average age. There were no significant differences for categorical PTSD diagnosis, abuse history, or other demographic variables between those with and without MI.
SUMMARY:
In this sample of Veterans with PNES, MI was present in 14.6%. Those with MI had more guilt and depressive symptoms than those without. An increased understanding of this condition may aid in the development of diagnostic screenings and therapy options for those with PNES.
Published by Elsevier Inc.
KEYWORDS:
Moral injury; PTSD; Psychogenic nonepileptic seizures; Veterans
2.
Epilepsy Behav. 2019 Nov 22;102:106675. doi: 10.1016/j.yebeh.2019.106675. [Epub ahead of print]
Management of status epilepticus in adults. Position paper of the Italian League against Epilepsy.
Minicucci F1, Ferlisi M2, Brigo F3, Mecarelli O4, Meletti S5, Aguglia U6, Michelucci R7, Mastrangelo M8, Specchio N9, Sartori S10, Tinuper P11.
Author information
- 1
- Epilepsy Center, Unit of Neurophysiology, Neurological Department, IRCCS San Raffaele Hospital, Milan, Italy. Electronic address: minicucci.fabio@hsr.it.
- 2
- Division of Neurology A, Azienda Ospedaliera Universitaria Integrata, Verona, Italy. Electronic address: monica.ferlisi@aovr.veneto.it.
- 3
- Division of Neurology, "Franz Tappeiner" Hospital, Merano, Italy; Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy.
- 4
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy. Electronic address: oriano.mecarelli@uniroma1.it.
- 5
- Department of Biomedical, Metabolic and Neural Sciences, Center for Neurosciences and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, OCB Hospital, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy. Electronic address: stefano.meletti@unimore.it.
- 6
- Epilepsy Center, Department of Medical and Surgical Sciences Regional, Magna Graecia University of Catanzaro, Catanzaro, Italy.
- 7
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Unit of Neurology, Bellaria Hospital, Bologna, Italy. Electronic address: roberto.michelucci@isnb.it.
- 8
- Pediatric Neurology Unit, "V. Buzzi" Children's Hospital, Pediatrics Department, ASST Fatebenefratelli Sacco, Milan, Italy. Electronic address: massimo.mastrangelo@asst-fbf-sacco.it.
- 9
- Department of Neuroscience, IRCCS Bambino Gesù Children's Hospital, Rome, Italy. Electronic address: nicola.specchio@opbg.net.
- 10
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy. Electronic address: stefano.sartori@unipd.it.
- 11
- IRCCS Istituto delle Scienze Neurologiche, Bellaria Hospital, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy. Electronic address: paolo.tinuper@unibo.it.
Abstract
Since the publication of the Italian League Against Epilepsy guidelines for the treatment of status epilepticus in 2006, advances in the field have ushered in improvements in the therapeutic arsenal. The present position paper provides neurologists, epileptologists, neurointensive care specialists, and emergency physicians with updated recommendations for the treatment of adult patients with status epilepticus. The aim is to standardize treatment recommendations in the care of this patient population.
Copyright © 2019 Elsevier Inc. All rights reserved.
KEYWORDS:
Antiepileptic drugs; Epilepsy; Italian League against Epilepsy; Position paper; Status epilepticus; Treatment
3.
Epilepsy Behav. 2019 Nov 22;102:106661. doi: 10.1016/j.yebeh.2019.106661. [Epub ahead of print]
Sleep quality and related clinical features in patients with epilepsy: A preliminary report.
Author information
- 1
- Dışkapı Yıldırım Beyazıt Training and Research Hospital Neurology Department, Ankara, Turkey. Electronic address: asliecetemel@yahoo.co.uk.
- 2
- Dışkapı Yıldırım Beyazıt Training and Research Hospital Neurology Department, Ankara, Turkey.
Abstract
OBJECTIVE:
The relationship between sleep and epilepsy is complex and involves multiple mechanisms. Patients with epilepsy (PWE) often report fatigue and daytime sleepiness, and are often diagnosed with comorbid sleep disorders that are thought to be a direct corollary of seizures, adverse effects of antiepileptic drugs (AEDs), or a combination of these two factors. The emergence of depressive symptomatology in PWE can also lead to decreases in quality of life. The aim of this study was to investigate the relationship between sleep quality, clinical characteristics, excessive daytime sleepiness (EDS), fatigue, and depression in PWE.
METHODS:
Seventy-five consecutive PWE were included in the study. Demographic data, type and frequency of seizures, treatment regimens, number of seizures in the last 12 months, and relationship between seizures and sleep quality were recorded. Sleep quality, fatigue, daytime sleepiness, and depression symptoms were evaluated using the Pittsburgh Sleep Quality Index (PSQI), Fatigue Severity Scale (FSS), Epworth Sleepiness Scale (ESS), and Beck Depression Inventory (BDI), respectively.
RESULTS:
Patients (43 females, 32 males) had a mean age of 31.3 ± 11 years, a mean age of epilepsy onset of 18 ± 11.4 years, and a mean disease duration of 13.2 ± 9.9 years. Thirty-two (42.7%) patients had poor sleep quality, while 44 (58.7%) had fatigue, 18 (24%) had daytime sleepiness, and 56 (74.7%) had depression. The FSS, ESS, and BDI scores of the patients with PSQI ≥5 were significantly higher (p = 0.048, p = 0.018, p < 0.001, respectively). Patients with poor sleep quality had more frequent seizures (p = 0.040).
CONCLUSIONS:
Our study found that poor sleep quality in PWE may be associated with frequency of seizures and symptoms of fatigue, daytime sleepiness, and depression. Determining sleep disorders in PWE is essential as it may be a determinant of the patients' quality of life.
Copyright © 2019 Elsevier Inc. All rights reserved.
KEYWORDS:
Depression; Epilepsy; Fatigue; Sleep disorders
4.
J Pediatr Gastroenterol Nutr. 2019 Dec;69(6):633-638. doi: 10.1097/MPG.0000000000002491.
Personalized Nutrition: Are We There Yet?
Author information
- 1
- Immunology Department, Weizmann Institute of Science, Rehovot, Israel.
Abstract
The human genome has been proposed to contribute to interpersonal variability in the way we respond to nutritional intake. However, personalized diets solely based on gene-nutrient interactions have not lived up to their expectations to date. Advances in microbiome research have indicated that a science-based generation of a personalized diet based on a combination of clinical and microbial features may constitute a promising new approach enabling accurate prediction of dietary responses. In addition, scientific advances in our understanding of defined dietary components and their effects on human physiology led to the incorporation and testing of defined diets as preventive and treatment approaches for diseases, such as epilepsy, ulcerative colitis, Crohn disease, and type 1 diabetes mellitus. Additionally, exciting new studies show that tailored diet regiments have the potential to modulate pharmaceutical treatment efficacy in cancer treatment. Overall, the true therapeutic potential of nutritional interventions is coming to light but is also facing substantial challenges in understanding mechanisms of activity, optimization of dietary interventions for specific human subpopulations, and elucidation of adverse effects potentially stemming from some dietary components in a number of individuals.
5.
J Am Assoc Nurse Pract. 2019 Nov 21. doi: 10.1097/JXX.0000000000000331. [Epub ahead of print]
New-onset seizure activity in a transplant patient on immunosuppressive therapy.
Author information
- 1
- Crouse Testing Center, Crouse Hospital, Syracuse, New York.
- 2
- Department of Emergency Services, Ellis Hospital, Schenectady, New York.
- 3
- United Concierge Medicine, Troy, New York.
Abstract
The evaluation of new-onset seizure activity must raise a much broader differential than just epilepsy. This case study highlights that broad differential and identifies an important, but less common, cause of seizure activity in specific patient populations. Information is summarized from recent primary research, case series, literature reviews, and meta-analyses. In the appropriate clinical context, the diagnosis of posterior reversible encephalopathy syndrome (PRES) should be considered as a cause of seizures. Posterior reversible encephalopathy syndrome is a neurotoxic syndrome characterized by posterior cerebral edema on imaging and triggered by a variety of inciting or predisposing factors. This article reviews suggestions for the identification and management of PRES. Because of the myriad factors, nurse practitioners should be familiar with PRES and may encounter it through primary care, emergency or urgent care, hospitalist medicine, or a variety of specialty roles.
6.
Dev Med Child Neurol. 2019 Nov 25. doi: 10.1111/dmcn.14403. [Epub ahead of print]
Management of apnea in infants with trisomy 18.
Taira R1, Inoue H1,2, Sawano T1,2, Fujiyoshi J1,2, Ichimiya Y1, Torio M1, Sanefuji M1, Ochiai M1,2, Sakai Y1, Ohga S1,2.
Author information
- 1
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
- 2
- Comprehensive Maternity and Perinatal Care Center, Kyushu University, Fukuoka, Japan.
Abstract
This case series aimed to characterize the clinical features, management, and outcomes of apnea in infants with trisomy 18. Participants in this study were infants with trisomy 18 who were born alive and admitted to the neonatal intensive care unit in Kyushu University Hospital from 2000 to 2018. Retrospective analysis was performed on clinical data recorded in our department. Twenty-seven infants with trisomy 18 were admitted to our hospital during the study period, of which 25 (nine males, 16 females) were enrolled as eligible participants in this study. Among them, 14 started presenting with apnea from median 3.5 days of age (range 0-47d). In these infants with apnea, eight received respiratory support of positive pressure ventilation (PPV). The 1-year survival rate of infants in the PPV group was higher than that of non-PPV-supported infants (5 out of 8 vs 0 out of 6 infants). Five PPV-supported infants received a diagnosis of epilepsy, which was controlled by antiepileptic drugs. Postnatal respiratory intervention provides better prognosis in infants with trisomy 18. Improved survival leads to accurate diagnosis and treatment of apneic events in association with epilepsy.
© 2019 Mac Keith Press.
7.
Clin Pract Cases Emerg Med. 2019 Aug 5;3(4):354-356. doi: 10.5811/cpcem.2019.6.43173. eCollection 2019 Nov.
Cardiac Arrhythmia Following an Epileptic Seizure.
Author information
- 1
- University of Chicago Medical Center, Section of Emergency Medicine, Chicago, Illinois.
Abstract
Sudden unexplained death in epilepsy (SUDEP) refers to a death in a patient with epilepsy that is not due to trauma, drowning, status epilepticus, or another apparent cause. Although the pathophysiology of SUDEP is incompletely understood, growing evidence supports the role of seizure-associated arrhythmias as a potential etiology. We present a unique case of a patient presenting with ventricular tachycardia shortly following a seizure, along with corresponding laboratory data. Awareness of high risk arrhythmias in seizure patients could lead to advances in understanding pathophysiology and treatment of this complication of seizure disorder and ultimately prevention of SUDEP.
Copyright: © 2019 Kuttab et al.
8.
Cureus. 2019 Oct 9;11(10):e5868. doi: 10.7759/cureus.5868.
A Wireless Neuroprosthesis for Patients with Drug-refractory Epilepsy: A Proof-of-Concept Study.
Author information
- 1
- Neurosurgery, Cyberknife Center, Centro Diagnostico Italiano, Milano, ITA.
- 2
- Neurosurgery, University of Toronto, Toronto, CAN.
- 3
- Clinical Neurophysiology, Aston University, Birmingham, GBR.
- 4
- Research and Development, AB Medica, Milano, ITA.
Abstract
Objective Acute or protracted cortical recording may be necessary for patients with drug-refractory epilepsy to identify the ictogenic regions before undergoing resection. Currently, these invasive recording techniques present certain limitations, one of which is the need for cables connecting the recording electrodes placed in the intracranial space with external devices displaying the recorded electrocorticographic signals. This equates to a direct connection between the sterile intracranial space with the non-sterile environment. Due to the increasing likelihood of infections with time, subdural grids are typically removed a few days after implantation, a limiting factor in localizing the epileptogenic zone if seizures are not frequent enough to be captured within this time-frame. Furthermore, patients are bound to stay in the hospital, connected by the wires to the recording device, thus increasing substantially the treatment costs. To address some of the current shortcomings of invasive monitoring, we developed a neuroprosthesis made of a subdural silicone grid connected to a wireless transmitter allowing prolonged electrocorticografic recording and direct cortical stimulation. This device consists of a silicone grid with 128-platinum/iridium contacts, connected to an implantable case providing wireless recording and stimulation. The case also houses a wirelessly rechargeable battery for chronic long-term implants. We report the results of the first human proof-of-concept trial for wireless transmission of electrocorticographic recordings using a device suited for long-term implantation in three patients with drug-refractory epilepsy. Methods Three patients with medically refractory epilepsy underwent the temporary intraoperative placement of the subdural grid connected to the wireless device for recording and transmission of electrocorticographic signals for a duration of five minutes before the conventional recording electrodes were placed or the ictal foci were resected. Results Wireless transmission of brain signals was successfully achieved. The wireless electrocorticographic signal was judged of excellent quality by a blinded neurophysiologist. Conclusions This preliminary experience reports the first successful placement of a wireless electrocorticographic recording device in humans. Long-term placement for prolonged wireless electrocorticographic recording in epilepsy patients will be the next step.
Copyright © 2019, Romanelli et al.
KEYWORDS:
brain mapping; brain-computer interface; cortical stimulation; electrocorticography; epilepsy; neuroprosthesis; wireless
9.
J Vis Exp. 2019 Nov 5;(153). doi: 10.3791/59845.
Short-Term Free-Floating Slice Cultures from the Adult Human Brain.
Fernandes A1, Mendes ND2, Almeida GM3, Nogueira GO3, Machado CM4, Horta-Junior JAC4, Assirati Junior JA5, Garcia-Cairasco N6, Neder L7, Sebollela A8.
Author information
- 1
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo; Department of Physiology, Ribeirão Preto Medical School, University of São Paulo.
- 2
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo; Department of Pathology and Forensic Medicine, Ribeirão Preto Medical School, University of São Paulo.
- 3
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo.
- 4
- Department of Anatomy, Institute of Biosciences, São Paulo State University.
- 5
- Clinical Hospital at the Ribeirão Preto Medical School, University of São Paulo.
- 6
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo.
- 7
- Department of Pathology and Forensic Medicine, Ribeirão Preto Medical School, University of São Paulo.
- 8
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo; sebollela@fmrp.usp.br.
Abstract
Organotypic, or slice cultures, have been widely employed to model aspects of the central nervous system functioning in vitro. Despite the potential of slice cultures in neuroscience, studies using adult nervous tissue to prepare such cultures are still scarce, particularly those from human subjects. The use of adult human tissue to prepare slice cultures is particularly attractive to enhance the understanding of human neuropathologies, as they hold unique properties typical of the mature human brain lacking in slices produced from rodent (usually neonatal) nervous tissue. This protocol describes how to use brain tissue collected from living human donors submitted to resective brain surgery to prepare short-term, free-floating slice cultures. Procedures to maintain and perform biochemical and cell biology assays using these cultures are also presented. Representative results demonstrate that the typical human cortical lamination is preserved in slices after 4 days in vitro (DIV4), with expected presence of the main neural cell types. Moreover, slices at DIV4 undergo robust cell death when challenged with a toxic stimulus (H2O2), indicating the potential of this model to serve as a platform in cell death assays. This method, a simpler and cost-effective alternative to the widely used protocol using membrane inserts, is mainly recommended for running short-term assays aimed to unravel mechanisms of neurodegeneration behind age-associated brain diseases. Finally, although the protocol is devoted to using cortical tissue collected from patients submitted to surgical treatment of pharmacoresistant temporal lobe epilepsy, it is argued that tissue collected from other brain regions/conditions should also be considered as sources to produce similar free-floating slice cultures.
10.
Epilepsy Behav. 2019 Nov 21:106653. doi: 10.1016/j.yebeh.2019.106653. [Epub ahead of print]
Education and epilepsy: Examples of good practice and cooperation. Report of the IBE Commission on Education.
Author information
- 1
- Neurological Institute, Facultad de Medicina, Universidad de la República, Uruguay.
- 2
- Dep. of Clinical Pharmacology and Therapeutics, Univ. of Malta Msida, Malta.
- 3
- Indian Epilepsy Association, Mumbai Chapter, India.
- 4
- National Office Epilepsy, IBE Chapter, Cape Town, South Africa.
- 5
- AVANCE - School and Association for children with epilepsy and special needs, Lebanon.
- 6
- Dep. of Neurology, Mongolian National University of Medical Sciences, Mongolia.
- 7
- v. Bodelschwingh Foundation Bethel, Bielefeld, Germany. Electronic address: margarete.pfaefflin@mara.de.
Abstract
Education for patients, for families, for professionals, and for officials is one of the most important tools for improving knowledge about epilepsy and fighting discrimination. There are many educational initiatives worldwide, but they are often known only at a local level. Studies on epilepsy educational programs are rare and therefore published to a limited extent. The newly established International Bureau for Epilepsy (IBE) Education Commission enforces the exchange of educational activities and best practices, discussing education content and topics, target groups, and their educational needs, timing, tutors, and funding. A brief review of examples of all continents will be given. The needs for studies and for more exchange and closer cooperation will be addressed with proposals for further actions.
Copyright © 2019 Elsevier Inc. All rights reserved.
KEYWORDS:
Child; Education; Epilepsy; Family; IBE; ILAE
11.
Neurol Clin. 2020 Feb;38(1):201-214. doi: 10.1016/j.ncl.2019.09.005.
Neuroimaging of Deep Brain Stimulation.
Author information
- 1
- Department of Functional Neurosurgery, Center of Neuromodulation, National Institute of Clinical Neurosciences, Amerikai út 57, Budapest 1145, Hungary. Electronic address: l.g.eross@gmail.com.
- 2
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University Buffalo Medical, 955 Main Street, Buffalo, NY 14203, USA.
- 3
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University Buffalo, 955 Main Street, Buffalo, NY 14203, USA.
Abstract
Deep brain stimulation is the most advanced and effective neuromodulation therapy for Parkinson disease, essential tremor, and generalized dystonia. This article discusses how imaging improves surgical techniques and outcomes and widens possibilities in translational neuroscience in Parkinson disease, essential tremor, generalized dystonia, and epilepsy. In movement disorders diffusion tensor imaging allows anatomic segment of cortical areas and different functional subregions within deep-seated targets to understand the side effects of stimulation and gain more data to describe the therapeutic mechanism of action. The introduction of visualization of white matter tracks increases the safety of neurosurgical techniques in functional neurosurgery and neuro-oncology.
Copyright © 2019 Elsevier Inc. All rights reserved.
KEYWORDS:
Deep brain stimulation; Diffusion tensor imaging; Functional imaging; Neuromodulation
12.
Postgrad Med. 2019 Nov 25. doi: 10.1080/00325481.2019.1697119. [Epub ahead of print]
Update on non-pharmacological interventions in parasomnias.
Author information
- 1
- Sleep Wake Epilepsy Center and Dept. of Neurology, Inselspital University Hospital, University of Bern, Bern, Switzerland.
- 2
- "Vita-Salute" San Raffaele University, Faculty of Psychology, Milan, Italy; IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy.
- 3
- Centre for experimental Neurology, Dept. of Neurology, Inselspital University Hospital, University of Bern, Bern, Switzerland.
- 4
- Department of Biomedical Research (DBMR), Inselspital University Hospital, University of Bern, Bern, Switzerland.
- 5
- Department of Neurology, Medical School, University of Cyprus, Nicosia, Cyprus.
Abstract
Parasomnias are abnormal behaviors that occur during the sleep and can be associated, in particular during adulthood, with impaired sleep quality, daytime dysfunction and occasionally with violent and harmful nocturnal behaviors. In these cases, therapies are often considered. Pharmacological treatments are invasive and often have limited efficacy. Therefore, behavioral approaches remain an important treatment option for several types of parasomnias. However, the evidence-based approaches are limited. In the current review, we highlight results from various non-pharmacological techniques on different types of parasomnias and provide a glimpse into the future of non-pharmacological treatments in this field.
13.
Medicine (Baltimore). 2019 Nov;98(46):e17670. doi: 10.1097/MD.0000000000017670.
Retrospective analysis of brain abscess in 183 patients: A 10-year survey.
Author information
- 1
- Department of Neurological Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou.
- 2
- Department of Neurological Surgery, Zhenhai Longsai Hospital, Ningbo, Zhejiang Province, China.
Abstract
This study aims to identify predictive factors related to clinical outcome, reoperation, and complications in patients with brain abscess.Patients with a diagnosis of brain abscess at discharge at the Second Affiliated Hospital of Zhejiang University School of Medicine between 2008 and 2018 were reviewed. Logistic regression was used to identify predictive factors associated with Glasgow Outcome Scale (GOS) at discharge, GOS at 1 year after discharge, reoperation and complications.Among 183 patients enrolled into the study, 142 patients had a good outcome at discharge (GOS ≥ 4) and 41 had a poor outcome (GOS ≤ 3). During the follow-up period, 20 additional patients had a good outcome. A total of 156 patients were treated by open craniotomy excision (n = 72) and aspiration (n = 84), 10 of whom underwent reoperation. Complications in surgical patients for brain abscess occurred in 54 patients. Poor outcome was related to Glasgow coma scale (P = .007) and ventricular proximity (P = .001). Surgical method was associated with reoperation (P = .04) and complications (P < .001). Seizure at admission was related to epilepsy (P < .001). Surgical method was related to postoperative intracranial hemorrhage (P = .02).Glasgow coma scale (GCS) and ventricular proximity were associated with poor outcome. Further, patients who underwent aspiration were more likely to experience reoperation, while open craniotomy excision (OCE) was related to complications. Patients presenting seizure at admission were more likely to develop epilepsy. Patients who underwent OCE tended to experience postoperative intracranial hemorrhage.
14.
Paediatr Drugs. 2019 Oct;21(5):371-378. doi: 10.1007/s40272-019-00346-6.
Triclofos Sodium for Pediatric Sedation in Non-Painful Neurodiagnostic Studies.
Author information
- 1
- Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, 4920235, Petach Tikva, Israel. eytank@clalit.org.il.
- 2
- Pediatric Sedation Services, Schneider Children's Medical Center of Israel, Petach Tikva, Israel. eytank@clalit.org.il.
- 3
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. eytank@clalit.org.il.
- 4
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- 5
- Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, 4920235, Petach Tikva, Israel.
- 6
- Institute of Neurology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
- 7
- Pediatric Sedation Services, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
Abstract
AIM:
Triclofos sodium (TFS) has been used for many years in children as a sedative for painless medical procedures. It is physiologically and pharmacologically similar to chloral hydrate, which has been censured for use in children with neurocognitive disorders. The aim of this study was to investigate the safety and efficacy of TFS sedation in a pediatric population with a high rate of neurocognitive disability.
METHODS:
The database of the neurodiagnostic institute of a tertiary academic pediatric medical center was retrospectively reviewed for all children who underwent sedation with TFS in 2014. Data were collected on demographics, comorbidities, neurologic symptoms, sedation-related variables, and outcome.
RESULTS:
The study population consisted of 869 children (58.2% male) of median age 25 months (range 5-200 months); 364 (41.2%) had neurocognitive diagnoses, mainly seizures/epilepsy, hypotonia, or developmental delay. TFS was used for routine electroencephalography in 486 (53.8%) patients and audiometry in 401 (46.2%). Mean (± SD) dose of TFS was 50.2 ± 4.9 mg/kg. Median time to sedation was 45 min (range 5-245), and median duration of sedation was 35 min (range 5-190). Adequate sedation depth was achieved in 769 cases (88.5%). Rates of sedation-related adverse events were low: apnea, 0; desaturation ≤ 90%, 0.2% (two patients); and emesis, 0.35% (three patients). None of the children had hemodynamic instability or signs of poor perfusion. There was no association between desaturations and the presence of hypotonia or developmental delay.
CONCLUSION:
TFS, when administered in a controlled and monitored environment, may be safe for use in children, including those with underlying neurocognitive disorders.
15.
PLoS Med. 2019 May 13;16(5):e1002802. doi: 10.1371/journal.pmed.1002802. eCollection 2019 May.
Predicting seizures in pregnant women with epilepsy: Development and external validation of a prognostic model.
Allotey J1,2, Fernandez-Felix BM3,4, Zamora J1,3,4, Moss N5, Bagary M6, Kelso A7, Khan R8, van der Post JAM9, Mol BW10, Pirie AM11, McCorry D7, Khan KS1,2, Thangaratinam S1,2.
Author information
- 1
- Barts Research Centre for Women's Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
- 2
- Multidisciplinary Evidence Synthesis Hub, Queen Mary University of London, London, United Kingdom.
- 3
- CIBER Epidemiology and Public Health, Madrid, Spain.
- 4
- Clinical Biostatistics Unit, Hospital Ramón y Cajal, Madrid, Spain.
- 5
- Patient and Public Involvement, Katie's Team, Katherine Twining Network, Queen Mary University of London, London, United Kingdom.
- 6
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
- 7
- Department of Neurology, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom.
- 8
- Department of Obstetrics and Gynaecology, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom.
- 9
- Department of Obstetrics and Gynaecology, University of Amsterdam, Academic Medical Centre, Amsterdam, The Netherlands.
- 10
- Monash University, Monash Medical Centre, Clayton, Victoria, Australia.
- 11
- NHS Education for Scotland, Edinburgh, United Kingdom.
Abstract
BACKGROUND:
Seizures are the main cause of maternal death in women with epilepsy, but there are no tools for predicting seizures in pregnancy. We set out to develop and validate a prognostic model, using information collected during the antenatal booking visit, to predict seizure risk at any time in pregnancy and until 6 weeks postpartum in women with epilepsy on antiepileptic drugs.
METHODS AND FINDINGS:
We used datasets of a prospective cohort study (EMPiRE) of 527 pregnant women with epilepsy on medication recruited from 50 hospitals in the UK (4 November 2011-17 August 2014). The model development cohort comprised 399 women whose antiepileptic drug doses were adjusted based on clinical features only; the validation cohort comprised 128 women whose drug dose adjustments were informed by serum drug levels. The outcome was epileptic (non-eclamptic) seizure captured using diary records. We fitted the model using LASSO (least absolute shrinkage and selection operator) regression, and reported the performance using C-statistic (scale 0-1, values > 0.5 show discrimination) and calibration slope (scale 0-1, values near 1 show accuracy) with 95% confidence intervals (CIs). We determined the net benefit (a weighted sum of true positive and false positive classifications) of using the model, with various probability thresholds, to aid clinicians in making individualised decisions regarding, for example, referral to tertiary care, frequency and intensity of monitoring, and changes in antiepileptic medication. Seizures occurred in 183 women (46%, 183/399) in the model development cohort and in 57 women (45%, 57/128) in the validation cohort. The model included age at first seizure, baseline seizure classification, history of mental health disorder or learning difficulty, occurrence of tonic-clonic and non-tonic-clonic seizures in the 3 months before pregnancy, previous admission to hospital for seizures during pregnancy, and baseline dose of lamotrigine and levetiracetam. The C-statistic was 0.79 (95% CI 0.75, 0.84). On external validation, the model showed good performance (C-statistic 0.76, 95% CI 0.66, 0.85; calibration slope 0.93, 95% CI 0.44, 1.41) but with imprecise estimates. The EMPiRE model showed the highest net proportional benefit for predicted probability thresholds between 12% and 99%. Limitations of this study include the varied gestational ages of women at recruitment, retrospective patient recall of seizure history, potential variations in seizure classification, the small number of events in the validation cohort, and the clinical utility restricted to decision-making thresholds above 12%. The model findings may not be generalisable to low- and middle-income countries, or when information on all predictors is not available.
CONCLUSIONS:
The EMPiRE model showed good performance in predicting the risk of seizures in pregnant women with epilepsy who are prescribed antiepileptic drugs. Integration of the tool within the antenatal booking visit, deployed as a simple nomogram, can help to optimise care in women with epilepsy.
- PMID:
- 31083654
- PMCID:
- PMC6513048
- DOI:
- 10.1371/journal.pmed.1002802
- [Indexed for MEDLINE]
16.
PLoS One. 2019 Feb 8;14(2):e0211901. doi: 10.1371/journal.pone.0211901. eCollection 2019.
In vivo, in vitro and in silico correlations of four de novo SCN1A missense mutations.
Nissenkorn A1,2,3, Almog Y4, Adler I4,5, Safrin M4, Brusel M4, Marom M3, Bercovich S6, Yakubovich D3,7, Tzadok M2,3, Ben-Zeev B2,3, Rubinstein M4,5,8.
Author information
- 1
- Service for Rare Disorders, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel HaShomer, Israel.
- 2
- Pediatric Neurology Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel HaShomer, Israel.
- 3
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
- 4
- Goldschleger Eye Research Institute, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
- 5
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
- 6
- The Arrow Project, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel HaShomer, Israel.
- 7
- Neonatal Intensive Care, Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel HaShomer, Israel.
- 8
- The Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Abstract
Mutations in the SCN1A gene, which encodes for the voltage-gated sodium channel NaV1.1, cause Dravet syndrome, a severe developmental and epileptic encephalopathy. Genetic testing of this gene is recommended early in life. However, predicting the outcome of de novo missense SCN1A mutations is difficult, since milder epileptic syndromes may also be associated. In this study, we correlated clinical severity with functional in vitro electrophysiological testing of channel activity and bioinformatics prediction of damaging mutational effects. Three patients, bearing the mutations p.Gly177Ala, p.Ser259Arg and p.Glu1923Arg, showed frequent intractable seizures that had started early in life, with cognitive and behavioral deterioration, consistent with classical Dravet phenotypes. These mutations failed to produce measurable sodium currents in a mammalian expression system, indicating complete loss of channel function. A fourth patient, who harbored the mutation p.Met1267Ile, though presenting with seizures early in life, showed lower seizure burden and higher cognitive function, matching borderland Dravet phenotypes. In correlation with this, functional analysis demonstrated the presence of sodium currents, but with partial loss of function. In contrast, six bioinformatics tools for predicting mutational pathogenicity suggested similar impact for all mutations. Likewise, homology modeling of the secondary and tertiary structures failed to reveal misfolding. In conclusion, functional studies using patch clamp are suggested as a prognostic tool, whereby detectable currents imply milder phenotypes and absence of currents indicate an unfavorable prognosis. Future development of automated patch clamp systems will facilitate the inclusion of such functional testing as part of personalized patient diagnostic schemes.
- PMID:
- 30735520
- PMCID:
- PMC6368302
- DOI:
- 10.1371/journal.pone.0211901
- [Indexed for MEDLINE]
17.
Neurology. 2019 Feb 5;92(6):e576-e586. doi: 10.1212/WNL.0000000000006877. Epub 2019 Jan 4.
Electromagnetic source imaging in presurgical workup of patients with epilepsy: A prospective study.
Duez L1, Tankisi H1, Hansen PO1, Sidenius P1, Sabers A1, Pinborg LH1, Fabricius M1, Rásonyi G1, Rubboli G1, Pedersen B1, Leffers AM1, Uldall P1, Jespersen B1, Brennum J1, Henriksen OM1, Fuglsang-Frederiksen A1, Beniczky S2.
Author information
- 1
- From the Departments of Clinical Neurophysiology (L.D., H.T., P.O.H., A.F.-F., S.B.) and Neurology (P.S.), Aarhus University Hospital; Departments of Neurology (A.S., L.H.P.), Clinical Neurophysiology (M.F., G. Rásonyi), Pediatrics, Child Neurology (P.U.), Neurosurgery (B.J., J.B.), and Clinical Physiology, Nuclear Medicine and PET (O.M.H.), Copenhagen University Hospital Rigshospitalet; Danish Epilepsy Centre (G. Rubboli, B.P., S.B.), Dianalund; and Department of Diagnostic Radiology (A.-M.L.), Hvidovre Hospital, Denmark.
- 2
- From the Departments of Clinical Neurophysiology (L.D., H.T., P.O.H., A.F.-F., S.B.) and Neurology (P.S.), Aarhus University Hospital; Departments of Neurology (A.S., L.H.P.), Clinical Neurophysiology (M.F., G. Rásonyi), Pediatrics, Child Neurology (P.U.), Neurosurgery (B.J., J.B.), and Clinical Physiology, Nuclear Medicine and PET (O.M.H.), Copenhagen University Hospital Rigshospitalet; Danish Epilepsy Centre (G. Rubboli, B.P., S.B.), Dianalund; and Department of Diagnostic Radiology (A.-M.L.), Hvidovre Hospital, Denmark. sandor.beniczky@aarhus.rm.dk.
Abstract
OBJECTIVE:
To determine the diagnostic accuracy and clinical utility of electromagnetic source imaging (EMSI) in presurgical evaluation of patients with epilepsy.
METHODS:
We prospectively recorded magnetoencephalography (MEG) simultaneously with EEG and performed EMSI, comprising electric source imaging, magnetic source imaging, and analysis of combined MEG-EEG datasets, using 2 different software packages. As reference standard for irritative zone (IZ) and seizure onset zone (SOZ), we used intracranial recordings and for localization accuracy, outcome 1 year after operation.
RESULTS:
We included 141 consecutive patients. EMSI showed localized epileptiform discharges in 94 patients (67%). Most of the epileptiform discharge clusters (72%) were identified by both modalities, 15% only by EEG, and 14% only by MEG. Agreement was substantial between inverse solutions and moderate between software packages. EMSI provided new information that changed the management plan in 34% of the patients, and these changes were useful in 80%. Depending on the method, EMSI had a concordance of 53% to 89% with IZ and 35% to 73% with SOZ. Localization accuracy of EMSI was between 44% and 57%, which was not significantly different from MRI (49%-76%) and PET (54%-85%). Combined EMSI achieved significantly higher odds ratio compared to electric source imaging and magnetic source imaging.
CONCLUSION:
EMSI has accuracy similar to established imaging methods and provides clinically useful, new information in 34% of the patients.
CLASSIFICATION OF EVIDENCE:
This study provides Class IV evidence that EMSI had a concordance of 53%-89% and 35%-73% (depending on analysis) for the localization of epileptic focus as compared with intracranial recordings-IZ and SOZ, respectively.
Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.
- PMID:
- 30610090
- PMCID:
- PMC6382058
- DOI:
- 10.1212/WNL.0000000000006877
- [Indexed for MEDLINE]
18.
JAMA Neurol. 2019 Feb 1;76(2):135-136. doi: 10.1001/jamaneurol.2018.3550.
The US Food and Drug Administration's Authorization of the First Cannabis-Derived Pharmaceutical: Are We Out of the Haze?
Author information
- 1
- Center for Health Policy and Media Engagement, George Washington University School of Nursing, Washington, DC.
- 2
- Department of Health Policy and Management, George Washington University Milken Institute School of Public Health, Washington, DC.
- 3
- Department of Neurology, University of Alabama at Birmingham School of Medicine.
- 4
- University of Alabama at Birmingham Epilepsy Center.
19.
BMJ Open. 2018 Sep 28;8(9):e021246. doi: 10.1136/bmjopen-2017-021246.
Perceptions of emergency care using a seizure care pathway for patients presenting to emergency departments in the North West of England following a seizure: a qualitative study.
Author information
- 1
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
- 2
- The Walton Centre NHS Foundation Trust, Liverpool, UK.
Abstract
OBJECTIVES:
To establish the appropriateness of a previously developed seizure care pathway by exploring to what extent patients valued the intervention and perceived it as being helpful or not.
DESIGN:
Qualitative descriptive study, using semistructured, in-depth interviews and thematic template analysis, theoretically informed by critical realism.
SETTING:
In North West England, a seizure care pathway has been developed in collaboration with a specialist neurology hospital to support clinical management of seizure patients on initial presentation to the emergency department (ED), as well as access to follow-up services on discharge, with the aim of improving patient experience. Three National Health Service (NHS) EDs and a specialist neurology hospital provided the setting for participant recruitment to this study.
PARTICIPANTS:
181 patients fulfilled the inclusion criterion with 27 participants taking part following their experience of an ED attendance and outpatient follow-up appointment after a seizure.
RESULTS:
Five main themes emerged from the data: decision to seek care, responsiveness of services, waiting and efficiency, information and support, and care continuity. Two integrative themes spanned the whole study: lived experience and communication. This paper reports on two of the main themes: care continuity, and waiting and efficiency. The average time between ED presentation and interview completion was 100 days.
CONCLUSIONS:
Implementation of a care pathway is a complex intervention, requiring long-term follow-up to assess its integration into practice and effectiveness in service improvement. The seizure care pathway has the potential to enhance the care of seizure patients in the ED and at follow-up by improving continuity and management of care. The study demonstrates good aspects of the seizure care pathway as observed by patients and also recognises shortcomings within current service provision and questions what the NHS should and should not be delivering. Our study suggests various ways to enhance the pathway at service level to potentially drive improved patient experience.
© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY. Published by BMJ.
KEYWORDS:
epilepsy; organisation of health services; qualitative research; quality in health care
- PMID:
- 30269063
- PMCID:
- PMC6169770
- DOI:
- 10.1136/bmjopen-2017-021246
- [Indexed for MEDLINE]
20.
Arch Dis Child. 2019 Feb;104(2):189-192. doi: 10.1136/archdischild-2017-313421. Epub 2018 Sep 28.
Sleep and epilepsy: unfortunate bedfellows.
Author information
- 1
- Child Health, University Hospital of Wales, Cardiff, UK.
- 2
- Sleep and Neurodisability, St Thomas Hospital, London, UK.
- 3
- Children's Sleep Medicine, Evelina Childrens Hospital, London, UK.
Abstract
The relationship between sleep and seizure disorders is a particularly vicious cycle. Nocturnal seizures can interrupt sleep while a number of factors, including antiepileptics and sleep disorders that cause sleep fragmentation, can worsen seizures. Understanding and managing seizures and related sleep disturbance is therefore an important and treatable intervention target that could potentially improve children's sleep, but also their learning, mood, behaviour, seizures and parental quality of life.
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
KEYWORDS:
quality Of life; seizures; sleep
- PMID:
- 30266875
- PMCID:
- PMC6362435
- DOI:
- 10.1136/archdischild-2017-313421
- [Indexed for MEDLINE]
21.
Arch Dis Child. 2019 Feb;104(2):172-178. doi: 10.1136/archdischild-2017-314642. Epub 2018 Jul 17.
Long-term outcomes after group B streptococcus infection: a cohort study.
Author information
- 1
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore.
- 2
- Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia.
- 3
- Department of Microbiology, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia.
- 4
- Sydney Children's Hospital Network, NSW Pregnancy and Newborn Services, Randwick, New South Wales, Australia.
- 5
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health, School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia.
- 6
- Department of Neonatology, The Canberra Hospital, Garran, Australian Capital Territory, Australia.
- 7
- Faculty of Medicine, The Australian National University, Deakin, Australian Capital Territory, Australia.
- 8
- Early Start Research Institute, University of Wollongong, Wollongong, New South Wales, Australia.
- 9
- Department of Paediatrics, Wollongong Hospital, Wollongong, New South Wales, Australia.
- 10
- Illawarra Health and Medical Research Institute and School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.
- 11
- School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia.
Abstract
OBJECTIVE:
To describe the risk of death and hospitalisation until adolescence of children after group B streptococcus (GBS) infection during infancy.
DESIGN:
Population-based cohort study.
SETTING:
New South Wales, Australia.
PATIENTS:
All registered live births from 2000 to 2011.
INTERVENTIONS:
Comparison of long-term outcomes in children with the International Statistical Classification of Diseases and Related Health Problems-10th Revision discharge codes corresponding to GBS infections and those without.
MAIN OUTCOME MEASURES:
Death and hospitalisation.
RESULTS:
A total of 1206 (0.1%) children (936 (77.6%)≥37 weeks' gestation) were diagnosed with GBS infection. Over the study period, infection rates decreased from 2.1 (95% CI 1.8 to 2.4) to 0.7 (95% CI 0.5 to 0.9) per 1000 live births. Infants with GBS infection were born at lower gestation (mean 37.6 vs 39.0 weeks), were more likely very low birth weight (<1500 g, OR 9.1(95% CI 7.4 to 11.3)), born premature (OR 3.9(95% CI 3.4 to 4.5)) and have 5 min Apgar scores ≤5 (OR 6.7(95% CI 5.1 to 8.8)). Children with GBS had three times the adjusted odds of death (adjusted OR (AOR) 3.0(95% CI 2.1 to 4.3)) or rehospitalisations (AOR 3.1(95% CI 2.7 to 3.5)). Thirty-six (3.0%) with GBS died, with >50% of deaths occurring <28 days. Children with GBS were hospitalised more frequently (median 2 vs 1), for longer duration (mean 3.7 vs 2.2 days) and were at higher risk for problems with genitourinary (OR 3.1(95% CI 2.8 to 3.5)) and nervous (OR 2.0 (95% CI1.7 to 2.3)) systems.
CONCLUSIONS:
Despite decreasing GBS rates, the risk of poor health outcomes for GBS-infected children remains elevated, especially during the first 5 years. Survivors continue to be at increased risk of death and chronic conditions requiring hospitalisations, such as cerebral palsy and epilepsy.
© Author(s) (or their employer(s)) 2018. No commercial re-use. See rights and permissions. Published by BMJ.
KEYWORDS:
infectious diseases; mortality; neonatology
22.
J Physiol. 2018 Oct;596(19):4729-4752. doi: 10.1113/JP275970. Epub 2018 Sep 7.
ERG3 potassium channel-mediated suppression of neuronal intrinsic excitability and prevention of seizure generation in mice.
Author information
- 1
- State Key Laboratory of Natural and Biomimetic Drugs, Department of Molecular and Cellular Pharmacology, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, 100191, China.
- 2
- Department of Neurology, Shengjing Hospital affiliated to China Medical University, Shenyang, 110000, China.
- 3
- Peking University Sixth Hospital (Institute of Mental Health), Beijing, 100191, China.
- 4
- National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, 100191, China.
- 5
- Key Laboratory for Neuroscience, Ministry of Education, Beijing, 100191, China.
Abstract
KEY POINTS:
ERG3 channels have a high expression level in the central nervous system. Knockdown of ERG3 channels enhances neuronal intrinsic excitability (caused by decreased fast afterhyperpolarization, shortened delay time to the generation of an action potential and enhanced summation of somatic excitatory postsynaptic potentials) in hippocampal CA1 pyramidal neurons and dentate gyrus granule cells. The expression of ERG3 protein is reduced in human and mouse hippocampal epileptogenic foci. Knockdown of ERG3 channels in hippocampus enhanced seizure susceptibility, while mice treated with the ERG channel activator NS-1643 were less prone to epileptogenesis. The results provide strong evidence that ERG3 channels have a crucial role in the regulation of neuronal intrinsic excitability in hippocampal CA1 pyramidal neurons and dentate gyrus granule cells and are critically involved in the onset and development of epilepsy.
ABSTRACT:
The input-output relationship of neuronal networks depends heavily on the intrinsic properties of their neuronal elements. Profound changes in intrinsic properties have been observed in various physiological and pathological processes, such as learning, memory and epilepsy. However, the cellular and molecular mechanisms underlying acquired changes in intrinsic excitability are still not fully understood. Here, we demonstrate that ERG3 channels are critically involved in the regulation of intrinsic excitability in hippocampal CA1 pyramidal neurons and dentate gyrus granule cells. Knock-down of ERG3 channels significantly increases neuronal intrinsic excitability, which is mainly caused by decreased fast afterhyperpolarization, shortened delay time to the generation of an action potential and enhanced summation of somatic excitatory postsynaptic potentials. Interestingly, the expression level of ERG3 protein is significantly reduced in human and mouse brain tissues with temporal lobe epilepsy. Moreover, ERG3 channel knockdown in hippocampus significantly enhanced seizure susceptibility, while mice treated with the ERG channel activator NS-1643 were less prone to epileptogenesis. Taken together, our results suggest ERG3 channels play an important role in determining the excitability of hippocampal neurons and dysregulation of these channels may be involved in the generation of epilepsy. ERG3 channels may thus be a novel therapeutic target for the prevention of epilepsy.
© 2018 The Authors. The Journal of Physiology © 2018 The Physiological Society.
KEYWORDS:
ERG channels; Epilepsy; Intrinsic excitability
23.
J Physiol. 2018 Dec;596(23):5675-5686. doi: 10.1113/JP275428. Epub 2018 May 23.
Therapeutic potential to reduce brain injury in growth restricted newborns.
Author information
- 1
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, 4029, Australia.
Abstract
Brain injury in intrauterine growth restricted (IUGR) infants is a major contributing factor to morbidity and mortality worldwide. Adverse outcomes range from mild learning difficulties, to attention difficulties, neurobehavioral issues, cerebral palsy, epilepsy, and other cognitive and psychiatric disorders. While the use of medication to ameliorate neurological deficits in IUGR neonates has been identified as warranting urgent research for several years, few trials have been reported. This review summarises clinical trials focusing on brain protection in the IUGR newborn as well as therapeutic interventions trialled in animal models of IUGR. Therapeutically targeting mechanisms of brain injury in the IUGR neonate is fundamental to improving long-term neurodevelopmental outcomes. Inflammation is a key mechanism in neonatal brain injury; and therefore an appealing target. Ibuprofen, an anti-inflammatory drug currently used in the preterm neonate, may be a potential therapeutic candidate to treat brain injury in the IUGR neonate. To better understand the potential of ibuprofen and other therapeutic agents to be neuroprotective in the IUGR neonate, long-term follow-up information of neurodevelopmental outcomes must be studied. Where agents such as ibuprofen are shown to be effective, have a good safety profile and are relatively inexpensive, they can be widely adopted and lead to improved outcomes.
© 2018 The Authors. The Journal of Physiology © 2018 The Physiological Society.
KEYWORDS:
growth retardation; ibuprofen; inflammation
- PMID:
- 29700828
- PMCID:
- PMC6265565
- [Available on 2019-12-01]
- DOI:
- 10.1113/JP275428
- [Indexed for MEDLINE]
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