The cortical silent period (CSP) following transcranial magnetic stimulation reflects GABAB-mediated inhibition in the primary motor cortex (M1), and could contribute to understand the ...pathophysiological substrates of epilepsies. Increased CSP duration has been reported in idiopathic generalized epilepsy (IGE) and in partial epilepsy (PE) involving the M1, although other studies yielded discordant findings. In this meta-analysis we systematically assessed the consistency of CSP changes in untreated epileptic patients. We searched for controlled studies evaluating the CSP in drug-naïve or drug-free patients with IGE or PE. The mean difference between CSP duration obtained in patients and controls was calculated. Fourteen studies (267 patients and 234 controls) were included. A significant mean difference was found, with longer CSP in patients than in controls. The difference was still greater if IGE patients only were analyzed. CSP modifications did not depend from differences in motor threshold between patients and controls. Meta-analysis confirms CSP modifications in epilepsies, with enhancement of this cortical inhibitory measure in most IGE patients. This provides a rationale for investigations aiming to verify the hypotheses that increased CSP reflects compensatory neural phenomena counteracting transition from the interictal to ictal state, and that CSP variability reflects the pathophysiological heterogeneity of epileptic syndromes.
Perceptual events occur in multiple sensory modalities. Recent neuroimaging data challenge the traditional models arguing for sensory integration to occur in higher-order association cortices and ...support the hypothesis of a multisensory interplay at low-level sensory-specific cortex. We used an on-line interference approach by rTMS to investigate the role of the left lateral occipital cortex (LOC) in audio-visual (AV) object recognition process. Fifteen healthy volunteers performed a visual identification task of degraded pictures (living and non-living) presented alone (V) or simultaneously to coherent (c-AV) or non-coherent (nc-AV) sounds. Focal 10-Hz rTMS at an intensity of 100% resting motor threshold was delivered simultaneously to the picture (500 ms). Two blocks of 60 pictures were randomly displayed in two different experimental conditions: rTMS of the left LOC and over Cz (cortical control area). Accuracy and reaction time of identification were analyzed. rTMS of the left LOC produced a worsening of the accuracy compared to rTMS over Cz specifically in the c-AV condition. Interestingly, the effect was significant for stimuli belonging to the living semantic category. These data support the view that audiovisual interaction effect may occur at early stage of recognition processing.
In this study, we conducted two experiments to evaluate the effect of different types of odors on a time reproduction task, comparing performances of males to those of females. In the first ...experiment, subjects had to estimate short (510, 600, 690 ms) and long (1700, 2000, 2300 ms) interval durations under three odor conditions: positive, negative and neutral. A gender specific effect of olfactory stimulation on time estimation was found only for short durations. Namely, females were less accurate (overestimated) in reproducing short time intervals during the unpleasant odor presentation. This effect was confirmed and strengthened in the second experiment in which the intensity of the negative odor was enhanced. The present findings suggest that the neural network underlying time estimation is more “sensitive” to context manipulations in females than in men. PRACTICAL APPLICATIONS: The first important point is that there might be relevant gender differences in the processing of time (time estimation) that are mediated by olfactory stimulation. This new evidence might have important implications and applications in health issues and especially in workplace safety, for example in jobs or contexts in which fast processing and rapid decisions or choices are required. Therefore, the knowledge that females are more influenced by unpleasant odors than males during time estimation should be seriously considered in situations in which time plays a crucial role such as during rapid decision‐making, where automatic processes should be efficiently activated. Overall, the higher sensitivity to specific olfactory stimulation observed in women probably reflects individual differences in a complex process such as time processing.
Objectives: To assess the recurrence rate of epilepsy attributable to discontinuation of treatment in seizure free patients and to identify the risk factors for recurrence. Methods: 330 patients ...referred to an epilepsy centre who were seizure free for at least 2 years while on stable monotherapy were the study population. Discontinuation of antiepileptic drugs (AEDs) was proposed to all eligible patients or to their carers after discussion of the risks and benefits. Depending on whether they accepted or refused treatment withdrawal, the patients were stratified into two cohorts and followed up until seizure relapse or 31 March 1999, whichever came first. For each patient, records were taken of the main demographic and clinical variables. Results: The sample comprised 225 patients who entered the discontinuation programme and 105 who decided to continue treatment. Twenty nine patients (28%) continuing treatment had a relapse, compared with 113 (50%) of those entering the withdrawal programme. For patients continuing treatment, the probability of remission was 95% at 6 months, 91% at 12 months, 82% at 24 months, 80% at 36 months, and 68% at 60 months. The corresponding values for patients discontinuing treatment were 88%, 74%, 57%, 51%, and 48%. After adjusting for the principal prognostic factors, in patients discontinuing AEDs the risk of seizure relapse was 2.9 times that of patients continuing treatment. A relation was also found between relapse and duration of active disease, number of years of remission while on treatment, and abnormal psychiatric findings. Conclusions: Seizure free referral patients on stable monotherapy who elect to withdraw drug treatment are at higher risk of seizure relapse compared with patients continuing treatment. Severity of disease and seizure free period are significant prognostic factors.
In carotid endarterectomy (CEA), EEG and somatosensory evoked potentials (SEPs) are the most commonly used monitoring techniques to prevent perioperative stroke. However, which of these methods is ...the most appropriate is not definitely established. Here we evaluated retrospectively simultaneous EEG and SEP recordings. Our CEA series was analyzed backward to identify 30 patients requiring carotid shunt. Shunting was performed in 7.1% of 420 consecutive CEA over a 20-month period. All CEAs were continuously monitored by multi-channel EEG and SEPs before, during and 20 min following carotid cross-clamping. The most reliable SEP criterion for shunting was marked amplitude reduction or disappearance of cortical components (N20, P25), usually associated or preceded by a unilateral or bilateral suppression of EEG activity. Three of the shunted patients had minor postoperative neurological deficits. Amongst the 390 non-shunted patients, 1 had a postoperative ischemic stroke and 1 one had a cerebral hemorrhage. Findings confirm that SEPs are less sensitive but more specific than EEG for the detection of cerebral ischemia in CEA. The number of shunting and major ischemic events in non-shunted patients associated to simultaneous EEG and SEP monitoring was lower than those commonly reported in the literature of CEA.
The impact of educational strategies in the management of adverse treatment effects and drug interactions in adult patients with epilepsy with comorbidities remains undetermined.
The EDU-COM study is ...a randomised, pragmatic trial investigating the effect of a patient-tailored educational plan in patients with epilepsy with comorbidity.
174 adult patients with epilepsy with chronic comorbidities, multiple-drug therapy and reporting at least one adverse treatment effect and/or drug interaction at study entry were randomly assigned to the educational plan or usual care. The primary endpoint was the number of patients becoming free from adverse treatment events and/or drug interactions after a 6-month follow-up. The number of adverse treatment events and drug interactions, health-related quality of life (HRQOL) summary score changes and the monetary costs of medical contacts and drugs were assessed as secondary outcomes.
The primary endpoint was met by 44.0% of patients receiving the educational plan versus 28.9% of those on usual care (p=0.0399). The control group reported a significantly higher risk not to meet successfully the primary endpoint at the end of the study: OR (95% CI) of 2.29 (1.03 to 5.09). A separate analysis on drug adverse effects and drug interactions showed that the latter were more sensitive to the effect of educational treatment. Quality of life and costs were not significantly different in the two groups.
A patient-tailored educational strategy is effective in reducing drug-related problems (particularly drug interactions) in epilepsy patients with chronic comorbidities, without adding significant monetary costs. Registered at ClinicalTrials.gov, identifier NCT01804322, (http://www.clinicaltrials.gov).
This epidemiological study in a group of Italian children was undertaken in order to increase our knowledge of the prevalence of Molar Incisor Hypomineralisation (MIH) in different European ...countries.
A population of school children aged 7.3 - 8.3 years, living in Lissone, Northern Italy, was examined for the presence and severity of MIH.
Of a total of 227 children (113 females), 31 (13.7%) had MIH, the tooth prevalence in the permanent first molars being 5.8%. Fifteen children (6.6%) had demarcated opacities in the incisors with a tooth prevalence of 2.1%. The defects in the molars were mild with the exception of one child who had severe defects.
MIH was quite common in this Italian town, and the prevalence figures were near those reported in Scandinavian countries but clearly higher than those from Dresden, Germany.
Vigabatrin is a newly licensed drug for use in patients with epilepsy. We investigated whether this drug was comparable to standard first-line monotherapy in efficacy and incidence of adverse events. ...We enrolled 459 patients with newly diagnosed, previously untreated partial epileptic seizures from 44 European centres and randomly assigned them carbamazepine 600 mg daily (n=230) or vigabatrin 2 g daily (n=229). After initial maintenance doses were reached, doses were adjusted downwards (in the case of adverse events) or upwards (in the case of seizures) by the clinician. The primary outcome was time to withdrawal because of lack of efficacy or adverse events. Secondary outcomes included efficacy (time to 6-month remission of seizures, time to first seizure after initial dose stabilisation), and adverse events (incidence and severity). Analysis was by intention to treat. Time to withdrawal for lack of efficacy or adverse events did not differ between groups (p=0.318). Vigabatrin was better tolerated than carbamazepine with fewer withdrawals, but was more frequently associated with psychiatric symptoms (58 25% vs 34 15%) and weight gain (25 11% vs 12 5%). Carbamazepine was associated with rash (22 10% vs seven 3%). All efficacy outcomes favoured carbamazepine and failed to show equivalence between the two drugs. No significant difference was found for time to achieve 6 months of remission from seizures (p=0.058), but the most powerful outcome, time to first seizure after the first 6 weeks from randomisation, showed carbamazepine to be significantly more effective than vigabatrin (p=0.0001). Vigabatrin seems less effective but better tolerated than carbamazepine, which is the first-choice drug for the treatment of partial epilepsies. Vigabatrin cannot therefore be recommended as a first-line drug for monotherapy in this group of patients.
PDF
