When should we test patients with epilepsy for autoimmune antibodies? Results from a French retrospective single center study

BACKGROUND AND PURPOSE

Seizures represent a core symptom of autoimmune encephalitides with specific therapeutic issues. To date, patients with new-onset seizures or established epilepsy are not systematically tested for autoimmune antibodies. We aimed to identify clinical and paraclinical criterion that could help to select patients requiring additional autoimmune antibodies serum and cerebrospinal fluid (CSF) detection.

METHODS

In this retrospective single center study from the French Salpêtrière Hospital, data from 286 adult patients with epilepsy who received an autoantibody assay for the first time were analyzed. All patients were evaluated at our institution between January 2007 and December 2018 for assessment of new-onset epilepsy (n = 90) or established epilepsy (n = 196). We only analyzed patients that were screened for autoimmune antibodies. Demographic, clinical and neuroimaging measures were compared between patients with and without autoimmune encephalitis using Fisher's exact test for categorical variables and Welch's t test for continuous variables. Our primary goal was to identify significant factors that differentiated patients with and without autoimmune encephalitis.

RESULTS

We identified 27 patients with autoimmune epilepsy (9.4% of the patients who had been tested for autoantibodies). The significant factors differentiating patients with and without autoimmune encephalitis were: (i) the existence of a new-onset focal epilepsy + (e.g., newly diagnosed epilepsy < 6 months associated with additional symptoms, mainly cognitive or psychiatric symptoms), (ii) the presence of faciobrachial dystonic seizures very suggestive of anti- Leucine-rich glioma inactivated 1 (LGI1) encephalitis, and (iii) the presence of magnetic resonance imaging (MRI) abnormalities suggestive of encephalitis.

CONCLUSION

New-onset focal seizures combined with cognitive or psychiatric symptoms support the test for autoimmune antibodies. Further clinical already known red flags for an autoimmune origin are the presence of faciobrachial dystonic seizures and MRI signal changes consistent with encephalitis. On the other hand, isolated new-onset seizures and chronic epilepsy, even with associated symptoms, seem rarely linked to autoimmune encephalitis and should not lead to systematic testing.

Pan-European resistance monitoring programmes encompassing food-borne bacteria and target pathogens of food-producing and companion animals

Antimicrobial resistance is a concern both for animal and human health. Veterinary programmes monitoring resistance of animal and zoonotic pathogens are therefore essential. Various European countries have implemented national surveillance programmes, particularly for zoonotic and commensal bacteria, and the European Food Safety Authority (EFSA) is compiling the data. However, harmonisation is identified as a weakness and an essential need in order to compare data across countries. Comparisons of resistance monitoring data among national programmes are hampered by differences between programmes, such as sampling and testing methodology, and different epidemiological cut-off values or clinical breakpoints. Moreover, only very few valid data are available regarding target pathogens both of farm and companion animals. The European Animal Health Study Centre (CEESA) attempts to fill these gaps. The resistance monitoring programmes of CEESA have been a collaboration of veterinary pharmaceutical companies for over a decade and include two different projects: the European Antimicrobial Susceptibility Surveillance in Animals (EASSA) programme, which collects food-borne bacteria at slaughter from healthy animals, and the pathogen programmes that collect first-intention target pathogens from acutely diseased animals. The latter comprises three subprogrammes: VetPath; MycoPath; and ComPath. All CEESA projects include uniform sample collection and bacterial identification to species level in various European Union (EU) member states. A central laboratory conducts quantitative susceptibility testing to antimicrobial agents either important in human medicine or commonly used in veterinary medicine. This 'methodology harmonisation' allows easy comparisons among EU member states and makes the CEESA programmes invaluable to address food safety and antibiotic efficacy.

Impact of a preventive programme on the occurrence of incidents during the transport of critically ill patients

OBJECTIVE

Incidents related to transport of critically ill patients have been extensively reported. The objective of this study was to determine the effect of an interdisciplinary preventive programme used by all intensive care unit team members involved in patients' transport on the rate of these incidents.

METHODS

A clinical quality improvement audit using a prospective pre and post intervention design was performed among medical and surgical patients hospitalised in intensive care who required intra or inter-hospital transport.

RESULTS

A total of 180 transports occurred in the pre-implementation phase of the study and 187 transports in the post-implementation phase. A 20% absolute reduction of incidents was observed (57.2% vs. 37.4%, p<0.001). Statistically significant reductions were obtained for the technical problems category of incidents (25% vs. 7.5%, p<0.001) as well as the problems related to patient's mobilisation category (14.4% vs. 7.5%, p=0.05). Clinically significant trends were also observed for the clinical deterioration (24.4% vs. 17.1%, p=0.11) and undesired delay before test (23.9% vs. 17.6%, p=0.14) categories but did not reach statistical significance.

CONCLUSIONS

A preventive programme applied by all care providers involved in transport of critically ill patients was associated with a reduction of incidents. The application of such a programme should be acknowledged as a standard of care considering the risks inherent to the transportation of ICU patients.

New limits on the drift of fundamental constants from laboratory measurements

We have remeasured the absolute 1S-2S transition frequency nu(H) in atomic hydrogen. A comparison with the result of the previous measurement performed in 1999 sets a limit of (-29+/-57) Hz for the drift of nu(H) with respect to the ground state hyperfine splitting nu(Cs) in 133Cs. Combining this result with the recently published optical transition frequency in 199Hg+ against nu(Cs) and a microwave 87Rb and 133Cs clock comparison, we deduce separate limits on alpha/alpha=(-0.9+/-2.9) x 10(-15) yr(-1) and the fractional time variation of the ratio of Rb and Cs nuclear magnetic moments mu(Rb)/mu(Cs) equal to (-0.5+/-1.7) x 10(-15) yr(-1). The latter provides information on the temporal behavior of the constant of strong interaction.

Search for variations of fundamental constants using atomic fountain clocks

Over five years, we have compared the hyperfine frequencies of 133Cs and 87Rb atoms in their electronic ground state using several laser-cooled 133Cs and 87Rb atomic fountains with an accuracy of approximately 10(-15). These measurements set a stringent upper bound to a possible fractional time variation of the ratio between the two frequencies: d/dt ln([(nu(Rb))/(nu(Cs))]=(0.2+/-7.0)x 10(-16) yr(-1) (1sigma uncertainty). The same limit applies to a possible variation of the quantity (mu(Rb)/mu(Cs))alpha(-0.44), which involves the ratio of nuclear magnetic moments and the fine structure constant.

Controlling the cold collision shift in high precision atomic interferometry

We present a new method based on a transfer of population by adiabatic passage that allows one to prepare cold atomic samples with a well-defined ratio of atomic density and atom number. This method is used to perform a measurement of the cold collision frequency shift in a laser cooled cesium clock at the percent level, which makes the evaluation of the cesium fountain accuracy at the 10(-16) level realistic. With improvements, the adiabatic passage would allow measurements of density-dependent phase shifts at the 10(-3) level in high precision experiments.