Summary
Objective
The definition of drug‐resistant epilepsy (DRE) affects case identification and treatment, and impacts prevalence or incidence estimates and health burden estimation in ...epidemiology. The objective of this systematic review is to evaluate the consistency between definitions of DRE in the literature and the official definition in the International League Against Epilepsy (ILAE) guidelines, and to estimate the incidence, prevalence, and risk factors for DRE.
Methods
MEDLINE and EMBASE were searched for observational studies of DRE published between January 1980 and July 2015. The definitions of DRE in these studies were compared with the definition in the ILAE guidelines. Random‐effect model meta‐analyses were used to generate pooled estimates of prevalence or incidence and pooled odds ratios of the association with risk factors.
Results
Thirty‐five studies met inclusion criteria, including 13 080 epilepsy patients and 3941 patients with DRE. The definition of DRE varied widely across studies, with only 12% meeting the requirements of the ILAE definition. The pooled prevalence proportion of DRE among epilepsy patients was 0.30 (95% confidence interval CI 0.19‐0.42), and the pooled incidence proportion was 0.15 (95% CI 0.11‐0.19). Age at onset, symptomatic epilepsy, abnormal neuroimaging findings, abnormal electroencephalography results, history of mental retardation, neuropsychiatric disorders, febrile seizure, and status epilepticus increased risk for DRE.
Significance
There are limited high‐quality data available on DRE. Lack of consistency in definitions limits the ability to obtain robust estimates on the burden of DRE. More data based on the ILAE definition from well‐designed epidemiologic studies are needed to generate accurate and reliable results.
This randomized trial showed that two different doses of oral cannabidiol resulted in greater reductions in drop-seizure and total-seizure frequencies than placebo among patients with the ...Lennox–Gastaut syndrome, a severe developmental epileptic encephalopathy.
The second half of the 20th century has been characterised by the rural abandonment in several regions of the Mediterranean basin. The general collapse of traditional agriculture and livestock ...activities brought about an intensive migration movement from inland to coastal areas, which produced a massive forest cover increase in abandoned rural areas. This socioeconomic, spatial and environmental change has led to a situation unknown for centuries in the Mediterranean landscapes. As a consequence, large wildfires have increased enormously in importance in a society with a predominant urban vision over the rest of the territory. Indeed, public opinion considers wildfires as major natural disturbances related to climate change causing at the end deforestation, while its prerequisite, a substantial increase of forest cover due to rural collapse, is less known. This research aimed to deepen the knowledge about forest evolution and its implications after the land abandonment process that started in the second half of the 20th century. The substantive source of information was obtained from a photointerpretation by sampling, using five general land-cover and land-use types and four specific land-cover types over a period of 50 years (1957–2007) in the province of Castelló (Valencian Region, Spain). Results showed that the area dominated by dense forests (shrublands and woodlands) has increased from 17% to 28%, and the area dominated by their transitional land uses after farming abandonment has increased from 8% to 21%. Transition matrices enabled a precise identification of changes among dominant categories over the studied period. Random and systematic transitions between categories have been analysed and a map of forest evolution pathways could be drawn, in which a double alternative path was identified. In the general context of progressive evolution to dense forests in the Mediterranean region, we have also found different evolution rates which may depend on site conditions. Their specific soil and climatic factors should be further analysed in order to improve our understanding of future forest evolution in the Mediterranean region at a local scale. A robust knowledge of these processes will contribute to improve forest management and land-use planning while optimising resilience, carbon storage and the provision of environmental services.
•Rural abandonment has brought a new territorial paradigm in Mediterranean areas.•Land-use and land-cover change over 50 years was analysed by photointerpretation.•Forest growth involves both internal densification and external expansion.•A double route for forest evolution has been identified at a regional scale.•The increasing trend of forests poses new challenges in the Mediterranean region.
•The specific contribution of GUAs to the SDGs has been analysed.•Green urban areas contribute directly to the achievement of SDG11, SDG15 and SDG13.•Equity in sustainable development has been ...assessed at a sub-neighbourhood level.•Equity requires an adequate location, size, quantity and quality of GUA.
The Agenda for Sustainable Development 2030 of United Nations is made up of the 17 Sustainable Development Goals (SDGs) that humanity will have to meet by 2030. In achieving the SDGs, green urban areas (GUA) play a fundamental role at the local level as they provide recreational and bioclimatic regulatory functions and act as a carbon sink, as well. Specifically, the GUAs contribute directly to three SDGs: SDG 11 Sustainable cities and communities, SDG 13 Climate Action and SDG 15 Life on land.
This paper evaluates direct contribution of GUA to this SDGs with high spatial resolution in the case study of the city of Valencia (Spain). The evaluation carried out has made it possible to make a diagnosis of the quantity and accessibility of GUA at sub-neighbourhood level. The results for SDG 11 show that only 9.23% of the population do not have desirable access to GUA and 2.73% live in areas without easy walking distance access to GUA. On the other hand, the evaluation of SDG 15 shows that each inhabitant has at their disposal 10 m2 of GUA, below the average of cities of more than 250,000 inhabitants in Spain. The high spatial resolution of the evaluation has also made it possible to identify the city areas with the worst access to GUA and the least amount of GUA per inhabitant. In consequence, the results allow determining zones with high potential to improve. Additionally, the quantification of the CO2 fixed by the GUA carried out for the evaluation of SDG 13, shows that the fixed carbon is equivalent to 0.04% of total gross GHG emissions of the city and is 36% higher than the total GHG emissions of the annual fuel consumption of the total fleet in the city. Finally, the monitoring of the indicators applied allows evaluating the evolution of the GUA to improve the sustainable development of the city.
The aim of this study was to describe the profile of patients diagnosed with Dravet syndrome (DS), their clinical management, and the impact of DS on their quality of life (QoL) and family. Data of ...80 patients from 11 centres in Spain was collected. Patients (47.5% female) were 12.7 (9.6) years on average (SD, standard deviation). Despite the first episode occurred when patients were a mean (SD) of 0.4 (0.2) years, DS was not diagnosed until they were 6.9 (10.1) years old. The majority (86.7%) had SCN1A gene mutations and 73.4% had seizures during the last year (mostly generalized motor seizures 47.8%). The mean (SD) number of status epilepticus episodes was 3.6 (8.0) since diagnosis and 0.1 (0.5) in the last year. On the Health Utilities Index Mark (HUI) multi-attribute scale, the mean global score (SD) was 0.56 (0.24) in HUI2 and 0.32 (0.37) in HUI3. The impact of the disease was severe in most patients (HUI2, 81%; HUI3, 83.5%). In the Care-related QoL (CarerQol) the mean (SD) well-being score was 7.2 (2.1). Most caregivers (90%) were satisfied with their caregiving tasks, although 75% had difficulties combining these tasks with daily activities, 68.8% reported mental health problems and 61.2% physical problems.
The
PER
a
M
panel pooled analys
I
s of effec
T
iveness and tolerability (PERMIT) study was a pooled analysis of data from 44 real-world studies from 17 countries, in which people with epilepsy (PWE; ...focal and generalized) were treated with perampanel (PER). Retention and effectiveness were assessed after 3, 6, and 12 months, and at the last visit (last observation carried forward). Effectiveness assessments included 50% responder rate (≥ 50% reduction in seizure frequency from baseline) and seizure freedom rate (no seizures since at least the prior visit); in PWE with status epilepticus, response was defined as seizures under control. Safety and tolerability were assessed by evaluating adverse events (AEs) and discontinuation due to AEs. The Full Analysis Set included 5193 PWE. Retention, effectiveness and safety/tolerability were assessed in 4721, 4392 and 4617, respectively. Retention on PER treatment at 3, 6, and 12 months was 90.5%, 79.8%, and 64.2%, respectively. Mean retention time on PER treatment was 10.8 months. The 50% responder rate was 58.3% at 12 months and 50.0% at the last visit, and the corresponding seizure freedom rates were 23.2% and 20.5%, respectively; 52.7% of PWE with status epilepticus responded to PER treatment. Overall, 49.9% of PWE reported AEs and the most frequently reported AEs (≥ 5% of PWE) were dizziness/vertigo (15.2%), somnolence (10.6%), irritability (8.4%), and behavioral disorders (5.4%). At 12 months, 17.6% of PWEs had discontinued due to AEs. PERMIT demonstrated that PER is effective and generally well tolerated when used to treat people with focal and/or generalized epilepsy in everyday clinical practice.
Abstract
In this VERTICO early science paper we explore in detail how environmental mechanisms, identified in H
i
, affect the resolved properties of molecular gas reservoirs in cluster galaxies. The ...molecular gas is probed using ALMA ACA (+TP) observations of
12
CO(2–1) in 51 spiral galaxies in the Virgo cluster (of which 49 are detected), all of which are included in the VIVA H
i
survey. The sample spans a stellar mass range of
9
≤
log
M
⋆
/
M
⊙
≤
11
. We study molecular gas radial profiles, isodensity radii, and surface densities as a function of galaxy H
i
deficiency and morphology. There is a weak correlation between global H
i
and H
2
deficiencies, and resolved properties of molecular gas correlate with H
i
deficiency: galaxies that have large H
i
deficiencies have relatively steep and truncated molecular gas radial profiles, which is due to the removal of low-surface-density molecular gas on the outskirts. Therefore, while the environmental mechanisms observed in H
i
also affect molecular gas reservoirs, there is only a moderate reduction of the total amount of molecular gas.
Abstract
Galactic interactions and subsequent mergers are a paramount channel for galaxy evolution. In this work, we use the data from 236 star-forming CALIFA galaxies with integrated molecular gas ...observations in their central region (approximately within an effective radius)—from the APEX millimeter telescope and the CARMA millimeter telescope array. This sample includes isolated (126 galaxies) and interacting galaxies in different merging stages (110 galaxies; from pairs, merging, and postmerger galaxies). We show that the impact of interactions and mergers in the center of galaxies is revealed as an increase in the fraction of molecular gas (compared to isolated galaxies). Furthermore, our results suggest that the change in star formation efficiency is the main driver for both an enhancement and/or suppression of the central star formation—except in merging galaxies where the enhanced star formation appears to be driven by an increase of molecular gas. We suggest that gravitational torques due to the interaction and subsequent merger transport cold molecular gas inwards, increasing the gas fraction without necessarily increasing star formation.
Objective
We searched the medical literature from the last 15 years (1998 to 2013) relating to the etiology, diagnosis, and treatment of vulvodynia. The evidence was reviewed supporting the ...therapeutic proposals currently in use and propose the incorporation of novel, minimally invasive, interventional therapies, within the context of a multidisciplinary approach.
Methods
This was a systematic review of all relevant studies with no language restrictions. Studies were identified through Medline/PubMed (1998 to March 2013), the Cochrane Library (2001 to 2013), and conference records and book chapters. The keywords used included “chronic pelvic pain,” “vulvodynia,” “vestibulodynia,” and search terms “etiology,” “diagnosis,” and “treatment” were added. The levels of evidence were assessed using grading system for “Therapy/Prevention/Etiology/Harm” developed by the Centre for Evidence‐Based Medicine (CEBM). The grading system assists in clinical decision‐making, and we decided to use “The Grading of Recommendations Assessment, Development, and Evaluation (GRADE).”
Results
A total of 391 papers were assessed. Of these, 215 were analyzed and 175 were excluded, as they pertained to areas not directly related to the disease under review.
Conclusion
The optimal therapy for vulvar pain syndrome remains elusive, with low percentages of therapeutic success, using either local or systemic pharmacological approaches. Surgery involving invasive and often irreversible therapeutic procedures has resulted in success for certain subtypes of vulvodynia. We present a multidisciplinary approach whereby pain treatment units may provide an intermediate level of care between standard medical and surgical treatments.
•Epitrack total score significantly contributes to better QOL composite score.•Epitrack total score contributes to perceived energy and cognitive self-rating.•The number of ASMs mediates the ...relationship between cognitive deficits and QOL.•The DDD of ASMs does not mediate the association between cognition and QOL.
To assess whether cognitive performance predicts quality of life (QOL) in patients with drug-resistant temporal lobe epilepsy (TLE), using the Epitrack cognitive screening tool, while considering the mediating role of the number of anti-seizure medications (ASMs) and controlling for seizure-related, social, and emotional factors.
Seventy-five adult patients with drug-resistant TLE (mean age = 39.76 years, SD = 11.66) underwent a presurgical neuropsychological assessment. Main Outcome Measures: Cognitive performance (Epitrack), depression (BDI-II), trait anxiety (STAI); and QOL (QOLIE-31) were assessed.
Adjusting for seizure-related, social, and emotional factors, the Epitrack total score significantly contributed to QOL composite score, and energy and cognitive self-rating subscales. We found a significant indirect effect of the Epitrack total score on QOL composite score and seizure worry and social functioning subscales via the number of ASMs.
Our findings underline the relevance of cognitive functioning on QOL and the clinical utility of Epitrack to track cognitive side effects of ASMs and, consequently, to predict and manage QOL in this population.
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