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Rafferty T, Koeppen-Babcock A, Muppidi S, Li Y, Le S. Utilization of APE2 and RITE2 scores in autoimmune encephalitis patients with seizures. Epilepsy Behav 2024; 154:109737. [PMID: 38518672 DOI: 10.1016/j.yebeh.2024.109737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 03/07/2024] [Accepted: 03/10/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE Immune-mediated seizures are rare but are increasingly recognized as an etiology of seizures resistant to anti-seizure medications (ASMs). Antibody Prevalence in Epilepsy 2 (APE2) and Response to Immunotherapy in Epilepsy 2 (RITE2) scores were developed recently to identify patients who may be seropositive for serum central nervous system (CNS) specific antibodies (Ab) and may benefit from immunotherapy (Dubey et al. 2018). The goal of this study was to apply APE2 and RITE2 scores to an independent cohort of patients with seizures secondary to autoimmune encephalitis (AE) and to further verify the sensitivity and specificity of the scores. PRINCIPAL RESULTS We conducted a retrospective study at Stanford University Hospital between 2008 and 2021 and included patients who had acute seizures and AE using diagnostic criteria from Graus (n = 34 definite AE, 10 probable AE, and 12 possible AE) (Graus et al. 2016). Patients were excluded if they did not have a serum Ab panel investigated or had alternate diagnoses (n = 55). APE2 and RITE2 scores were calculated based on clinical and diagnostic data (n = 56). Serum Ab were positive in 73 % of patients, in which 63 % cases carried CNS specific Ab. An APE2 score ≥ 4 had a sensitivity of 97 % and specificity of 14 % to predict a positive serum CNS specific Ab. A RITE2 score ≥ 7 had a sensitivity of 93 % and specificity of 60 % to predict seizure responsiveness to immunotherapy. CONCLUSION APE2 and RITE2 scores had high sensitivities but low specificities to predict seropositivity and seizure responsiveness to immunotherapy in patients with autoimmune encephalitis with seizures.
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Affiliation(s)
- Trevor Rafferty
- Department of Neurology and Neurological Sciences, Stanford University, CA, USA
| | | | - Srikanth Muppidi
- Department of Neurology and Neurological Sciences, Stanford University, CA, USA
| | - Yi Li
- Department of Neurology and Neurological Sciences, Stanford University, CA, USA
| | - Scheherazade Le
- Department of Neurology and Neurological Sciences, Stanford University, CA, USA.
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Yilmaz M, Tekten BO. Serum prolactin level and lactate dehydrogenase activity in patients with epileptic and nonepileptic seizures: A cross-sectional study. Medicine (Baltimore) 2021; 100:e27329. [PMID: 34559153 PMCID: PMC8462555 DOI: 10.1097/md.0000000000027329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 09/07/2021] [Indexed: 01/05/2023] Open
Abstract
It is important to diagnose epilepsy in a timely and accurate manner, and also to distinguish it from non-epileptic conditions. The present study was aimed at determining postictal serum prolactin levels and lactate dehydrogenase (LDH) activities in patients with new-onset seizure admitted to the emergency department in order to assess whether they could be used in the differentiation of epileptic seizure (ES) from nonepileptic seizure (NES).Eighty-five patients were included prospectively in this study. Patients were divided into 2 groups with respect to epilepsy diagnosis, and the final groups were comprised of 36 patients with ES and 49 patients with NES. Blood samples were obtained within 1 hour of seizure.No significant differences between groups were observed in prolactin levels and in the percentage of patients with abnormal prolactin level (P = .569 and .239, respectively). The median LDH activity was significantly higher in those with ES compared with those with NES (P = .031). The percentage of patients with elevated LDH levels was similar between 2 groups (P = .286).This was the first study to examine LDH activities in terms of its role in differentiation of seizure origin in the postictal period in patients hospitalized with seizure. Our study demonstrated that serum LDH activities within 1 hour after the seizure appear to be increased in patients with ES compared with those with NES, suggesting the potential role of LDH activities as a diagnostic tool in distinction of seizure types. Our study supports the hypothesis that LDH-antagonists may have a role in the management of seizure and epilepsy.
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Affiliation(s)
- Murat Yilmaz
- Department of Neurology, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Beliz Oztok Tekten
- Department of Emergency Medicine, Bolu Abant Izzet Baysal University, Bolu, Turkey
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Sokołowska B, Kozińska J, Szczepanek D, Wąsik-Szczepanek E, Kozioł M, Majowicz D, Juda A, Hus M. An epileptic seizure and haemorrhage into the ventricular system of the brain as the first manifestations of acquired haemophilia A - Case report. Ann Agric Environ Med 2021; 28:531-533. [PMID: 34558281 DOI: 10.26444/aaem/140306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Acquired haemophilia (AH) is a suddenly occurring severe blood diathesis that affects both males and females and is caused by autoantibodies which inhibit coagulation factor VIII. The report describes an unusual case of acquired haemophilia in which an epileptic seizure and haemorrhage into the ventricular system of the brain were the first manifestations of the disease. In addition, APTT was prolonged to 94.6 seconds and the factor VIII level was as low as 1.5%. The level of anti-FVIII antibody was extremely high - 272BU/ml. The patient did not undergo invasive diagnostic procedure or an operation. Recombinant factor VIIa was used to control the bleeding. In order to eradicate the inhibitor, the patient received prednisone and cyclophosphamide. Complete remission was achieved after 5.5 weeks of treatment.
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Affiliation(s)
- Bożena Sokołowska
- Department of Haematooncology and Bone Marrow Transplantation, Medical University, Lublin, Poland
| | - Justyna Kozińska
- Department of Haematooncology and Bone Marrow Transplantation, Medical University, Lublin, Poland
| | - Dariusz Szczepanek
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University, Lublin, Poland
| | - Ewa Wąsik-Szczepanek
- Department of Haematooncology and Bone Marrow Transplantation, Medical University, Lublin, Poland
| | - Magdalena Kozioł
- Department of Haematooncology and Bone Marrow Transplantation, Medical University, Lublin, Poland
| | - Daria Majowicz
- Department of Haematooncology and Bone Marrow Transplantation, Medical University, Lublin, Poland
| | - Adrian Juda
- Department of Haematooncology and Bone Marrow Transplantation, Medical University, Lublin, Poland
| | - Marek Hus
- Department of Haematooncology and Bone Marrow Transplantation, Medical University, Lublin, Poland
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Moise AM, Karakis I, Herlopian A, Dhakar M, Hirsch LJ, Cotsonis G, LaRoche S, Cabrera Kang CM, Westover B, Rodriguez A. Continuous EEG Findings in Autoimmune Encephalitis. J Clin Neurophysiol 2021; 38:124-129. [PMID: 31800465 PMCID: PMC7263965 DOI: 10.1097/wnp.0000000000000654] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Autoimmune encephalitis (AE) is a cause of new-onset seizures, including new-onset refractory status epilepticus, yet there have been few studies assessing the EEG signature of AE. METHODS Multicenter retrospective review of patients diagnosed with AE who underwent continuous EEG monitoring. RESULTS We identified 64 patients (male, 39%; white, 49%; median age, 44 years); of whom, 43 (67%) were antibody-proven AE patients. Of the patients with confirmed antibody AE, the following were identified: N-methyl-D-aspartate receptor (n = 17, 27%), voltage-gated potassium channel (n = 16, 25%), glutamic acid decarboxylase (n = 6, 9%), and other (n = 4, 6%). The remaining patients were classified as probable antibody-negative AE (n = 11, 17%), definite limbic encephalitis (antibody-negative) (n = 2, 3%), and Hashimoto encephalopathy (n = 8, 13%). Fifty-three percent exhibited electrographic seizures. New-onset refractory status epilepticus was identified in 19% of patients. Sixty-three percent had periodic or rhythmic patterns; of which, 38% had plus modifiers. Generalized rhythmic delta activity was identified in 33% of patients. Generalized rhythmic delta activity and generalized rhythmic delta activity plus fast activity were more common in anti-N-methyl-D-aspartate AE (P = 0.0001 and 0.0003, respectively). No other periodic or rhythmic patterns exhibited AE subtype association. Forty-two percent had good outcome on discharge. Periodic or rhythmic patterns, seizures, and new-onset refractory status epilepticus conferred an increased risk of poor outcome (OR, 6.4; P = 0.0012; OR, 3; P = 0.0372; OR, 12.3; P = 0.02, respectively). CONCLUSION Our study confirms a signature EEG pattern in anti-N-methyl-D-aspartate AE, termed extreme delta brush, identified as generalized rhythmic delta activity plus fast activity in our study. We found no other pattern association with other AE subtypes. We also found a high incidence of seizures among patients with AE. Finally, periodic or rhythmic patterns, seizures, and new-onset refractory status epilepticus conferred an increased risk of poor outcome regardless of AE subtype.
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Affiliation(s)
- Anna-Marieta Moise
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, U.S.A
- Mission Neurosciences Program, Epilepsy Department, Mission Health, Asheville, North Carolina, U.S.A
| | - Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Aline Herlopian
- Department of Neurology and Yale Comprehensive Epilepsy Center, Yale University, New Haven, Connecticut, U.S.A
| | - Monica Dhakar
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Lawrence J. Hirsch
- Department of Neurology and Yale Comprehensive Epilepsy Center, Yale University, New Haven, Connecticut, U.S.A
| | - George Cotsonis
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Suzette LaRoche
- Mission Neurosciences Program, Epilepsy Department, Mission Health, Asheville, North Carolina, U.S.A
| | | | - Brandon Westover
- MGH Epilepsy Service and Division of Clinical Neurophysiology, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Andres Rodriguez
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, U.S.A
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Lee K, Bohnert S, Vair C, Mikler J, Dunn JF. Cerebral blood flow and oxygenation in rat brain after soman exposure. Toxicol Lett 2021; 336:50-56. [PMID: 33147512 DOI: 10.1016/j.toxlet.2020.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 08/14/2020] [Accepted: 10/20/2020] [Indexed: 11/28/2022]
Abstract
Nerve agent exposure can cause debilitating neurological damage even with treatment. Currently accepted treatments involve attenuating the cholinergic crisis and seizure onset but do not focus directly on neuroprotection. Hence, there is a need for improved treatments to reduce neurological deficits. It is important to understand the pathophysiology of nerve agent mediated injury in order to identify effective treatment targets. Nerve agent-induced seizures are believed to be the main contributor to the neuropathology. Recently seizures have been shown to cause vascular changes that may actually attenuate neurological damage. This study evaluated the effect of soman-induced convulsive seizures on the relationship between CNS oxygen consumption and supply. To simultaneously assess changes in oxygenation and perfusion, rats were implanted with permanently fixed fiber-optic tissue oxygen sensing probes in the motor cortex and imaged with continuous arterial spin labelling MRI to measure cerebral blood flow. Baseline tissue oxygen tension (ptO2) and cerebral blood flow (CBF) were measured in isoflurane anaesthetized rats at least one day prior to soman or saline exposure. Rats were pretreated with HI-6 dimethansulfonate and atropine methyl nitrate (125 mg/kg and 20 mg/kg; intraperitoneal) followed by a convulsive dose of soman (90 μg/kg; subcutaneous) or equal volume of saline. Three additional treatments of HI-6/AMN were administered to improve survival. At 1.5 -hs after exposure, ptO2 and cerebral blood flow measurements were conducted. There was a significant decrease in CBF 1.5 -hs following soman exposure but no change in ptO2 was found. When we correlated ptO2 and CBF, for a given ptO2, there was lower CBF following soman exposure. This may indicate metabolism is inhibited, possibly because of mitochondrial impairment, therefore reducing oxygen demand. These data show hypoperfusion in brain following soman exposure which would be expected to contribute to soman-related neuropathology.
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Affiliation(s)
- Kevin Lee
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sara Bohnert
- Defence Research and Development Canada- Suffield Research Centre, Department of National Defence, Alberta, Canada
| | - Cory Vair
- Defence Research and Development Canada- Suffield Research Centre, Department of National Defence, Alberta, Canada
| | - John Mikler
- Defence Research and Development Canada- Suffield Research Centre, Department of National Defence, Alberta, Canada
| | - Jeff F Dunn
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Mathis D, Beese K, Rüegg C, Plecko B, Hersberger M. LC-MS/MS method for the differential diagnosis of treatable early onset inherited metabolic epilepsies. J Inherit Metab Dis 2020; 43:1102-1111. [PMID: 32319100 DOI: 10.1002/jimd.12244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/25/2020] [Accepted: 04/17/2020] [Indexed: 12/12/2022]
Abstract
Rapid diagnosis and early specific treatment of metabolic epilepsies due to inborn errors of metabolism (IEMs) is crucial to avoid irreversible sequalae. Nowadays, besides the profile analysis of amino- and organic acids, a range of additional targeted assays is used for the selective screening of those diseases. This strategy can lead to long turn-around times, repeated sampling and diagnostic delays. To replace those individual targeted assays, we developed a new liquid chromatography mass spectrometry method (LC-MS/MS) for the differential diagnosis of inherited metabolic epilepsies that are potentially treatable. The method was developed to simultaneously quantify 12 metabolites (sulfocysteine, guanidinoacetate, creatine, pipecolic acid, Δ1 -piperideine-6-carboxylate (P6C), proline, Δ1 -pyrroline-5-carboxylate (P5C), and the B6 -vitamers) enabling the diagnosis of nine different treatable IEMs presenting primarily with early-onset epilepsy. Plasma and urine samples were mixed with internal standards, precipitated and the supernatants were analyzed by LC-MS/MS. In comparison with previous assays, no derivatization of the metabolites is necessary for analysis. This LC-MS method was validated for quantitative results for all metabolites except P6C and P5C for which semiquantitative results were obtained due to the absence of commercially available standards. Coefficients of variation for all analytes were below 15% and recovery rates range between 80% and 120%. Analysis of patient samples with known IEMs demonstrated the diagnostic value of the method. The presented assay covers a selected panel of biochemical markers, improves the efficiency in the laboratory, and potentially leads to faster diagnoses and earlier treatment avoiding irreversible damage in patients affected with IEMs.
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Affiliation(s)
- Déborah Mathis
- Division of Clinical Chemistry and Biochemistry, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Karin Beese
- Division of Clinical Chemistry and Biochemistry, University Children's Hospital Zurich, Zurich, Switzerland
| | - Carmen Rüegg
- Division of Clinical Chemistry and Biochemistry, University Children's Hospital Zurich, Zurich, Switzerland
| | - Barbara Plecko
- Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Martin Hersberger
- Division of Clinical Chemistry and Biochemistry, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
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Çikriklar HI, Kotan D, Yücel M, Ceylan M, Çiftçi GG, Bayraktutan ÖF, Çiftçi IH. The role of Orexin-A levels in epileptic seizure. Neurosci Lett 2020; 734:135097. [PMID: 32485288 DOI: 10.1016/j.neulet.2020.135097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/16/2020] [Accepted: 05/23/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this study is to determine the usefulness of Orexin-A levels in differentiating between epileptic seizures and psychogenic non-epileptic seizures in patients presenting to the emergency service with epileptic seizure-type symptoms. METHODS A total of 80 individuals were included in this study, including 59 who presented to the emergency service within the first four hours of having been diagnosed with generalized tonic-clonic seizures (39 with epileptic seizures (ES) and 20 with pseudoseizures (PNES) and 21 controls. Orexin-A levels were measured in venous blood samples. RESULTS The mean Orexin-A levels were 5.16 ng/mL in the control group, 7.17 ng/mL in the PNES group, and 11.08 ng/mL in the ES group (Table 1). The mean Orexin-A level of the ES group was significantly different from both the control group and the PNES group (Table 1, p < 0.001); the difference between the control group and the PNES group was not significant (p > 0.05). CONCLUSIONS Results of this study suggest that blood Orexin-A may be an effective biomarker in the differential diagnosis of epileptic seizures/psychogenic non-epileptic seizures in patients presenting to the emergency service with an epileptic seizure-type clinical picture.
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Affiliation(s)
| | - Dilcan Kotan
- Altinsehir Mahallesi 326. Sokak No:7 Daire:20, NILÜFER, Bursa, Turkey
| | - Murat Yücel
- Altinsehir Mahallesi 326. Sokak No:7 Daire:20, NILÜFER, Bursa, Turkey
| | - Mustafa Ceylan
- Altinsehir Mahallesi 326. Sokak No:7 Daire:20, NILÜFER, Bursa, Turkey
| | - Gönül G Çiftçi
- Altinsehir Mahallesi 326. Sokak No:7 Daire:20, NILÜFER, Bursa, Turkey
| | | | - Ihsan H Çiftçi
- Altinsehir Mahallesi 326. Sokak No:7 Daire:20, NILÜFER, Bursa, Turkey
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Zheng SF, Lin P, Lin ZY, Shang-Guan HC, Chen GR, Zhang YB, Lin YX, Kang DZ, Yao PS. Lower Serum Iron and Hemoglobin Levels are Associated with Acute Seizures in Patients with Ruptured Cerebral Aneurysms. Neurocrit Care 2020; 31:501-506. [PMID: 31161421 DOI: 10.1007/s12028-019-00746-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE The aim of the study is to investigate the value of serum iron and hemoglobin levels for predicting acute seizures following aneurysmal subarachnoid hemorrhage (aSAH). METHODS Clinical and laboratorial data from patients with ruptured intracranial aneurysms were collected in the retrospective study. Age, sex, symptom onset, history of diabetes and hypertension, history of coronary artery disease, temperature, Hunt-Hess grade, Fisher grade, aneurysm location, hemoglobin, serum potassium, sodium, calcium, phosphorus, and iron were collected. Acute seizures were determined as seizures within 1 week following aSAH. Propensity score matching (PSM) analyses were performed to correct imbalances in patient characteristics between seizure and non-seizure groups. RESULTS A total of 760 patients were included. Incidence of acute seizures following aSAH was 6.4%. In the univariate analysis, significant differences were detected in age, admission Hunt-Hess grade, Fisher grade, hemoglobin, serum sodium, and serum iron between seizure and non-seizure groups. In multivariate logistic regression model, lower serum iron was considered as a risk factor for acute seizures (OR 0.182, 95% CI 0.084-0.393, p = 0.000), as well as lower hemoglobin (OR 0.977, 95% CI 0.962-0.993, p = 0.004) and higher serum sodium (OR 1.072, 95% CI 1.003-1.145, p = 0.039). After PSM, there were no significant differences in age, admission Hunt-Hess grade, Fisher grade, and serum sodium between seizure and non-seizure groups. The matched seizure group had lower serum iron and hemoglobin levels compared with the matched non-seizure group (p < 0.05). The optimal cutoff value for serum iron and hemoglobin levels as a predictor of acute seizure after aSAH was determined as 9.9 mmol/L (sensitivity was 81.63% and the specificity was 65.40%) and 119 g/L (sensitivity was 63.27% and the specificity was 70.18%), respectively. CONCLUSIONS Serum iron and hemoglobin levels were inversely associated with a high risk of acute seizures following aSAH.
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Affiliation(s)
- Shu-Fa Zheng
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, NO. 20 Chazhong Road, Taijiang District, Fuzhou City, 350004, China
| | - Peng Lin
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, NO. 20 Chazhong Road, Taijiang District, Fuzhou City, 350004, China
| | - Zhang-Ya Lin
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, NO. 20 Chazhong Road, Taijiang District, Fuzhou City, 350004, China
| | - Huang-Cheng Shang-Guan
- Department of Critical Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Guo-Rong Chen
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, NO. 20 Chazhong Road, Taijiang District, Fuzhou City, 350004, China
| | - Yi-Bin Zhang
- Department of Neurosurgery, Dehua County Hospital, Quanzhou, China
| | - Yuan-Xiang Lin
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, NO. 20 Chazhong Road, Taijiang District, Fuzhou City, 350004, China
| | - De-Zhi Kang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, NO. 20 Chazhong Road, Taijiang District, Fuzhou City, 350004, China.
| | - Pei-Sen Yao
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, NO. 20 Chazhong Road, Taijiang District, Fuzhou City, 350004, China.
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Sanya EO, Adeyanju OA, Olarinoye JK, Bello H, Alaofin WA, Wahab KW, Soladoye AA. Magnesium Supplementation did not affect the Antiseizure Property of Ketogenic Diet but Reduced Lipid Dysmetabolism. West Afr J Med 2020; 37:7-12. [PMID: 32030705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Ketogenic diets (KD) have been used globally in epilepsy management. Similarly, supplementation of diets with magnesium has been associated with disease prevention and improvement. However, the effect of magnesium (Mg) supplementation in conjunction with KD on epilepsy has not yet been investigated. We hypothesized that magnesium supplementation in KD would improve the effectiveness of the diet. METHODS Forty-eight male Wistar rats were used for the study. The animals were fed on 4 diet types: I-normal rat chow (ND), II-ND with Mg supplement (ND+Mg), III-medium chain ketogenic diet (KD) and IV-KD with Mg supplement (KD+Mg). Animals in each group were divided into 3: experimental, control and observatory. The experimental drug was intraperitoneal Pentylenetetrazole (PTZ) administered at 25 mg/kg. The rats were observed for 2 hours after the drug administration and induced seizures noted. The levels of serum electrolytes and plasma lipid levels were determined using standard methods. RESULTS The seizure latency was significantly prolonged 60.8±0.5mins in group III compared with 8.7±2.1mins in group I (p<0.05). The seizure duration was 42.5±2.5mins in group III and 142.3±4.7 in group I (p<0.05). With Mg supplementation, seizure latency was 62.6±1.5mins in group IV and 7.9±0.7mins in group I (p<0.05). The seizure duration was 45.5±4.5min in group IV and 139.3±3.9mins in group II (p< 0.05). The KD-fed rats showed a tendency to develop dyslipidemia as evidenced by elevated Total Cholesterol /HDL and LDL/HDL (2.32±0.32 and 1.19±0.08) in group III, which was reversed in the KD+Mg fed group IV (1.96±0.32 and 1.08±0.09) with p<0.05. CONCLUSION Mg supplementation of KD did not affect its antiseizure property and does not confer antiseizure effect on ND. Mg supplement showed a tendency to reduce derangement in lipid metabolism associated with KD.
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Affiliation(s)
- E O Sanya
- Neurology Division, Department of Medicine, University of Ilorin, P. O. Box 5314, Ilorin, Kwara State, Nigeria
| | - O A Adeyanju
- Department of Physiology, University of Ilorin,Kwara State, Nigeria
| | | | - H Bello
- Neurology Division, Department of Medicine, University of Ilorin, Kwara State, Nigeria
| | - W A Alaofin
- Neurology Division, Department of Medicine, University of Ilorin, Kwara State, Nigeria
| | - K W Wahab
- Neurology Division, Department of Medicine, University of Ilorin, Kwara State, Nigeria
| | - A A Soladoye
- Neurology Division, Department of Medicine, University of Ilorin, Kwara State, Nigeria
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Millar S, Stone N, Bellman Z, Yates A, England T, O'Sullivan S. A systematic review of cannabidiol dosing in clinical populations. Br J Clin Pharmacol 2019; 85:1888-1900. [PMID: 31222854 PMCID: PMC6710502 DOI: 10.1111/bcp.14038] [Citation(s) in RCA: 130] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 06/07/2019] [Accepted: 06/10/2019] [Indexed: 12/11/2022] Open
Abstract
AIMS Cannabidiol (CBD) is a cannabis-derived medicinal product with potential application in a wide-variety of contexts; however, its effective dose in different disease states remains unclear. This review aimed to investigate what doses have been applied in clinical populations, in order to understand the active range of CBD in a variety of medical contexts. METHODS Publications involving administration of CBD alone were collected by searching PubMed, EMBASE and ClinicalTrials.gov. RESULTS A total of 1038 articles were retrieved, of which 35 studies met inclusion criteria covering 13 medical contexts. Twenty-three studies reported a significant improvement in primary outcomes (e.g. psychotic symptoms, anxiety, seizures), with doses ranging between <1 and 50 mg/kg/d. Plasma concentrations were not provided in any publication. CBD was reported as well tolerated and epilepsy was the most frequently studied medical condition, with all 11 studies demonstrating positive effects of CBD on reducing seizure frequency or severity (average 15 mg/kg/d within randomised controlled trials). There was no signal of positive activity of CBD in small randomised controlled trials (range n = 6-62) assessing diabetes, Crohn's disease, ocular hypertension, fatty liver disease or chronic pain. However, low doses (average 2.4 mg/kg/d) were used in these studies. CONCLUSION This review highlights that CBD has a potential wide range of activity in several pathologies. Pharmacokinetic studies as well as conclusive phase III trials to elucidate effective plasma concentrations within medical contexts are severely lacking and highly encouraged.
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Affiliation(s)
- S.A. Millar
- Division of Medical Sciences and Graduate Entry Medicine, School of MedicineUniversity of Nottingham, Royal Derby HospitalDerbyUK
| | - N.L. Stone
- Division of Medical Sciences and Graduate Entry Medicine, School of MedicineUniversity of Nottingham, Royal Derby HospitalDerbyUK
| | - Z.D. Bellman
- Division of Medical Sciences and Graduate Entry Medicine, School of MedicineUniversity of Nottingham, Royal Derby HospitalDerbyUK
| | | | - T.J. England
- Division of Medical Sciences and Graduate Entry Medicine, School of MedicineUniversity of Nottingham, Royal Derby HospitalDerbyUK
| | - S.E. O'Sullivan
- Division of Medical Sciences and Graduate Entry Medicine, School of MedicineUniversity of Nottingham, Royal Derby HospitalDerbyUK
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Dafotakis M, Heckelmann J, Zechbauer S, Litmathe J, Brokmann J, Willmes K, Surges R, Matz O. [Laboratory diagnostics in transient loss of consciousness : Serum lactate compared to serum creatine kinase as diagnostic indicator for generalized tonic-clonic seizures]. Nervenarzt 2019; 89:922-927. [PMID: 29564468 DOI: 10.1007/s00115-018-0505-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Laboratory parameters can help in the differential diagnostics of acute episodes of transient loss of consciousness. Especially serum lactate and serum creatine kinase (CK) levels may provide valuable hints to distinguish generalized tonic-clonic seizures (GTCS) from syncope. MATERIAL AND METHODS Serum lactate levels at admission and CK levels 10-48 h after the episodes that led to admission were compared between patients with GTCS (n = 30) and those with syncope (n = 15). In addition, sensitivity and specificity of lactate and CK as diagnostic markers for syncope and GTCS were determined. RESULTS The serum lactate and serum CK levels were significantly increased in patients with GTCS as compared to syncope patients (serum lactate: p < 0.001; CK: p < 0.005). The area under the curve (AUC) for serum lactate as an indicator for GTCS was 0.94 (95% confidence interval [CI] 0.88-1.0). For CK the receiver operating characteristics (ROC) analysis produced an AUC of only 0.77 (95% CI: 0.63-0.9). CONCLUSION The determination of the lactate value as point-of-care diagnostics appears to be highly relevant in the rapid clarification of unclear episodes with transient loss of consciousness. The CK level at follow-up is also suitable for distinguishing GTCS from syncope but is inferior to the serum lactate value.
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Affiliation(s)
- M Dafotakis
- Klinik für Neurologie, Universitätsklinikum RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - J Heckelmann
- Klinik für Neurologie, Universitätsklinikum RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - S Zechbauer
- Klinik für Neurologie, Universitätsklinikum RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - J Litmathe
- Klinik für Neurologie, Universitätsklinikum RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - J Brokmann
- Zentrale Notaufnahme, Universitätsklinikum RWTH Aachen, Aachen, Deutschland
| | - K Willmes
- Klinik für Neurologie, Universitätsklinikum RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - R Surges
- Klinik für Neurologie, Universitätsklinikum RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - O Matz
- Klinik für Neurologie, Universitätsklinikum RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
- Zentrale Notaufnahme, Universitätsklinikum RWTH Aachen, Aachen, Deutschland.
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Chmielewska N, Maciejak P, Turzyńska D, Sobolewska A, Wisłowska-Stanek A, Kołosowska K, Płaźnik A, Szyndler J. The role of UCH-L1, MMP-9, and GFAP as peripheral markers of different susceptibility to seizure development in a preclinical model of epilepsy. J Neuroimmunol 2019; 332:57-63. [PMID: 30952062 DOI: 10.1016/j.jneuroim.2019.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/06/2019] [Accepted: 03/28/2019] [Indexed: 01/03/2023]
Abstract
In our study, we assessed the potency of the brain-derived proteins ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), matrix metalloproteinase 9 (MMP-9), glial fibrillary acidic protein (GFAP) and the immune activation indicators interleukin 1β (IL-1β) and interleukin 6 (IL-6) as peripheral biomarkers of different susceptibilities to kindling in a preclinical model. We observed increased plasma UCH-L1 levels in kindled vs. control animals. Furthermore, MMP-9 and IL-1β concentrations were the lowest in rats resistant to kindling. In summary, UCH-L1 is an indicator of neuronal loss and BBB disruption after seizure. MMP-9 and IL-1β may indicate resistance to kindling. UCH-L1, MMP-9 and IL-1β may have utility as peripheral biomarkers with translational potency in the clinic.
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Affiliation(s)
- Natalia Chmielewska
- Department of Neurochemistry, Institute of Psychiatry and Neurology, Sobieskiego Street 9, 02-957 Warsaw, Poland.
| | - Piotr Maciejak
- Department of Neurochemistry, Institute of Psychiatry and Neurology, Sobieskiego Street 9, 02-957 Warsaw, Poland; Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology CePT, Medical University of Warsaw, Banacha 1B, 02-097 Warsaw, Poland
| | - Danuta Turzyńska
- Department of Neurochemistry, Institute of Psychiatry and Neurology, Sobieskiego Street 9, 02-957 Warsaw, Poland
| | - Alicja Sobolewska
- Department of Neurochemistry, Institute of Psychiatry and Neurology, Sobieskiego Street 9, 02-957 Warsaw, Poland
| | - Aleksandra Wisłowska-Stanek
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology CePT, Medical University of Warsaw, Banacha 1B, 02-097 Warsaw, Poland
| | - Karolina Kołosowska
- Department of Neurochemistry, Institute of Psychiatry and Neurology, Sobieskiego Street 9, 02-957 Warsaw, Poland
| | - Adam Płaźnik
- Department of Neurochemistry, Institute of Psychiatry and Neurology, Sobieskiego Street 9, 02-957 Warsaw, Poland; Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology CePT, Medical University of Warsaw, Banacha 1B, 02-097 Warsaw, Poland
| | - Janusz Szyndler
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology CePT, Medical University of Warsaw, Banacha 1B, 02-097 Warsaw, Poland
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FAN M, DONG S, ZOU X, ZHENG B, HUANG Y, WANG J, ZENG L. [Correlation of phosphorylated S6 protein expression in blood and brain tissue in mice and rats with kainic acid-induced seizure]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2019; 48:303-309. [PMID: 31496163 PMCID: PMC8800752 DOI: 10.3785/j.issn.1008-9292.2019.06.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/15/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To determine the correlation of phosphorylated ribosomal S6 protein (P-S6) content in blood and brain tissue in mice and rats with seizure. METHODS Seizure models were induced by intraperitoric injection of kainic acid (KA) in C57BL/mice and SD rats. Flow cytometry was used to detect the content of P-S6 in blood; Western blot was used to detect the expression of P-S6 in brain tissues. The correlation between P-S6 expression in blood and in brain tissue was examine by Pearson analysis, and the correlation between P-S6 expression in blood and the severity of seizure was also observed. RESULTS Western blotting analysis showed that the expression of P-S6 was significantly increased in peripheral blood and brain tissue in mice 1 h after KA-induced seizure,and the expression levels increased to (1.49±0.45) times (P<0.05) and (2.55±0.66) times (P <0.01) of the control group, respectively. Flow cytometry showed that the positive percentage and average fluorescence intensity of P-S6 in the blood of mice increased significantly 1 h after KA-induced seizures (P<0.01), which was consistent with the expression of P-S6 in brain tissue (r=0.8474, P<0.01). Flow cytometry showed that the average fluorescence intensity of P-S6 in blood increased from 14.89±9.75 to 52.35±21.72 (P<0.01) in rats with seizure, which was consistent with the change of P-S6 in brain tissue (r=0.9385, P<0.01). Rats with higher levels of seizure were of higher levels of P-S6 in peripheral blood. CONCLUSIONS Consistent correlation of P-S6 expression is demonstrated in peripheral blood and in brain tissue after KA-induced seizure, suggesting that the expression of P-S6 in blood can accurately reflect the changes of mTOR signaling pathway in brain tissue.
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Affiliation(s)
| | | | | | | | | | - Jianda WANG
- 王健达(1988-), 男, 硕士, 住院医师, 主要从事神经内科学研究; E-mail:
;
https://orcid.org/0000-0001-7148-3183
| | - Linghui ZENG
- 曾玲晖(1972-), 女, 博士, 教授, 博士生导师, 主要从事神经药理学研究; E-mail:
;
https://orcid.org/0000-0002-5924-4419
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14
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Dimeski G, Treacy O, Marshall G. A very rare interference with the valproate method on the Beckman DxC 800 general chemistry analyser. Clin Chem Lab Med 2019; 57:e67-e70. [PMID: 30157029 DOI: 10.1515/cclm-2018-0716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 07/27/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Goce Dimeski
- Department of Chemical Pathology, Pathology Queensland, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, Queensland 4102, Australia
- School of Medicine, University of Queensland, Brisbane, Australia, Phone: +61 7 3176 2290, Fax: +61 7 3176 7070
| | - Oliver Treacy
- Department of Chemical Pathology, Pathology Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - George Marshall
- Queensland Medical Laboratories, Biochemistry Department, Murrarie, Queensland, Australia
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15
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Wiwattanadittakul N, Prust M, Gaillard WD, Massaro A, Vezina G, Tsuchida TN, Gropman AL. The utility of EEG monitoring in neonates with hyperammonemia due to inborn errors of metabolism. Mol Genet Metab 2018; 125:235-240. [PMID: 30197275 DOI: 10.1016/j.ymgme.2018.08.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 08/21/2018] [Accepted: 08/21/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Continuous EEG studies demonstrate that neonates with seizures due to cerebral pathology, such as hypoxia ischemia, exhibit predominantly electrographic seizures (i.e. those only detected with EEG because they lack clinical features). Previous small case series demonstrate EEG changes and seizures during hyperammonemia associated with inborn errors of metabolism (IEM) but there are no reports utilizing continuous EEG in these conditions. OBJECTIVE To characterize seizures and evaluate the utility of continuous EEG recording during hyperammonemia due to inborn errors of metabolism. METHODS We retrospectively reviewed medical records and EEG tracings of neonates who presented with hyperammonemia due to inborn errors of metabolism who had continuous EEG and full medical records available for review, including follow up. RESULTS Eight neonates with hyperammonemia were studied, 7 had urea cycle defects: Argininosuccinate lyase deficiency [3], (ornithine transcarbamylase deficiency [3], carbomyl phosphate synthase deficiency [1] and one had an organic acidemia: Methylmalonic acidemia [1]. Most common presentations were lethargy and poor feeding at 12-72 h of life. The highest blood ammonia level was 874 μmol/L (median); range 823-1647 μmol/L (normal value <50 μmol/L in term neonates). Seven were treated with hemodialysis in addition to nitrogen scavengers. Seven neonates had seizures; six had only electrographic seizures. Seizures initially occurred within 24-36 h of clinical presentation, sometimes with normal ammonia and glutamine levels. Neonates with seizures all lacked state changes on EEG. Inter burst interval duration correlated with degree of hyperammonemia. Two cases with normal plasma ammonia but increasing interburst interval duration were proven to have stroke by MRI. CONCLUSIONS Seizures occur frequently in neonates with hyperammonemia; most can be detected only with continuous EEG. Seizures may occur when ammonia and glutamine levels are normal. Interburst interval duration is associated with ammonia levels or cerebral dysfunction from other brain pathology. Continuous EEG can be a useful tool for managing infants with hyperammonemia and may be essential for seizure management especially for infants in deep metabolic coma.
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MESH Headings
- Amino Acid Metabolism, Inborn Errors/blood
- Amino Acid Metabolism, Inborn Errors/diagnostic imaging
- Amino Acid Metabolism, Inborn Errors/physiopathology
- Ammonia/blood
- Argininosuccinate Synthase/blood
- Argininosuccinic Aciduria/blood
- Argininosuccinic Aciduria/diagnostic imaging
- Argininosuccinic Aciduria/physiopathology
- Electroencephalography
- Female
- Glutamine/blood
- Humans
- Hyperammonemia/blood
- Hyperammonemia/diagnostic imaging
- Hyperammonemia/physiopathology
- Hypoxia-Ischemia, Brain/blood
- Hypoxia-Ischemia, Brain/diagnostic imaging
- Hypoxia-Ischemia, Brain/physiopathology
- Infant
- Infant, Newborn
- Male
- Metabolism, Inborn Errors/blood
- Metabolism, Inborn Errors/diagnostic imaging
- Metabolism, Inborn Errors/physiopathology
- Ornithine Carbamoyltransferase Deficiency Disease/blood
- Ornithine Carbamoyltransferase Deficiency Disease/diagnostic imaging
- Ornithine Carbamoyltransferase Deficiency Disease/physiopathology
- Seizures/blood
- Seizures/diagnostic imaging
- Seizures/physiopathology
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Affiliation(s)
- Natrujee Wiwattanadittakul
- Department of Pediatrics, Chiang Mai University Hospital, Chiang Mai University, Chiang Mai, Thailand; Center for Neuroscience, Children Neuroscience, Medical System, George Washington University, Washington, DC, United States
| | - Morgan Prust
- Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - William Davis Gaillard
- Center for Neuroscience, Children Neuroscience, Medical System, George Washington University, Washington, DC, United States
| | - An Massaro
- Center for Neuroscience, Children Neuroscience, Medical System, George Washington University, Washington, DC, United States
| | - Gilbert Vezina
- Center for Neuroscience, Children Neuroscience, Medical System, George Washington University, Washington, DC, United States
| | - Tammy N Tsuchida
- Center for Neuroscience, Children Neuroscience, Medical System, George Washington University, Washington, DC, United States
| | - Andrea L Gropman
- Center for Neuroscience, Children Neuroscience, Medical System, George Washington University, Washington, DC, United States.
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16
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Gulcebi MI, Kendirli T, Turgan ZA, Patsalos PN, Onat Yilmaz F. The effect of serum levetiracetam concentrations on therapeutic response and IL1-beta concentration in patients with epilepsy. Epilepsy Res 2018; 148:17-22. [PMID: 30326332 DOI: 10.1016/j.eplepsyres.2018.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/07/2018] [Accepted: 09/26/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Assessment of the relevance between serum drug concentration to its therapeutic response is a valid monitoring strategy for the clinical efficacy of antiepileptic drugs (AEDs). Levetiracetam (LEV) is a broad spectrum AED with a possible anti-inflammatory effect. We aimed to determine the relationship between LEV concentrations and its therapeutic response, and the effect of LEV on IL1-beta concentrations in patients with epilepsy. METHODS Patients on monotherapy (n = 7) or polytherapy (n = 15) with LEV for their seizures management were included. Blood samples of each patient were collected: just before LEV intake, 1 h, 2 h, 4 h and 8 h following the last dose. Serum LEV concentrations were measured by liquid chromatography mass spectrometry and IL1-beta concentrations by chemiluminescent immunometric assay. Concentration to dose (C/D) ratio values was used for analyses. LEV concentrations were compared between responders (≤1 seizure/month) and non-responders (>1 seizure/month) and patients with or without adverse reactions. IL1-beta concentrations before and at 2 h following LEV ingestion were compared in order to detect the effect of the increase in serum LEV concentration on IL1-beta. RESULTS Although there was no change in LEV (C/D) ratio or LEV maximum concentration (Cmax)/D ratio of the responders and non-responders, the C/D ratio following 1 h of LEV intake (2.17 ± 0.59 kg.day/L) and Cmax/D ratio (2.25 ± 0.56 kg.day/L) in the patients with adverse effects was significantly higher than for the patients without adverse effects (1.09 ± 0.12 kg.day/L and 1.49 ± 0.14 kg.day/L respectively). A statistically significant decrease was found in the IL1-beta concentration to LEV (C/D) ratio with the increase in LEV concentration in patients on LEV monotherapy. CONCLUSION The possible relationship between LEV Cmax and its therapeutic response or IL1-beta concentrations may be an importance indication of LEV antiepileptic efficacy. Consequently, monitoring LEV Cmax values may enhance LEV adherence because patients would be less likely to develop adverse effects.
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Affiliation(s)
- Medine I Gulcebi
- Department of Medical Pharmacology, School of Medicine, University of Marmara, Istanbul, Turkey
| | - Tansel Kendirli
- Department of Neurology, School of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Zehra Asik Turgan
- Department of Medical Pharmacology, School of Medicine, University of Marmara, Istanbul, Turkey
| | - Philip N Patsalos
- Department of Clinical & Experimental Epilepsy, NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London, United Kingdom; Therapeutic Drug Monitoring Unit, Chalfont Centre for Epilepsy, Chalfont St. Peter, United Kingdom
| | - Filiz Onat Yilmaz
- Department of Medical Pharmacology, School of Medicine, University of Marmara, Istanbul, Turkey.
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17
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Dubinski D, Won SY, Behmanesh B, Brawanski N, Geisen C, Seifert V, Senft C, Konczalla J. The clinical relevance of ABO blood type in 100 patients with acute subdural hematoma. PLoS One 2018; 13:e0204331. [PMID: 30286106 PMCID: PMC6171832 DOI: 10.1371/journal.pone.0204331] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 09/06/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The correlation of depleted blood through midline shift in acute subdural hematoma remains the most reliable clinical predictor to date. On the other hand, patient's ABO blood type has a profound impact on coagulation and hemostasis. We conducted this study to evaluate the role of patient's blood type in terms of incidence, clinical course and outcome after acute subdural hematoma bleeding. METHODS 100 patients with acute subdural hematoma treated between 2010 and 2015 at the author's institution were included. Baseline characteristics and clinical findings including Glasgow coma scale, Glasgow outcome scale, hematoma volume, rebleeding, midline shift, postoperative seizures and the presence of anticoagulation were analyzed for their association with ABO blood type. RESULTS Patient's with blood type O were found to have a lower midline shift (p<0.01) and significantly less seizures (OR: 0.43; p<0.05) compared to non-O patients. Furthermore, patients with blood type A had the a significantly higher midline shift (p<0.05) and a significantly increased risk for postoperative seizures (OR: 4.01; p<0.001). There was no difference in ABO blood type distribution between acute subdural hematoma patients and the average population. CONCLUSION The ABO blood type has significant influence on acute subdural hematoma sequelae. Patient's with blood type O benefit in their clinical course after acute subdural hematoma whereas blood type A patients are at highest risk for increased midline shift and postoperative seizures. Further studies elucidating the biological mechanisms of blood type depended hemostaseology and its role in acute subdural hematoma are required for the development of an appropriate intervention.
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Affiliation(s)
- Daniel Dubinski
- Department of Neurosurgery, University Hospital, Goethe University, Frankfurt, Germany
| | - Sae-Yeon Won
- Department of Neurosurgery, University Hospital, Goethe University, Frankfurt, Germany
| | - Bedjan Behmanesh
- Department of Neurosurgery, University Hospital, Goethe University, Frankfurt, Germany
| | - Nina Brawanski
- Department of Neurosurgery, University Hospital, Goethe University, Frankfurt, Germany
| | - Christof Geisen
- Institute for Transfusion Medicine and Immunohematology, Goethe University, Frankfurt, Germany
| | - Volker Seifert
- Department of Neurosurgery, University Hospital, Goethe University, Frankfurt, Germany
| | - Christian Senft
- Department of Neurosurgery, University Hospital, Goethe University, Frankfurt, Germany
| | - Juergen Konczalla
- Department of Neurosurgery, University Hospital, Goethe University, Frankfurt, Germany
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18
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Voinescu PE, Park S, Chen LQ, Stowe ZN, Newport DJ, Ritchie JC, Pennell PB. Antiepileptic drug clearances during pregnancy and clinical implications for women with epilepsy. Neurology 2018; 91:e1228-e1236. [PMID: 30185446 PMCID: PMC6161546 DOI: 10.1212/wnl.0000000000006240] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 06/15/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To characterize the magnitude and time course of pregnancy-related clearance changes for different antiepileptic drugs (AEDs): levetiracetam, oxcarbazepine, topiramate, phenytoin, and valproate. A secondary aim was to determine if a decreased AED serum concentration was associated with increased seizure frequency. METHODS Women with epilepsy were enrolled preconception or early in pregnancy and prospectively followed throughout pregnancy and the first postpartum year with daily diaries of AED doses, adherence, and seizures. Study visits with AED concentration measurements occurred every 1-3 months. AED clearances in each trimester were compared to nonpregnant baseline using a mixed linear regression model, with adjustments for age, race, and hours postdose. In women on monotherapy, 2-sample t test was used to compare the ratio to target concentrations (RTC) between women with seizure worsening each trimester and those without. RESULTS AED clearances were calculated for levetiracetam (n = 18 pregnancies), oxcarbazepine (n = 4), topiramate (n = 10), valproate (n = 5), and phenytoin (n = 7). Mean maximal clearances were reached for (1) levetiracetam in first trimester (1.71-fold baseline clearance) (p = 0.0001), (2) oxcarbazepine in second trimester (1.63-fold) (p = 0.0001), and (3) topiramate in second trimester (1.39-fold) (p = 0.025). In 15 women on AED monotherapy, increased seizure frequency in the first, second, and all trimesters was associated with a lower RTC (p < 0.05). CONCLUSION AED clearance significantly changes by the first trimester for levetiracetam and by the second trimester for oxcarbazepine and topiramate. Lower RTC was associated with seizure worsening. Early therapeutic drug monitoring and dose adjustment may be helpful to avoid increased seizure frequency.
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Affiliation(s)
- P Emanuela Voinescu
- From Brigham and Women's Hospital (P.E.V., L.Q.C., P.B.P.), Harvard Medical School; Harvard Chan School of Public Health (S.P.), Boston, MA; University of Wisconsin School of Medicine and Public Health (Z.N.S.), Madison; University of Miami Miller School of Medicine (D.J.N.), FL; and Emory University School of Medicine (J.C.R.), Atlanta, GA
| | - Suna Park
- From Brigham and Women's Hospital (P.E.V., L.Q.C., P.B.P.), Harvard Medical School; Harvard Chan School of Public Health (S.P.), Boston, MA; University of Wisconsin School of Medicine and Public Health (Z.N.S.), Madison; University of Miami Miller School of Medicine (D.J.N.), FL; and Emory University School of Medicine (J.C.R.), Atlanta, GA
| | - Li Q Chen
- From Brigham and Women's Hospital (P.E.V., L.Q.C., P.B.P.), Harvard Medical School; Harvard Chan School of Public Health (S.P.), Boston, MA; University of Wisconsin School of Medicine and Public Health (Z.N.S.), Madison; University of Miami Miller School of Medicine (D.J.N.), FL; and Emory University School of Medicine (J.C.R.), Atlanta, GA
| | - Zachary N Stowe
- From Brigham and Women's Hospital (P.E.V., L.Q.C., P.B.P.), Harvard Medical School; Harvard Chan School of Public Health (S.P.), Boston, MA; University of Wisconsin School of Medicine and Public Health (Z.N.S.), Madison; University of Miami Miller School of Medicine (D.J.N.), FL; and Emory University School of Medicine (J.C.R.), Atlanta, GA
| | - D Jeffrey Newport
- From Brigham and Women's Hospital (P.E.V., L.Q.C., P.B.P.), Harvard Medical School; Harvard Chan School of Public Health (S.P.), Boston, MA; University of Wisconsin School of Medicine and Public Health (Z.N.S.), Madison; University of Miami Miller School of Medicine (D.J.N.), FL; and Emory University School of Medicine (J.C.R.), Atlanta, GA
| | - James C Ritchie
- From Brigham and Women's Hospital (P.E.V., L.Q.C., P.B.P.), Harvard Medical School; Harvard Chan School of Public Health (S.P.), Boston, MA; University of Wisconsin School of Medicine and Public Health (Z.N.S.), Madison; University of Miami Miller School of Medicine (D.J.N.), FL; and Emory University School of Medicine (J.C.R.), Atlanta, GA
| | - Page B Pennell
- From Brigham and Women's Hospital (P.E.V., L.Q.C., P.B.P.), Harvard Medical School; Harvard Chan School of Public Health (S.P.), Boston, MA; University of Wisconsin School of Medicine and Public Health (Z.N.S.), Madison; University of Miami Miller School of Medicine (D.J.N.), FL; and Emory University School of Medicine (J.C.R.), Atlanta, GA.
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19
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Karceski S. Pregnancy, anti-seizure medications, and seizures. Neurology 2018; 91:e1271-e1274. [PMID: 30249683 DOI: 10.1212/wnl.0000000000006231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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20
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Matz O, Heckelmann J, Zechbauer S, Litmathe J, Brokmann JC, Willmes K, Schulz JB, Dafotakis M. Early postictal serum lactate concentrations are superior to serum creatine kinase concentrations in distinguishing generalized tonic-clonic seizures from syncopes. Intern Emerg Med 2018; 13:749-755. [PMID: 28900842 DOI: 10.1007/s11739-017-1745-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 09/04/2017] [Indexed: 10/18/2022]
Abstract
Concentrations of serum creatine kinase (CK) and serum lactate are frequently measured to help differentiate between generalized tonic-clonic seizures (GTCS) and syncope. The aim of this prospective cohort study was to systematically compare these two markers. The primary outcome is the measurement of serum lactate and CK in blood samples drawn within 2 h of the event in patients admitted with either a GTCS (n = 49) or a syncope (n = 36). Furthermore, the specificity and sensitivity of serum lactate and CK are determined as diagnostic markers in distinguishing between GTCS and syncope. GTCS patients have significantly higher serum lactate levels compared to syncope patients (p < 0.001). In contrast, CK does not differ between groups at admission. Regarding the first hour after the seizure, we identify a cut-off for serum lactate of 2.45 mmol/l for diagnosing GTCS as the cause of an impairment of consciousness with a sensitivity of 0.94 and a specificity of 0.93 (AUC: 0.97; 95% CI 0.94-1.0). In the second hour after the event, the ROC analysis yields similar results (AUC: 0.94; 95% CI 0.85-1.0). Serum lactate is a sensitive and specific diagnostic marker to discriminate GTCS from syncope and is superior to CK early after admission to the emergency department.
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Affiliation(s)
- Oliver Matz
- Department of Neurology, University Hospital, Rheinisch-Westfälische Technische Hochschule [RWTH] Aachen, Aachen, Germany.
- Emergency Department, University Hospital, Rheinisch-Westfälische Technische Hochschule [RWTH] Aachen, Aachen, Germany.
| | - Jan Heckelmann
- Department of Neurology, University Hospital, Rheinisch-Westfälische Technische Hochschule [RWTH] Aachen, Aachen, Germany
| | - Sebastian Zechbauer
- Department of Neurology, University Hospital, Rheinisch-Westfälische Technische Hochschule [RWTH] Aachen, Aachen, Germany
| | - Jens Litmathe
- Department of Neurology, University Hospital, Rheinisch-Westfälische Technische Hochschule [RWTH] Aachen, Aachen, Germany
| | - Jörg C Brokmann
- Emergency Department, University Hospital, Rheinisch-Westfälische Technische Hochschule [RWTH] Aachen, Aachen, Germany
| | - Klaus Willmes
- Department of Neurology, University Hospital, Rheinisch-Westfälische Technische Hochschule [RWTH] Aachen, Aachen, Germany
| | - Jörg B Schulz
- Department of Neurology, University Hospital, Rheinisch-Westfälische Technische Hochschule [RWTH] Aachen, Aachen, Germany
- JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH, RWTH Aachen University, Aachen, Germany
| | - Manuel Dafotakis
- Department of Neurology, University Hospital, Rheinisch-Westfälische Technische Hochschule [RWTH] Aachen, Aachen, Germany
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Shaikh AS, Li Y, Cao L, Guo R. Analysis of phenytoin drug concentration for evaluation of clinical response, uncontrolled seizures and toxicity. Pak J Pharm Sci 2018; 31:1697-1700. [PMID: 30203765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The narrow therapeutic index, non-linear pharmacokinetics and unpredictable absorption require regular therapeutic monitoring of phenytoin. The influence of genetic differences, sex, age and race on the phenytoin plasma levels and its metabolites is well recognized. This study is aimed at evaluating phenytoin plasma drug concentration and its relationship with clinical response, persistent seizures and toxicity in different gender and various age groups of Chinese epileptic patients. This knowledge will help the clinicians in adjusting the drug dosages of phenytoin in various sub-groups of epileptic patients for enhancing the safety, efficacy and minimizing the toxicity of phenytoin. A total of 48 plasma samples of epileptic patients for measuring the plasma phenytoin concentration were received. Only patients displaying persistent seizures or suspected of adverse effects were requested for drug monitoring. All these samples were analyzed for therapeutic drug monitoring with Enzyme-multiplied immunoassay technique. Surprisingly, it was found that majorities (85.5%) of samples were out of the reference range, of which 69% of samples were in sub-therapeutic levels and 16.5% of samples were above therapeutic levels. Only 14.5% of all samples had phenytoin levels in the therapeutic range. The difference in plasma concentration of phenytoin was notably altered in gender and various age groups. Careful attention must be applied to specific gender and particular age group on an individual basis in the interpretation of plasma concentration results, in order to facilitate the modification of doses and develop the best approach in treatment and to obtain the desired clinical response because multiple factors can affect the phenytoin plasma concentration. Through these results, it can be concluded that a good correlation exists between phenytoin plasma concentration and clinical response. Therefore, regular therapeutic monitoring of phenytoin and screening of HLA-A, B, C and DRB1 genotypes before prescribing phenytoin in epileptic patients is essentially required to achieve maximum clinical response and prevent the serious toxicity.
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Affiliation(s)
- Abdul Sami Shaikh
- Institute of Clinical Pharmacology, Qilu Hospital of Shandong University, Jinan, China / Department of Pharmacy, Shah Abdul Latif University, Khairpur, Pakistan
| | - Yi Li
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, China
| | - Lili Cao
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, China
| | - Ruichen Guo
- Institute of Clinical Pharmacology, Qilu Hospital of Shandong University, Jinan, China
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Andersen SL, Andersen S, Vestergaard P, Olsen J. Maternal Thyroid Function in Early Pregnancy and Child Neurodevelopmental Disorders: A Danish Nationwide Case-Cohort Study. Thyroid 2018; 28:537-546. [PMID: 29584590 DOI: 10.1089/thy.2017.0425] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Maternal thyroid dysfunction may adversely affect fetal brain development, but more evidence is needed to refine this hypothesis. The aim of this study was to evaluate potential fetal programming by abnormal maternal thyroid function on child neurodevelopmental disorders. METHODS The design was a case-cohort study within the Danish National Birth Cohort (1997-2003). From the eligible cohort of 71,706 women, a random 12% sub-cohort (n = 7624) was selected, and all women (n = 2276) whose child was diagnosed with seizures, specific developmental disorder (SDD), autism spectrum disorder (ASD), and/or attention-deficit/hyperactivity disorder (ADHD) up to December 31, 2010, were identified. All women had a blood sample drawn in early pregnancy (median week 9), and the stored sample was used for measurement of free thyroxine and thyrotropin. Method- and week-specific reference ranges were used for classification of maternal thyroid function. A weighted Cox proportional hazards model was used to estimate adjusted hazard ratio (aHR) with 95% confidence intervals (CI) for neurodevelopmental disorders in children exposed to maternal thyroid dysfunction. RESULTS The overall frequency of abnormal maternal thyroid function was 12.5% in the sub-cohort and significantly higher among cases of ASD (17.9%; aHR = 1.5 [CI 1.1-2.1]), but not among other types of neurodevelopmental disorders (febrile seizures: 12.7%; epilepsy: 13.1%; SDD: 12.6%; and ADHD: 14.0%). However, evaluation of subtypes of maternal thyroid dysfunction showed that maternal overt hypothyroidism (thyrotropin >10 mIU/L) was a risk factor for epilepsy in the child (aHR = 3.5 [CI 1.2-10]), as was overt hyperthyroidism for cases diagnosed within the first year of life (aHR = 3.0 [CI 1.03-8.4]). Furthermore, both maternal hypothyroidism (aHR = 1.8 [CI 1.1-2.7]) and overt hyperthyroidism (aHR = 2.2 [CI 1.1-4.4]) were risk factors for ASD in the child, and isolated low free thyroxine was associated with ASD (aHR = 4.9 [CI 2.03-11.9]) and ADHD (aHR = 2.3 [CI 1.2-4.3]) in girls but not in boys. CONCLUSIONS Abnormal maternal thyroid function in early pregnancy was associated with epilepsy, ASD, and ADHD in the child, but associations differed by subtypes of exposure and by child age and sex. More evidence on subtypes and severity of maternal thyroid function is needed, and alternative outcomes of child neurodevelopment may be warranted.
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Affiliation(s)
- Stine Linding Andersen
- 1 Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- 2 Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Stig Andersen
- 3 Department of Geriatrics, Aalborg University Hospital, Aalborg, Denmark
- 4 Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Peter Vestergaard
- 1 Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- 4 Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jørn Olsen
- 5 Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Glinton KE, Benke PJ, Lines MA, Geraghty MT, Chakraborty P, Al-Dirbashi OY, Jiang Y, Kennedy AD, Grotewiel MS, Sutton VR, Elsea SH, El-Hattab AW. Disturbed phospholipid metabolism in serine biosynthesis defects revealed by metabolomic profiling. Mol Genet Metab 2018; 123:309-316. [PMID: 29269105 DOI: 10.1016/j.ymgme.2017.12.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/08/2017] [Accepted: 12/08/2017] [Indexed: 01/28/2023]
Abstract
Serine biosynthesis defects are autosomal recessive metabolic disorders resulting from the deficiency of any of the three enzymes involved in de novo serine biosynthesis, specifically phosphoglycerate dehydrogenase (PGDH), phosphoserine aminotransferase (PSAT), and phosphoserine phosphatase (PSP). In this study, we performed metabolomic profiling on 4 children with serine biosynthesis defects; 3 with PGDH deficiency and 1 with PSAT deficiency. The evaluations were performed at baseline and with serine and glycine supplementation. Metabolomic profiling performed at baseline showed low phospholipid species, including glycerophosphocholine, glycerophosphoethanolamine, and sphingomyelin. All children had low serine and glycine as expected. Low glycerophosphocholine compounds were found in 4 children, low glycerophosphoethanolamine compounds in 3 children, and low sphingomyelin species in 2 children. Metabolic profiling with serine and glycine supplementation showed normalization of most of the low phospholipid compounds in the 4 children. Phospholipids are the major component of plasma and intracellular membranes, and phosphatidylcholine is the most abundant phospholipid of all mammalian cell types and subcellular organelles. Phosphatidylcholine is of particular importance for the nervous system, where it is essential for neuronal differentiation. The observed low phosphatidylcholine species in children with serine biosynthesis defects that improved after serine supplementation, supports the role of serine as a significant precursor for phosphatidylcholine. The vital role that phosphatidylcholine has during neuronal differentiation and the pronounced neurological manifestations in serine biosynthesis defects suggest that phosphatidylcholine deficiency occurring secondary to serine deficiency may have a significant contribution to the development of the neurological manifestations in individuals with serine biosynthesis defects.
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Affiliation(s)
- Kevin E Glinton
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Paul J Benke
- Joe DiMaggio Children's Hospital and Florida Atlantic School of Medicine, Hollywood, FL, USA
| | - Matthew A Lines
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | | | - Osama Y Al-Dirbashi
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; College of Medicine and Health Sciences, United Arab Emirate University, Al-Ain, United Arab Emirates
| | - Yi Jiang
- Baylor Genetics, Houston, TX, USA
| | | | - Michael S Grotewiel
- Department of Human and Molecular Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - V Reid Sutton
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Baylor Genetics, Houston, TX, USA
| | - Sarah H Elsea
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Baylor Genetics, Houston, TX, USA
| | - Ayman W El-Hattab
- Division of Clinical Genetic and Metabolic Disorders, Tawam Hospital, Al-Ain, United Arab Emirates.
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Abstract
Psychogenic non-epileptic seizures (PNES) is a conversion disorder that reflects underlying psychological distress. Female patients with PNES often present with a history of prolonged stressors, especially sexual abuse. In the current study, we studied the relationship between neuropeptide Y (NPY) and PNES symptoms in women with a history of sexual abuse. NPY has been associated with resilience to stress and we hypothesized that low levels would increase the extent and severity of PNES symptoms in this patient population. Serum levels of NPY, and related hormones were measured in fifteen female PNES patients and sixty female controls. PNES patients reported more severe abuse histories, feeling of abandonment, and decreased perception of quality of life than controls. Importantly, they also had lower NPY levels. Our analysis indicates that low levels of NPY in PNES may confer greater vulnerability to exhibit seizure-like symptoms and lower quality of life.
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Affiliation(s)
- Michael Winterdahl
- a Department of Nuclear Medicine and PET Center , Aarhus University , Aarhus , Denmark
| | - Alessandro Miani
- a Department of Nuclear Medicine and PET Center , Aarhus University , Aarhus , Denmark
| | - Moana J H Vercoe
- b Center for Neuroeconomics Studies , Claremont Graduate University , Claremont , CA , USA
| | - Antonia Ciovica
- c Department of Psychiatry , Loma Linda University School of Medicine , Loma Linda , CA , USA
| | - Lori Uber-Zak
- d Department of Neurology , Loma Linda University Medical Center , Loma Linda , CA , USA
| | - Charlotte Ulrikka Rask
- e Research Clinic for Functional Disorders and Psychosomatics , Aarhus University Hospital , Aarhus , Denmark
- f Child and Adolescent Psychiatry Center , Aarhus University Hospital , Aarhus , Denmark
| | - Paul J Zak
- b Center for Neuroeconomics Studies , Claremont Graduate University , Claremont , CA , USA
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25
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Semb S, Helgstrand F, Hjørne F, Bytzer P. Persistent severe hypomagnesemia caused by proton pump inhibitor resolved after laparoscopic fundoplication. World J Gastroenterol 2017; 23:6907-6910. [PMID: 29085234 PMCID: PMC5645624 DOI: 10.3748/wjg.v23.i37.6907] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/12/2017] [Accepted: 07/12/2017] [Indexed: 02/06/2023] Open
Abstract
Magnesium deficiency can cause a variety of symptoms, including potentially life-threatening complications such as seizures, cardiac arrhythmias and secondary electrolyte disturbances. Hypomagnesemia can be a serious adverse effect to proton pump inhibitor (PPI) therapy, which is worrying due to the widespread use of PPIs. Current evidence suggest that the mechanism of PPI induced hypomagnesemia is impaired intestinal magnesium absorption. In this report, we present the case of a long-term PPI user with persistent hypomagnesemia with severe symptoms at presentation. He was unable to stop PPI treatment because of severe reflux symptoms, and was dependent on weekly intravenous magnesium infusions, until his magnesium levels finally normalized without the need for supplementation after a successful laparoscopic fundoplication.
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Affiliation(s)
- Synne Semb
- Department of Gastroenterology, Zealand University Hospital, 4600 Køge, Denmark
| | - Frederik Helgstrand
- Department of Surgery, Zealand University Hospital, 4600 Køge, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen N, Denmark
| | - Flemming Hjørne
- Department of Surgery, Zealand University Hospital, 4600 Køge, Denmark
| | - Peter Bytzer
- Department of Gastroenterology, Zealand University Hospital, 4600 Køge, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen N, Denmark
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26
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Viering DHHM, de Baaij JHF, Walsh SB, Kleta R, Bockenhauer D. Genetic causes of hypomagnesemia, a clinical overview. Pediatr Nephrol 2017; 32:1123-1135. [PMID: 27234911 PMCID: PMC5440500 DOI: 10.1007/s00467-016-3416-3] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/02/2016] [Accepted: 05/04/2016] [Indexed: 12/16/2022]
Abstract
Magnesium is essential to the proper functioning of numerous cellular processes. Magnesium ion (Mg2+) deficits, as reflected in hypomagnesemia, can cause neuromuscular irritability, seizures and cardiac arrhythmias. With normal Mg2+ intake, homeostasis is maintained primarily through the regulated reabsorption of Mg2+ by the thick ascending limb of Henle's loop and distal convoluted tubule of the kidney. Inadequate reabsorption results in renal Mg2+ wasting, as evidenced by an inappropriately high fractional Mg2+ excretion. Familial renal Mg2+ wasting is suggestive of a genetic cause, and subsequent studies in these hypomagnesemic families have revealed over a dozen genes directly or indirectly involved in Mg2+ transport. Those can be classified into four groups: hypercalciuric hypomagnesemias (encompassing mutations in CLDN16, CLDN19, CASR, CLCNKB), Gitelman-like hypomagnesemias (CLCNKB, SLC12A3, BSND, KCNJ10, FYXD2, HNF1B, PCBD1), mitochondrial hypomagnesemias (SARS2, MT-TI, Kearns-Sayre syndrome) and other hypomagnesemias (TRPM6, CNMM2, EGF, EGFR, KCNA1, FAM111A). Although identification of these genes has not yet changed treatment, which remains Mg2+ supplementation, it has contributed enormously to our understanding of Mg2+ transport and renal function. In this review, we discuss general mechanisms and symptoms of genetic causes of hypomagnesemia as well as the specific molecular mechanisms and clinical phenotypes associated with each syndrome.
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Affiliation(s)
- Daan H H M Viering
- Centre for Nephrology, University College London, London, UK
- Department of Physiology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jeroen H F de Baaij
- Department of Physiology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stephen B Walsh
- Centre for Nephrology, University College London, London, UK
| | - Robert Kleta
- Centre for Nephrology, University College London, London, UK.
- Paediatric Nephrology, Great Ormond Street Hospital, London, UK.
| | - Detlef Bockenhauer
- Centre for Nephrology, University College London, London, UK
- Paediatric Nephrology, Great Ormond Street Hospital, London, UK
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27
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Lee JW, Choi YJ, Park S, Gil HW, Song HY, Hong SY. Serum S100 protein could predict altered consciousness in glyphosate or glufosinate poisoning patients. Clin Toxicol (Phila) 2017; 55:357-359. [PMID: 28301275 DOI: 10.1080/15563650.2017.1286013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 01/12/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Central nervous system (CNS) complications such as seizures and reduced consciousness are important in glufosinate and may occur in severe glyphosate poisoning. The aim of this study was to assess the possible role of serum S100B protein as a biochemical marker of CNS complications associated with glyphosate or glufosinate poisoning. METHODS The study enrolled 40 patients (23 glyphosate poisoning and 17 glufosinate poisoning). Altered consciousness and seizure were observed during hospitalization. S100B level was measured with fully automated modular analytic E170 system using electrochemoluminometric immunoassay. RESULTS Among 40 patients, neurologic features were observed in 12 patients with a median time to onset of 21.5 (IQR 8.25-24.75) h. Serum S100B concentrations measured on admission were higher in the group with neurologic features than in the group without neurologic features [0.148 μg/L (IQR 0.128-0.248) vs. 0.072 μg/L (IQR 0.047-0.084), p < .001]. Univariate analysis of measured patient raw parameters using a ROC curve showed that S100B was a significant predictor of neurologic features in glyphosate and glufosinate poisoning. The area under the ROC curve was 0.894 (95% confidential interval 0.791-0.998). When S100B was set at 0.0965, its sensitivity and specificity for predicting neurologic features in glyphosate and glufosinate poisoning were 92% and 82%, respectively. CONCLUSIONS In our pilot study, S100B was a significant predictor of neurologic complications in patients with glyphosate and glufosinate poisoning. Large prospective cohorts are needed to confirm this finding.
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Affiliation(s)
- Jung-Won Lee
- a Department of Emergency Medicine , Soonchunhyang University Cheonan Hospital , Cheonan , Republic of Korea
| | - Young-Jin Choi
- b Department of Laboratory Medicine , Soonchunhyang University Cheonan Hospital , Cheonan , Republic of Korea
| | - Samel Park
- c Department of Internal Medicine , Soonchunhyang University Cheonan Hospital , Cheonan , Republic of Korea
| | - Hyo-Wook Gil
- c Department of Internal Medicine , Soonchunhyang University Cheonan Hospital , Cheonan , Republic of Korea
| | - Ho-Yeon Song
- d Department of Microbiology , College of Medicine, Soonchunhyang University , Cheonan , Republic of Korea
| | - Sae-Yong Hong
- c Department of Internal Medicine , Soonchunhyang University Cheonan Hospital , Cheonan , Republic of Korea
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28
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Sanya EO, Soladoye AO, Desalu OO, Kolo PM, Olatunji LA, Olarinoye JK. Antiseizure Effects of Ketogenic Diet on Seizures Induced with Pentylenetetrazole, 4-Aminopyridine and Strychnine in Wistar Rats. Niger J Physiol Sci 2017; 31:115-119. [PMID: 28262846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 03/06/2017] [Indexed: 06/06/2023]
Abstract
The ketogenic diet (KD) is a cheap and effective alternative therapy for most epilepsy. There are paucity of experimental data in Nigeria on the usefulness of KD in epilepsy models. This is likely to be responsible for the poor clinical acceptability of the diet in the country. This study therefore aimed at providing experimental data on usefulness of KD on seizure models. The study used 64 Wistar rats that were divided into two dietary groups [normal diet (ND) and ketogenic diet (KD)]. Animal in each group were fed for 35days. Medium chain triglyceride ketogenic diet (MCT-KD) was used and it consisted of 15% carbohydrate in normal rat chow long with 5ml sunflower oil (25% (v/w). The normal diet was the usual rat chow. Seizures were induced with one of Pentelyntetrazole (PTZ), 4-Aminopyridine (AP) and Strychnine (STR). Fasting glucose, ketosis level and serum chemistry were determined and seizure parameters recorded. Serum ketosis was significantly higher in MCT-KD-fed rats (12.7 ±2.6) than ND-fed (5.17±0.86) rats. Fasting blood glucose was higher in ND-fed rats (5.3±0.9mMol/l) than in MCT-KD fed rats (5.1±0.5mMol/l) with p=0.9. Seizure latency was significantly prolonged in ND-fed compared with MCT-KD fed rats after PTZ-induced seizures (61±9sec vs 570±34sec) and AP-induced seizures (49±11sec vs 483±41sec). The difference after Str-induced seizure (51±7 vs 62±8 sec) was not significan. The differences in seizure duration between ND-fed and MCT-KD fed rats with PTZ (4296±77sec vs 366±46sec) and with AP (5238±102sec vs 480±67sec) were significant (p<0.05), but not with STR (3841±94sec vs 3510±89sec) respectively. The mean serum Na+ was significantly higher in MCT-KD fed (141.7±2.1mMol/l) than ND-fed rats (137±2.3mMol/l). There was no significant difference in mean values of other serum electrolytes between the MCT-KD fed and ND-fed animals. MCT-KD caused increase resistance to PTZ-and AP-induced seizures, but has no effect on STR-induced seizures. This antiseizure property is probably mediated through GABAergic receptors (PTZ effect) and blockade of membrane bound KATP channels (AP effect) with some enhancement by serum ketosis.
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Affiliation(s)
- E O Sanya
- Department of Medicine, University of Ilorin, Ilorin.
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29
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Hashemi P, Roshan-Milani S, Saboory E, Ebrahimi L, Soltanineghad M. Interactive effects of prenatal exposure to restraint stress and alcohol on pentylenetetrazol-induced seizure behaviors in rat offspring. Alcohol 2016; 56:51-57. [PMID: 27542557 DOI: 10.1016/j.alcohol.2016.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 07/04/2016] [Accepted: 07/07/2016] [Indexed: 01/13/2023]
Abstract
Prenatal exposure to stress or alcohol increases vulnerability of brain regions involved in neurobehavioral development and programs susceptibility to seizure. To examine how prenatal alcohol interferes with stress-sensitive seizures, corticosterone (COS) blood levels and pentylenetetrazol (PTZ)-induced seizure behaviors were investigated in rat pups, prenatally exposed to stress, alcohol, or both. Pregnant rats were exposed to stress and saline/alcohol on 17, 18, and 19 days of pregnancy and divided into four groups of control-saline (CS), control-alcohol (CA), restraint stress-saline (RS), and restraint stress-alcohol (RA). In CS/CA groups, rats received saline/alcohol (20%, 2 g/kg, intraperitoneally [i.p.]). In RS/RA groups, rats were exposed to restraint stress by being held immobile in a Plexiglas® tube (twice/day, 1 h/session), and received saline/alcohol, simultaneously. After parturition, on postnatal days 6 and 15 (P6 & P15), blood samples were collected from the pups to determine COS level. On P15 and P25, PTZ (45 mg/kg) was injected into the rest of the pups and seizure behaviors were then recorded. COS levels increased in pups of the RS group but not in pups of the RA group. Both focal and tonic-clonic seizures were prevalent and severe in pups of the RS group, whereas only focal seizures were prominent in pups of the CA group. However, pups prenatally exposed to co-administration of alcohol and stress, unexpectedly, did not show additive epileptic effects. The failure of pups prenatally exposed to alcohol to show progressive or facilitatory epileptic responses to stressors, indicates decreased plasticity and adaptability, which may negatively affect HPA-axis performance or hippocampal structure/function.
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Affiliation(s)
- Paria Hashemi
- Department of Physiology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran; Physiology Research Center, Department of Physiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Shiva Roshan-Milani
- Neurophysiology Research Center, Urmia University of Medical Sciences, Urmia, Iran; Cellular and Molecular Research Center, Urmia University of Medical Sciences, Urmia, Iran.
| | - Ehsan Saboory
- Department of Physiology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran; Neurophysiology Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Loghman Ebrahimi
- Department of Physiology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Maryam Soltanineghad
- Department of Physiology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
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Wang D, Wang X, Kong J, Wu J, Lai M. GC-MS-Based metabolomics discovers a shared serum metabolic characteristic among three types of epileptic seizures. Epilepsy Res 2016; 126:83-9. [PMID: 27450370 DOI: 10.1016/j.eplepsyres.2016.07.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 07/02/2016] [Accepted: 07/14/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Understanding the overall and common metabolic changes of seizures can provide novel clues for their control and prevention. Here, we aim to investigate the global metabolic feature of serum for three types of seizures. METHODS We recruited 27 patients who had experienced a seizure within 48h (including 11 who had a generalized seizure, nine who had a generalized seizure secondary to partial seizure and seven who had a partial seizure) and 23 healthy controls. We analyzed the global metabolic changes of serum after seizures using gas chromatography-mass spectrometry-based metabolomics. Based on differential metabolites, the metabolic pathways and their potential to diagnose seizures were analyzed, and metabolic differences among three types of seizures were compared. RESULTS The metabolic profiles of serum were distinctive between the seizure group and the controls but were not different among the three types of seizures. Compared to the controls, patients with seizures had higher levels of lactate, butanoic acid, proline and glutamate and lower levels of palmitic acid, linoleic acid, elaidic acid, trans-13-octadecenoic acid, stearic acid, citrate, cysteine, glutamine, asparagine, and glyceraldehyde in the serum. Furthermore, these differential metabolites had common change trends among the three types of seizures. Related pathophysiological processes reflected by these metabolites are energy deficit, inflammation, nervous excitation and neurotoxicity. Importantly, transamination inhibition is suspected to occur in seizures. Lactate, glyceraldehyde and trans-13-octadecenoic acid in serum jointly enabled a precision of 92.9% for diagnosing seizures. CONCLUSIONS There is a common metabolic feature in three types of seizures. Lactate, glyceraldehyde and trans-13-octadecenoic acid levels jointly enable high-precision seizure diagnosis.
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Affiliation(s)
- Dian Wang
- Department of Forensic Medicine, Shantou University Medical College, China
| | - Xingxing Wang
- Department of Forensic Medicine, Shantou University Medical College, China
| | - Jing Kong
- Department of Forensic Medicine, Shantou University Medical College, China
| | - Jiayan Wu
- Department of Forensic Medicine, Shantou University Medical College, China
| | - Minchao Lai
- Department of Neurology, First Affiliated Hospital of Shantou University Medical College, China.
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Cossa AC, Lima DC, do Vale TG, de Alencar Rocha AKA, da Graça Naffah-Mazzacoratti M, da Silva Fernandes MJ, Amado D. Maternal seizures can affect the brain developing of offspring. Metab Brain Dis 2016; 31:891-900. [PMID: 27085526 DOI: 10.1007/s11011-016-9825-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 04/11/2016] [Indexed: 11/26/2022]
Abstract
To elucidate the impact of maternal seizures in the developing rat brain, pregnant Wistar rats were subjected to the pilocarpine-induced seizures and pups from different litters were studied at different ages. In the first 24 h of life, blood glucose and blood gases were analyzed. (14)C-leucine [(14)C-Leu] incorporation was used to analyze protein synthesis at PN1, and Western Blot method was used to analyze protein levels of Bax, Bcl-2 and Poly(ADP-ribose) polymerase-1 (PARP-1) in the hippocampus (PN3-PN21). During the first 22 days of postnatal life, body weight gain, length, skull measures, tooth eruption, eye opening and righting reflex have been assessed. Pups from naive mothers were used as controls. Experimental pups showed a compensated metabolic acidosis and hyperglycemia. At PN1, the [(14)C-Leu] incorporation into different studied areas of experimental pups was lower than in the control pups. During development, the protein levels of Bax, Bcl-2 and PARP-1 in the hippocampus of experimental pups were altered when compared with control pups. A decreased level of pro- and anti-apoptotic proteins was verified in the early postnatal age (PN3), and an increased level of pro-apoptotic proteins concomitant with a reduced level of anti-apoptotic protein was observed at the later stages of the development (PN21). Experimental pups had a delay in postnatal growth and development beyond disturb in protein synthesis and some protein expression during development. These changes can be result from hormonal alterations linked to stress and/or hypoxic events caused by maternal epileptic seizures during pregnancy.
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Affiliation(s)
- Ana Carolina Cossa
- Departamento de Neurologia e Neurocirurgia - Disciplina de Neurologia Experimental, Universidade Federal de São Paulo, UNIFESP, Rua Pedro de Toledo, 669, 2° Andar, São Paulo, SP, Brasil.
| | - Daiana Correia Lima
- Departamento de Neurologia e Neurocirurgia - Disciplina de Neurologia Experimental, Universidade Federal de São Paulo, UNIFESP, Rua Pedro de Toledo, 669, 2° Andar, São Paulo, SP, Brasil
| | | | - Anna Karynna Alves de Alencar Rocha
- Departamento de Neurologia e Neurocirurgia - Disciplina de Neurologia Experimental, Universidade Federal de São Paulo, UNIFESP, Rua Pedro de Toledo, 669, 2° Andar, São Paulo, SP, Brasil
| | - Maria da Graça Naffah-Mazzacoratti
- Departamento de Neurologia e Neurocirurgia - Disciplina de Neurologia Experimental, Universidade Federal de São Paulo, UNIFESP, Rua Pedro de Toledo, 669, 2° Andar, São Paulo, SP, Brasil
- Departamento de Bioquímica, Universidade Federal de São Paulo, UNIFESP - Rua 3 de maio, 100, São Paulo, BR, Brasil
| | - Maria José da Silva Fernandes
- Departamento de Neurologia e Neurocirurgia - Disciplina de Neurologia Experimental, Universidade Federal de São Paulo, UNIFESP, Rua Pedro de Toledo, 669, 2° Andar, São Paulo, SP, Brasil
| | - Debora Amado
- Departamento de Neurologia e Neurocirurgia - Disciplina de Neurologia Experimental, Universidade Federal de São Paulo, UNIFESP, Rua Pedro de Toledo, 669, 2° Andar, São Paulo, SP, Brasil
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Islam MN, Hossain MA, Yeasmin L, Dutta A, Ahmad F, Khan RH. Clinical Profile and Biochemical Abnormalities of Neonatal Seizure at NICU of a Tertiary Care Hospital. Mymensingh Med J 2016; 25:445-449. [PMID: 27612889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Seizures are most common neurological emergency in the neonatal period and present as a diagnostic and therapeutic challenge to clinicians worldwide. This prospective observational study was conducted in the Neonatal Intensive Care Unit of Mymensingh Medical College Hospital from January 2015 to March 2015. Total 318 patients were enrolled in the study who presented with convulsion. Most of the patients were term (72.95%) and birth weight was normal (77.3%). Around 75% patients were delivered at home. Most common causes of convulsion were Perinatal Asphyxia (78%) followed by Septicemia, Hypoglycemia and Meningitis in order of frequency. Commonest type of seizure was subtle seizure (45.5%). Most of the patients recovered completely (73%) and 8.4% patients died due to complications.
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Affiliation(s)
- M N Islam
- Dr Md Nazrul Islam, Assistant Professor, Department of Neonatology, Mymensingh Medical Colleg, Mymensingh, Bangladesh; E-mail:
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Gorbacheva EL, Gazarskava AS, Cherniiovskava EV, Glazova MV, Nikitina LS. [THE INVESTIGATION OF VASOPRESSIN SECRETION IN NORMAL CONDITION AND DURING SEIZURE ONSET IN KRUSHINSKY-MOLODKINA RATS]. Ross Fiziol Zh Im I M Sechenova 2015; 101:1347-1354. [PMID: 27017628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The aim of our study was to analyze vasopressin secretion rate from hypothalamic neurons in Krushinsky-Molodkina (KM) rats prone to audiogenic epilepsy in control and during audiogenic seizures. We evaluated vasopressin content in blood serum and neurophysin II amount in the neurohypophysis in KM rats as well as in Wistar rats. Obtained data demonstrated decreasing of vasopressin in the blood and at the same time increasing of neurophysin II content in the neurohy- pophysis of KM rats that revealed an inhibition of vasopressin release into blood circuit. The analysis of vasopressin content in blood on the different stages of audiogenic seizure showed significant increasing of vasopressin at clonustonus. Thus, we obtained first demonstration that in KM rats prone to audiogenic seizures vasopressin secretion rate is decreased in comparison to Wistar rats. Significantly upregulated vasopressin in blood at cloniconic stages reveals a participation of vasopressinergic neurosecretory system in the expression of audiogenic seizures.
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Trépanier MO, Kwong KM, Domenichiello AF, Chen CT, Bazinet RP, Burnham WM. Intravenous infusion of docosahexaenoic acid increases serum concentrations in a dose-dependent manner and increases seizure latency in the maximal PTZ model. Epilepsy Behav 2015; 50:71-6. [PMID: 26141815 DOI: 10.1016/j.yebeh.2015.05.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/20/2015] [Accepted: 05/22/2015] [Indexed: 12/18/2022]
Abstract
Docosahexaenoic acid (DHA) is an omega-3 polyunsaturated fatty acid (n-3 PUFA) that has been shown to raise seizure thresholds in the maximal pentylenetetrazole model following acute subcutaneous (s.c.) administration in rats. Following s.c. administration, however, the dose-response relationship for DHA has shown an inverted U-pattern. The purposes of the present experiment were as follows: (1) to determine the pattern of serum unesterified concentrations resulting from the intravenous (i.v.) infusions of various doses of DHA, (2) to determine the time course of these concentrations following the discontinuation of the infusions, and (3) to determine whether seizure protection in the maximal PTZ model would correlate with serum unesterified DHA levels. Animals received 5-minute i.v. infusions of saline or 25, 50, 100, or 200mg/kg of DHA via a cannula inserted into one of the tail veins. Blood was collected during and after the infusions by means of a second cannula inserted into the other tail vein (Experiment 1). A separate group of animals received saline or 12.5-, 25-, 50-, 100-, or 200 mg/kg DHA i.v. via a cannula inserted into one of the tail veins and were then seizure-tested in the maximal PTZ model either during infusion or after the discontinuation of the infusions. Slow infusions of DHA increased serum unesterified DHA concentrations in a dose-dependent manner, with the 200-mg/kg dose increasing the concentration approximately 260-fold compared with saline-infused animals. Following discontinuation of the infusions, serum concentrations rapidly dropped toward baseline, with half-lives of approximately 40 and 11s for the 25-mg/kg dose and 100-mg/kg dose, respectively. In the seizure-tested animals, DHA significantly increased latency to seizure onset in a dose-dependent manner. Following the discontinuation of infusion, seizure latency rapidly decreased toward baseline. Overall, our study suggests that i.v. infusion of unesterified DHA results in transient anticonvulsant effects which parallel unesterified DHA serum concentrations.
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Affiliation(s)
- Marc-Olivier Trépanier
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON M5S 1A8, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; University of Toronto Epilepsy Research Program, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Kei-Man Kwong
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON M5S 1A8, Canada; University of Toronto Epilepsy Research Program, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Anthony F Domenichiello
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Chuck T Chen
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Richard P Bazinet
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; University of Toronto Epilepsy Research Program, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - W M Burnham
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON M5S 1A8, Canada; University of Toronto Epilepsy Research Program, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
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Keihani Douste Z, Haghi Ashtiani MT, Shariat M, Tehrani F. Comparative Evaluation of Corrected QT and Ionized Calcium in Children. Acta Med Iran 2015; 53:579-581. [PMID: 26553087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2015] [Indexed: 06/05/2023] Open
Abstract
Convulsion is one of the most common problems in children and hypocalcemia is one the most frequent etiological items in children's convulsion. Corrected QT (QTc) in EKG is prolonged in hypocalcemia, so it can be a useful tool for evaluation of serum ionized calcium. In three groups (first seizure, multiple seizures, without seizure or control ) every 25 cases, QTc, serum ionized ca, total ca, ABG, and serum albumin level have been checked in the Department of Pediatrics of Imam Khomeini Hospital and outpatient department of Ahari children's medical center in 2008. Prolonged QTc was observed in 72% of convulsive children (36 cases) but only 19% of non-convulsive children (5 cases) showed this pattern. Ionized calcium was significantly higher in non-convulsive than convulsive groups. There was no correlation between prolonged QTc and total serum calcium; however, this correlation with low ionized calcium was significant. QTc is an easy and rapid method for serum ionized calcium evaluation.
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Affiliation(s)
- Zarrin Keihani Douste
- Department of Pediatric Neurology, Imam Khomeini Medical Complex, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mamak Shariat
- Family Health Institute, Maternal Fetal Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Tehrani
- Family Health Institute, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Merbl Y, Sommer A, Chai O, Aroch I, Zimmerman G, Friedman A, Soreq H, Shamir M. Tumor necrosis factor-α and interleukin-6 concentrations in cerebrospinal fluid of dogs after seizures. J Vet Intern Med 2014; 28:1775-81. [PMID: 25308784 PMCID: PMC4895630 DOI: 10.1111/jvim.12462] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 06/06/2014] [Accepted: 08/21/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Idiopathic and acquired epilepsy are common in dogs. Up to 30% of these dogs are refractory to pharmacological treatment. Accumulating experimental evidence indicates that brain immune response and presence of inflammatory mediators decrease the threshold for individual seizures and contribute to epileptogenesis. HYPOTHESIS Dogs with seizures have higher cerebrospinal interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) concentrations compared to dogs with no seizures. METHODS A prospective double blinded study; cerebrospinal fluid (CSF) and serum IL-6, TNF-α and total protein (TP) concentrations were measured by a blinded investigator for the study group and CSF IL-6 and TNF-α levels and TP concentrations were measured in the control group (CG). ANIMALS Dogs presented with seizures that had enough CSF collected to allow analysis were included in the study group. Twelve apparently healthy, quarantined, stray dogs served as control (CG). RESULTS Cerebrospinal fluid TNF-α and IL-6 concentrations were significantly higher (P = .011, P = .039) in dogs with seizures (0 ± 70.66, 0.65 ± 10.93 pg/mL) compared to the CG (0 ± 19, 0.73 ± 0.55 pg/mL). When assessing cytokine concentrations of specifically the idiopathic epilepsy (IE) dogs compared to the CG, only TNF-α concentrations (8.66 ± 62, 0 ± 19 pg/mL) were significantly higher (P = .01). CSF TP concentrations were not significantly higher in the study dogs compared to the CG. CONCLUSIONS AND CLINICAL IMPORTANCE Higher TNF-α and IL-6 concentration in the CSF of dogs with naturally occurring seizures. The higher supports the hypothesis that inflammatory processes through certain mediators play a role in the pathogenesis of seizures in dogs.
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Affiliation(s)
- Y. Merbl
- Koret School of Veterinary MedicineHebrew University of JerusalemRehovotIsrael
| | - A. Sommer
- Koret School of Veterinary MedicineHebrew University of JerusalemRehovotIsrael
| | - O. Chai
- Koret School of Veterinary MedicineHebrew University of JerusalemRehovotIsrael
| | - I. Aroch
- Koret School of Veterinary MedicineHebrew University of JerusalemRehovotIsrael
| | - G. Zimmerman
- Edmond and Lily Safra Center of Brain ScienceHebrew University of JerusalemJerusalemIsrael
| | - A. Friedman
- Department of Life SciencesBen‐Gurion University of the NegevBeer ShevaIsrael
| | - H. Soreq
- Edmond and Lily Safra Center of Brain ScienceHebrew University of JerusalemJerusalemIsrael
- Department of Biological ChemistryAlexander Silberman Institute of Life SciencesHebrew University of JerusalemJerusalemIsrael
| | - M.H. Shamir
- Koret School of Veterinary MedicineHebrew University of JerusalemRehovotIsrael
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Zhang YD, Gu F, Xie HQ, Ji CY, Zhang XL, Zhang Y, Pang WW. [Serum hydrogen sulfide levels in children with benign infantile convulsions associated with mild gastroenteritis]. Zhongguo Dang Dai Er Ke Za Zhi 2014; 16:1096-1099. [PMID: 25406550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To study the changes and significance of serum hydrogen sulfide (H2S) levels in children with benign infantile convulsions associated with mild gastroenteritis (BICE). METHODS Forty-two hospitalized children diagnosed with BICE were recruited to the observation group, and 46 children admitted due to acute gastroenteritis alone were recruited to the control group. Serum H2S levels were measured by a spectrophotometer. RESULTS The serum H2S level in the observation group was significantly lower than in the control group (28±12 μmol/L vs 45±10 μmol/L; P<0.01). The patients with a number of convulsions greater than or equal to two had significantly lower serum H2S levels than those with a number less than two (P<0.05). The number of convulsions was negatively correlated with serum H2S level in BICE patients (r=-0.485, P=0.001). When a convulsion exceeded 5 minues in duration, the duration was negatively correlated with serum H2S level (r=-0.736, P=0.004). CONCLUSIONS The reduction in endogenous H2S level might be one of the causes of convulsions in BICE patients. The degree of reduction in H2S level is associated with the number of convulsions and the duration of convulsion (when it exceeds 5 minues). Further investigation is needed to determine the clinical significance of these results.
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Affiliation(s)
- Yuan-Da Zhang
- Baoding Children's Hospital, Baoding, Hebei 071000, China.
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Hasegawa S, Matsushige T, Inoue H, Takahara M, Kajimoto M, Momonaka H, Oka M, Isumi H, Emi S, Hayashi M, Ichiyama T. Serum and cerebrospinal fluid levels of visinin-like protein-1 in acute encephalopathy with biphasic seizures and late reduced diffusion. Brain Dev 2014; 36:608-12. [PMID: 24075506 DOI: 10.1016/j.braindev.2013.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 08/22/2013] [Accepted: 08/28/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) has recently been recognized as an encephalopathy subtype. Typical clinical symptoms of AESD are biphasic seizures, and MRI findings show reduced subcortical diffusion during clustering seizures with unconsciousness after the acute phase. Visinin-like protein-1 (VILIP-1) is a recently discovered protein that is abundant in the central nervous system, and some reports have shown that VILIP-1 may be a prognostic biomarker of conditions such as Alzheimer's disease, stroke, and brain injury. METHODS However, there have been no reports regarding serum and cerebrospinal fluid (CSF) levels of VILIP-1 in patients with AESD. We measured the serum and CSF levels of VILIP-1 in patients with AESD, and compared the levels to those in patients with prolonged febrile seizures (FS). RESULTS Both serum and CSF levels of VILIP-1 were significantly higher in patients with AESD than in patients with prolonged FS. Serum and CSF VILIP-1 levels were normal on day 1 of AESD. CONCLUSIONS Our results suggest that both serum and CSF levels of VILIP-1 may be one of predictive markers of AESD.
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Affiliation(s)
- Shunji Hasegawa
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Japan.
| | - Takeshi Matsushige
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Japan
| | - Hirofumi Inoue
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Japan
| | - Midori Takahara
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Japan
| | - Madoka Kajimoto
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Japan
| | - Hiroshi Momonaka
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Japan
| | - Momoko Oka
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Japan
| | - Hiroshi Isumi
- Department of Pediatrics, Tsudumigaura Handicapped Children's Hospital, Japan
| | - Sakie Emi
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Japan
| | - Megumi Hayashi
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Japan
| | - Takashi Ichiyama
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Japan; Department of Pediatrics, Tsudumigaura Handicapped Children's Hospital, Japan
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Kruer MC, Hoeftberger R, Lim KY, Coryell JC, Svoboda MD, Woltjer RL, Dalmau J. Aggressive course in encephalitis with opsoclonus, ataxia, chorea, and seizures: the first pediatric case of γ-aminobutyric acid type B receptor autoimmunity. JAMA Neurol 2014; 71:620-3. [PMID: 24590315 DOI: 10.1001/jamaneurol.2013.4786] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
IMPORTANCE Autoantibodies to the γ-aminobutyric acid type B (GABAB) receptor have recently been identified as a cause of autoimmune encephalitis. Most patients with GABAB encephalitis have presented with limbic encephalitis. About half of the cases reported have been paraneoplastic in origin, with the majority of tumors representing small cell lung cancer. OBSERVATIONS We describe a 3-year-old boy who presented with a mixed movement disorder (opsoclonus, ataxia, and chorea) as well as seizures refractory to treatment. His seizures required continuous pentobarbital sodium infusion to be controlled. Despite treatment with intravenous corticosteroids and immunoglobulins, the patient ultimately died of overwhelming sepsis. CONCLUSIONS AND RELEVANCE To our knowledge, this report represents the first pediatric case of GABAB-associated encephalitis. Our patient presented with encephalopathy, refractory seizures, and a mixed movement disorder rather than limbic encephalitis. γ-Aminobutyric acid type B receptor autoimmunity deserves consideration in pediatric patients presenting with encephalitis. Immune-mediated encephalitis with autoantibodies directed against synaptic proteins has become an important component of the differential diagnosis of patients with encephalitis. Current estimates suggest that a substantial proportion of patients once suspected to have viral encephalitis in fact have an autoimmune etiology for their symptoms.1 Additional autoantigen targets continue to be identified, and the phenotypic spectrum associated with autoimmune encephalitis continues to expand. We describe a 3-year-old patient who presented with acute-onset confusion, opsoclonus, chorea, and intractable seizures. Neuroimaging disclosed involvement of the brainstem, basal ganglia, and hippocampi. γ-Aminobutyric acid type B (GABAB) receptor autoantibodies were identified in the serum and cerebrospinal fluid (CSF). Despite immunomodulating therapy, the patient died of overwhelming sepsis. To our knowledge, this is the first description of a pediatric patient with GABAB receptor autoantibodies. The presence of opsoclonus, ataxia, and chorea expands the clinical phenotype and indicates that GABAB receptor autoimmunity should be considered in cases of pediatric encephalitis
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Chisti MJ, Salam MA, Ashraf H, Faruque ASG, Bardhan PK, Shahid ASMSB, Shahunja KM, Das SK, Ahmed T. Prevalence, clinical predictors, and outcome of hypocalcaemia in severely-malnourished under-five children admitted to an urban hospital in Bangladesh: a case-control study. J Health Popul Nutr 2014; 32:270-275. [PMID: 25076664 PMCID: PMC4216963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Hypocalcaemia is common in severely-malnourished children and is often associated with fatal outcome. There is very limited information on the clinical predicting factors of hypocalcaemia in hospitalized severely-malnourished under-five children. Our objective was to evaluate the prevalence, clinical predicting factors, and outcome of hypocalcaemia in such children. In this case-control study, all severely-malnourished under-five children (n=333) admitted to the Longer Stay Ward (LSW), High Dependency Unit (HDU), and Intensive Care Unit (ICU) of the Dhaka Hospital of icddr,b between April 2011 and April 2012, who also had their total serum calcium estimated, were enrolled. Those who presented with hypocalcaemia (serum calcium <2.12 mmol/L) constituted the cases (n=87), and those admitted without hypocalcaemia (n=246) constituted the control group in our analysis. The prevalence of hypocalcaemia among severely-malnourished under-five children was 26% (87/333). The fatality rate among cases was significantly higher than that in the controls (17% vs 5%; p < 0.001). Using logistic regression analysis, after adjusting for potential confounders, such as vomiting, abdominal distension, and diastolic hypotension, we identified acute watery diarrhoea (AWD) (OR 2.19, 95% CI 1.08-4.43, p = 0.030), convulsion on admission (OR 21.86, 95% CI 2.57-185.86, p = 0.005), and lethargy (OR 2.70, 95% CI 1.633-5.46, p = 0.006) as independent predictors of hypocalcaemia in severely-malnourished children. It is concluded, severely-malnourished children presenting with hypocalcaemia have an increased risk of death than those without hypocalcaemia. AWD, convulsion, and lethargy assessed on admission to hospital are the clinical predictors of hypocalcaemia in such children. Presence of these features in hospitalized children with severe acute malnutrition (SAM) should alert clinicians about the possibility of hypocalcaemia and may help undertake potential preventive measures, such as calcium supplementation, in addition to other aspects of management of such children, especially in the resource-poor settings.
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Nonoda Y, Iwasaki T, Ishii M. The efficacy of gabapentin in children of partial seizures and the blood levels. Brain Dev 2014; 36:194-202. [PMID: 23647918 DOI: 10.1016/j.braindev.2013.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Revised: 03/26/2013] [Accepted: 04/06/2013] [Indexed: 01/27/2023]
Abstract
AIM To evaluate the long-term efficacy of gabapentin (GBP) and usefulness of measurement of the blood level for the observation of patients that have partial seizures. METHODS Thirty patients (20 effective cases and 10 ineffective cases) treated with GBP for the localization related epilepsy had their peak blood levels of GBP. The levels were measured seven time points, one, 6, 12, 18, 24, 30, and 36month after the start of medication. The efficacy of GBP was evaluated at one month after the initiation of medication and every year for 3years, based on the R Ratio and the degree of improvement for the paroxysmal strength and length. RESULTS GBP levels were higher in the effective cases than the levels in the ineffective cases 6months after and 1year after the initiation of medication (p<0.05). The level 6months after the start in the effective cases was 5.429±2.384μg/ml (mean±SD), and 5.837±3.217μg/ml after 1year. The cases that were effective for 1year maintained approximately the same efficacy for 3years after the initiation of medication, but there was no correlation between the level and the R Ratio, paroxysmal strength and length. CONCLUSIONS No precise definition of the therapeutic range was recognized because of no correlation between GBP level and the improvement of clinical manifestations. We recommend the GBP optimal range that is established the range within 3-8μg/ml (mean; 5μg/ml) as therapeutic target without the side effect.
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Affiliation(s)
- Yutaka Nonoda
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
| | - Toshiyuki Iwasaki
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan.
| | - Masahiro Ishii
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
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Michalovicz LT, Konat GW. Peripherally restricted acute phase response to a viral mimic alters hippocampal gene expression. Metab Brain Dis 2014; 29:75-86. [PMID: 24363211 PMCID: PMC4343041 DOI: 10.1007/s11011-013-9471-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 12/13/2013] [Indexed: 11/26/2022]
Abstract
We have previously shown that peripherally restricted acute phase response (APR) elicited by intraperitoneal (i.p.) injection of a viral mimic, polyinosinic-polycytidylic acid (PIC), renders the brain hypersusceptible to excitotoxic insult as seen from profoundly exacerbated kainic acid (KA)-induced seizures. In the present study, we found that this hypersusceptibility was protracted for up to 72 h. RT-PCR profiling of hippocampal gene expression revealed rapid upregulation of 23 genes encoding cytokines, chemokines and chemokine receptors generally within 6 h after PIC challenge. The expression of most of these genes decreased by 24 h. However, two chemokine genes, i.e., Ccl19 and Cxcl13 genes, as well as two chemokine receptor genes, Ccr1 and Ccr7, remained upregulated for 72 h suggesting their possible involvement in the induction and sustenance of seizure hypersusceptibility. Also, 12 genes encoding proteins related to glutamatergic and GABAergic neurotransmission featured initial upregulation or downregulation followed by gradual normalization. The upregulation of the Gabrr3 gene remained upregulated at 72 h, congruent with its plausible role in the hypersusceptible phenotype. Moreover, the expression of ten microRNAs (miRs) was rapidly affected by PIC challenge, but their levels generally exhibited oscillating profiles over the time course of seizure hypersusceptibility. These results indicate that protracted seizure susceptibility following peripheral APR is associated with a robust polygenic response in the hippocampus.
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Nieoczym D, Socała K, Jedziniak P, Olejnik M, Wlaź P. Effect of sildenafil, a selective phosphodiesterase 5 inhibitor, on the anticonvulsant action of some antiepileptic drugs in the mouse 6-Hz psychomotor seizure model. Prog Neuropsychopharmacol Biol Psychiatry 2013; 47:104-10. [PMID: 23994662 DOI: 10.1016/j.pnpbp.2013.08.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 08/07/2013] [Accepted: 08/20/2013] [Indexed: 01/06/2023]
Abstract
Sildenafil, a selective phosphodiesterase 5 inhibitor (PDE5), has been recently reported to have both pro- and anticonvulsant action in various experimental models of seizures and epilepsy. Furthermore, it affects anticonvulsant action of some antiepileptic drugs (AEDs) in mice seizure tests and both pharmacodynamic and pharmacokinetic interactions were noted. The present study was carried out to investigate influence of sildenafil on the threshold for 6 Hz-induced psychomotor seizures in mice. Effect of sildenafil on activity of some AEDs, i.e., phenobarbital (PB), clonazepam (CZP), ethosuximide (ETS), valproic acid (VPA), tiagabine (TGB), oxcarbazepine (OXC) and levetiracetam (LEV), in 6 Hz test was also examined. Moreover, combination of sildenafil with LEV was investigated in terms of influence on motor coordination (determined by the chimney test), muscular strength (evaluated in the grip-strength test) and long-term memory (assessed in the passive avoidance task) in mice. To determine the type of pharmacological interaction between sildenafil and LEV, free plasma and total brain concentrations of this AED were determined by LC-MS/MS method. Sildenafil at a dose ranging from 10 to 40 mg/kg statistically increased psychomotor seizure threshold in mice. Moreover, sildenafil enhanced the anticonvulsant action of all the studied AEDs in this test. Interactions between this PDE5 inhibitor and PB, CZP, ETS, TGB and OXC seem to be pharmacodynamic. Since sildenafil increased free plasma and total brain concentration of LEV, interactions between these drugs have pharmacokinetic nature. This kind of interaction was also noted between sildenafil and VPA. Neither LEV (2.32 mg/kg) nor its co-administration with sildenafil (40 mg/kg) produced any significant changes in motor coordination, muscular strength and long-term memory in mice.
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Affiliation(s)
- Dorota Nieoczym
- Department of Animal Physiology, Institute of Biology and Biochemistry, Maria Curie-Skłodowska University, Lublin, Poland
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Abstract
BACKGROUND Antiepileptic medication interactions can complicate the management of epilepsy, by either increasing or reducing the effective serum concentrations thereby causing adverse effects or loss of seizure control. RESULTS A 14-year-old girl with well-controlled juvenile absence epilepsy lost control of her seizures acutely following the administration of carbapenem for pneumonia. Serum valproate concentrations fell by 90% within 48 hours following carbapenem and returned to baseline following its discontinuation. CONCLUSIONS Awareness of this clinically significant interaction alters clinical practice by avoiding carbapenem or temporary use of adjunctive medication to prevent the clinical consequences of this significant drug interaction.
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Affiliation(s)
- Firas A Taha
- Division of Pediatric Neurology, Nemour's Children's Clinic, and the Department of Neurology, Mayo Clinic, Jacksonville, Florida
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Phabphal K, Geater A, Limapichat K, Sathirapanya P, Setthawatcharawanich S, Leelawattana R. The association between CYP 2C9 polymorphism and bone health. Seizure 2013; 22:766-71. [PMID: 23849849 DOI: 10.1016/j.seizure.2013.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 03/26/2013] [Accepted: 06/10/2013] [Indexed: 11/19/2022] Open
Abstract
PURPOSE There is a strong scientific rationale to support the view that cytochrome P450 (CYP P450) enzyme-inducing AEDs induce bone loss in patients with epilepsy. However, no study has investigated the association between CYP 2C9 polymorphism and bone mineral density (BMD), 25-hydroxyvitamin D or parathyroid hormone levels in patients with epilepsy. This study sought to determine the association between BMD and CYP 2C9 polymorphism. METHODS Ninety-three patients taking phenytoin as monotherapy were examined for CYP 2C9 polymorphism, vitamin D level and parathyroid hormone level and underwent basic chemistry testing. The bone mineral density of the lumbar spine and left femur were measured using dual-energy X-ray absorptiometry. RESULTS The results indicated that about 18.3% of the patients with epilepsy were positive for CYP2C9*3. Furthermore, bone mineral density was associated with CYP 2C9 polymorphism epileptic patients. Specifically, patients with 2C9 polymorphism had higher T-scores and Z-scores of the femoral neck (p=0.02 and 0.04, respectively), but not of the lumbar spine (p=0.27 and 0.06, respectively). There was also a trend of having higher serum PTH levels and statistically significantly lower 25-hydroxyvitamin D levels in patients with wild type than in those compared with CYP 2C9 polymorphism (p=0.05 and 0.03, respectively). Additionally, the patients with CYP 2C9 polymorphism had higher plasma levels of phenytoin, particularly when compared with those with wild type (p=0.01). However, there was no association between serum levels of phenytoin and low BMD at femoral neck or lumbar spine. CONCLUSION CYP 2C9 polymorphism is associated with higher BMD, independent of plasma levels of phenytoin.
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Affiliation(s)
- Kanitpong Phabphal
- Neurology Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
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van der Crabben SN, Verhoeven-Duif NM, Brilstra EH, Van Maldergem L, Coskun T, Rubio-Gozalbo E, Berger R, de Koning TJ. An update on serine deficiency disorders. J Inherit Metab Dis 2013; 36:613-9. [PMID: 23463425 DOI: 10.1007/s10545-013-9592-4] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 01/17/2013] [Accepted: 01/21/2013] [Indexed: 11/28/2022]
Abstract
Serine deficiency disorders are caused by a defect in one of the three synthesising enzymes of the L-serine biosynthesis pathway. Serine deficiency disorders give rise to a neurological phenotype with psychomotor retardation, microcephaly and seizures in newborns and children or progressive polyneuropathy in adult patients. There are three defects that cause serine deficiency of which 3-phosphoglycerate dehydrogenase (3-PGDH) deficiency, the defect affecting the first step in the pathway, has been reported most frequently. The other two disorders in L-serine biosynthesis phosphoserine aminotransferase (PSAT) deficiency and phosphoserine phosphatase (PSP) deficiency have been reported only in a limited number of patients. The biochemical hallmarks of all three disorders are low concentrations of serine in cerebrospinal fluid and plasma. Prompt recognition of affected patients is important, since serine deficiency disorders are treatable causes of neurometabolic disorders. The use of age-related reference values for serine in CSF and plasma can be of great help in establishing a correct diagnosis of serine deficiency, in particular in newborns and young children.
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Affiliation(s)
- S N van der Crabben
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
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Cesur Y, Yuca SA, Kaya A, Yilmaz C, Bay A. Vitamin D deficiency rickets in infants presenting with hypocalcaemic convulsions. W INDIAN MED J 2013; 62:201-204. [PMID: 24564040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM Hypocalcaemia evaluation of the clinical, biochemical and radiologicalfeatures of 91 infants with rickets who presented as hypocalcaemic convulsions. SUBJECTS AND METHODS Ninety-one hypocalcaemic infants who were brought to hospital with convulsion and diag-nosed with rickets related to vitamin D deficiency according to their clinical, biochemical and radio-logicalfeatures were retrospectively reviewed. RESULTS Mean values of the laboratory data were as follows: calcium 5.55 +/- 0.79 mg/dL, phosphorus 4.77 +/- 1.66 mg/dL, alkaline phosphatase 1525.5 +/- 925.4 U/L and parathormone 256.8 +/- 158.3 pg/mL. Serum 25-OH vitamin D levels were below normal (< 20 ng/mL) in 37 infants. CONCLUSION Vitamin D deficiency should be considered in infants presenting with hypocalcaemia. To avoid complications such as convulsions, clinicians should give vitamin D supplementation to such infants.
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Affiliation(s)
- Y Cesur
- Department of Pediatric Endocrinology, Yiiziincii Yil University, Faculty of Medicine, Van, Turkey
| | - S A Yuca
- Department of Pediatric Endocrinology, Yiiziincii Yil University, Faculty of Medicine, Van, Turkey
| | - A Kaya
- Department of Pediatric Endocrinology, Yiiziincii Yil University, Faculty of Medicine, Van, Turkey
| | - C Yilmaz
- Department of Pediatric Neurology, Yiiziincii Yil University, Faculty of Medicine, Van, Turkey
| | - A Bay
- Department of Pediatrics, Yiiziincii Yil University, Faculty of Medicine, Van, Turkey
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Abstract
Epilepsy is the third most common chronic neurological disorder. Clinical and experimental evidence supports the role of sex and influence of sex hormones on seizures and epilepsy as well as alterations of the endocrine system and levels of sex hormones by epileptiform activity. Conversely, seizures are sensitive to changes in sex hormone levels, which in turn may affect the seizure-induced neuronal damage. The effects of reproductive hormones on neuronal excitability and seizure-induced damage are complex to contradictory and depend on different mechanisms, which have to be accounted for in data interpretation. Both estradiol and progesterone/allopregnanolone may have beneficial effects for patients with epilepsy. Individualized hormonal therapy should be considered as adjunctive treatment in patients with epilepsy to improve seizure control as well as quality of life.
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Affiliation(s)
- Jana Velíšková
- Department of Cell Biology & Anatomy, New York Medical College, Valhalla, NY, USA.
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Cassandrini D, Cilio MR, Bianchi M, Doimo M, Balestri M, Tessa A, Rizza T, Sartori G, Meschini MC, Nesti C, Tozzi G, Petruzzella V, Piemonte F, Bisceglia L, Bruno C, Dionisi-Vici C, D'Amico A, Fattori F, Carrozzo R, Salviati L, Santorelli FM, Bertini E. Pontocerebellar hypoplasia type 6 caused by mutations in RARS2: definition of the clinical spectrum and molecular findings in five patients. J Inherit Metab Dis 2013; 36:43-53. [PMID: 22569581 DOI: 10.1007/s10545-012-9487-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 03/26/2012] [Accepted: 04/05/2012] [Indexed: 11/27/2022]
Abstract
Recessive mutations in the mitochondrial arginyl-transfer RNA synthetase (RARS2) gene have been associated with early onset encephalopathy with signs of oxidative phosphorylation defects classified as pontocerebellar hypoplasia 6. We describe clinical, neuroimaging and molecular features on five patients from three unrelated families who displayed mutations in RARS2. All patients rapidly developed a neonatal or early-infantile epileptic encephalopathy with intractable seizures. The long-term follow-up revealed a virtual absence of psychomotor development, progressive microcephaly, and feeding difficulties. Mitochondrial respiratory chain enzymes in muscle and fibroblasts were normal in two. Blood and CSF lactate was abnormally elevated in all five patients at early stages while appearing only occasionally abnormal with the progression of the disease. Cerebellar vermis hypoplasia with normal aspect of the cerebral and cerebellar hemispheres appeared within the first months of life at brain MRI. In three patients follow-up neuroimaging revealed a progressive pontocerebellar and cerebral cortical atrophy. Molecular investigations of RARS2 disclosed the c.25A>G/p.I9V and the c.1586+3A>T in family A, the c.734G>A/p.R245Q and the c.1406G>A/p.R469H in family B, and the c.721T>A/p.W241R and c.35A>G/p.Q12R in family C. Functional complementation studies in Saccharomyces cerevisiae showed that mutation MSR1-R531H (equivalent to human p.R469H) abolished respiration whereas the MSR1-R306Q strain (corresponding to p.R245Q) displayed a reduced growth on non-fermentable YPG medium. Although mutations functionally disrupted yeast we found a relatively well preserved arginine aminoacylation of mitochondrial tRNA. Clinical and neuroimaging findings are important clues to raise suspicion and to reach diagnostic accuracy for RARS2 mutations considering that biochemical abnormalities may be absent in muscle biopsy.
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Abstract
Objective The mammalian target of rapamycin (mTOR) pathway integrates signals from different nutrient sources, including amino acids and glucose. Compounds that inhibit mTOR kinase activity such as rapamycin and everolimus can suppress seizures in some chronic animal models and in patients with tuberous sclerosis. However, it is not known whether mTOR inhibitors exert acute anticonvulsant effects in addition to their longer term antiepileptogenic effects. To gain insights into how rapamycin suppresses seizures, we investigated the anticonvulsant activity of rapamycin using acute seizure tests in mice. Methods Following intraperitoneal injection of rapamycin, normal four-week-old male NIH Swiss mice were evaluated for susceptibility to a battery of acute seizure tests similar to those currently used to screen potential therapeutics by the US NIH Anticonvulsant Screening Program. To assess the short term effects of rapamycin, mice were seizure tested in ≤6 hours of a single dose of rapamycin, and for longer term effects of rapamycin, mice were tested after 3 or more daily doses of rapamycin. Results The only seizure test where short-term rapamycin treatment protected mice was against tonic hindlimb extension in the MES threshold test, though this protection waned with longer rapamycin treatment. Longer term rapamycin treatment protected against kainic acid-induced seizure activity, but only at late times after seizure onset. Rapamycin was not protective in the 6 Hz or PTZ seizure tests after short or longer rapamycin treatment times. In contrast to other metabolism-based therapies that protect in acute seizure tests, rapamycin has limited acute anticonvulsant effects in normal mice. Significance The efficacy of rapamycin as an acute anticonvulsant agent may be limited. Furthermore, the combined pattern of acute seizure test results places rapamycin in a third category distinct from both fasting and the ketogenic diet, and which is more similar to drugs acting on sodium channels.
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Affiliation(s)
- Adam L. Hartman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail: (ALH); (JMH)
| | - Polan Santos
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Alison Dolce
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - J. Marie Hardwick
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail: (ALH); (JMH)
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