Clinical outcomes in older surgical patients with mild cognitive impairment

Introduction

Older adults, including those with mild cognitive impairment (MCI), are increasingly undergoing surgery.

Treatment with Tertiary Oximes Prevents Seizures and Improves Survival Following Sarin Intoxication

The capability of the tertiary oximes, monoisonitrosoacetone (MINA) and diacetylmonoxime (DAM), to reactivate acetylcholinesterase (AChE) inhibited by sarin (GB) in the blood, brain, and peripheral tissues of guinea pigs was compared with that of the quaternary oximes 2-PAM, HLö7, and MMB-4. Animals were injected subcutaneously (s.c.) with 1.0?×?LD₅₀ of GB and treated intramuscularly (i.m.) 5 min later with one of these oximes. Sixty minutes after GB exposure, tissues were collected for AChE analysis. At low doses, MINA and DAM produced significant increases in AChE activity in all brain areas examined, but no significant AChE reactivation in peripheral tissues or blood. At higher doses, MINA and DAM increased AChE activity in the brain, peripheral tissues, and blood. In contrast, the quaternary oximes produced significant reactivation in peripheral tissues and blood AChE, but no significant reactivation of brain AChE. In another study, animals were pretreated i.m. with pyridostigmine 30 min prior to s.c. challenge with 2.0?×?LD₅₀ of GB and treated i.m. 1 min later with atropine sulfate (2.0 mg/kg), plus a varied dose of oximes. MINA and DAM prevented or terminated GB-induced seizure activity and protected against GB lethality in a dose-dependent fashion. In contrast, none of the quaternary oximes prevented or stopped GB-induced seizures. Thus, tertiary oximes reactivated AChE in the brain, improved survival, and terminated seizures following GB intoxication.     

Reactivation of organophosphate-inhibited acetylcholinesterase by quaternary pyridinium aldoximes

We investigated the relationship between the chemical structure of acetylcholinesterase (AChE; EC 3.1.1.7) reactivators and their potency in reactivating this enzyme, after prior inhibition by VX (O-ethyl-S-(2-diisopropylaminoethyl)-methylthiophosphonate), tabun, sarin, and cyclosarin. The oximes, pralidoxime (2-PAM), HI-6 [1-(2-hydroxyiminomethylpyridinium)-3-(4-carbamoylpyridinium)-2-oxa-propane dichloride], obidoxime and HS-6 [1-(2-hydroxyiminomethylpyridinium)-3-(3-carbamoylpyridinium)-2-oxa-propane dichloride] were used as representatives of the group of AChE reactivators. Rat brain AChE was used as the appropriate source of the enzyme. Our results confirm that there is no single broad-spectrum oxime suitable for the treatment of poisoning with all highly toxic organophosphorus agents.     

Intranasal sumatriptan for acute migraine attacks: a systematic review and meta-analysis

We performed this systematic review and meta-analysis to evaluate the tolerability and efficacy of intranasal sumatriptan, a selective serotonin agonist, compared to placebo or other migraine therapeutics for the treatment of acute migraine attacks. We searched PubMed, SCOPUS, Embase, and Cochrane CENTRAL for relevant randomized controlled trials (RCTs). Data were extracted from eligible studies and pooled as risk ratios (RR), using RevMan software. We performed subgroup and meta-regression analyses for different doses and treatment endpoints. Sixteen RCTs (n = 5925 patients) matched our inclusion criteria. The overall effect-estimate showed that intranasal sumatriptan was superior to placebo in terms of pain relief (RR = 1.70, 95% CI [1.31, 2.21], p < 0.0001) and headache relief (RR = 1.58, 95% CI [1.35, 1.84], p < 0.00001) at 2 h. Although sumatriptan was superior to placebo in terms of headache relief at 30 min (RR = 1.31, 95% CI [1.08, 1.59], p = 0.005), no significant difference was found between both groups in terms of the frequency of pain-free participants at 30 min (RR = 1.18, 95% CI [0.49, 2.88], p = 0.71). Subgroup analysis and meta-regression models showed that increasing the dose of sumatriptan reduced the time needed for headache relief; however, this clinical improvement with higher doses was associated with more frequent adverse events in comparison to smaller doses. In conclusion, intranasal sumatriptan is effective for the treatment of acute migraine attacks. However, it was associated with a six-fold increase in the risk of taste disturbance, compared to the placebo. Future RCTs are recommended to provide head-to-head comparison of different administration routes and drug formulations of sumatriptan.     

Selective Serotonin 3 Receptor Antagonist Treatment for Schizophrenia: Meta-analysis and Systematic Review

Double-blinded, randomized, placebo-control trials of selective serotonin 3 receptor antagonists (5-HT₃R-ANTs) for schizophrenia have differed in outcome. This meta-analysis tests the hypothesis that 5-HT₃R-ANTs are effective for the treatment for schizophrenia. We searched PubMed, the Cochrane Library database, and PsycINFO up to June 15, 2013. We conducted a systematic review and meta-analysis of individual patient data from randomized controlled trials comparing 5-HT₃R-ANTs add-on therapy with placebo. The risk ratio (RR), 95 % confidence intervals (CI), and standardized mean difference (SMD) were calculated. A random-effects model was used. Six studies (total n = 311) were identified. These included one granisetron plus risperidone study, one ondansetron plus risperidone study, one ondansetron plus haloperidol, and three tropisetron plus risperidone studies. The statistically significant effects of 5-HT₃R-ANTs add-on therapy on Positive and Negative Syndrome Scale (PANSS) total scores were SMD = ?1.03, CI = ?1.70 to ?0.36, p = 0.003 (I ² = 82 %, 5 studies, n = 261); on negative scores were SMD = ?1.10, CI = ?1.82 to ?0.39, p = 0.002 (I ² = 84 %, 5 studies, n = 261); and on PANSS general scores were SMD = ?0.70, CI = ?1.23 to ?0.17, p = 0.01 (I ² = 73 %, 5 studies, n = 261). However, 5-HT₃R-ANTs add-on therapy was not superior to placebo in PANSS positive scores (SMD = ?0.12, p = 0.33). Dropout due to all cause (RR = 0.80, p = 0.50), inefficacy (RR = 0.76, p = 0.65), or adverse events (RR = 0.84, p = 0.75) was similar in both groups. Constipation occurred significantly more often with 5-HT₃R-ANTs than placebo (RR = 2.05, CI = 1.07–3.91, p = 0.03, NNH = 11, p = 0.02). 5-HT₃R-ANTs add-on therapy is more beneficial on the psychopathology (especially negative symptoms) than controls in patients with schizophrenia, and 5-HT₃R-ANTs seem to be well-tolerated treatments.     

Therapeutic and reactivating efficacy of oximes K027 and K203 against a direct acetylcholinesterase inhibitor

As oxime-based structures are the only causal antidotes to organophosphate (OP)-inhibited acetylcholinesterase (AChE), the majority of studies on these have been directed towards their synthesis and testing. In this study, experimental bispyridinium oximes K027 and K203, which have shown promising results in the last decade of research, were examined in vivo for their therapeutic and reactivating ability in acute poisoning by the direct AChE-inhibitor dichlorvos (DDVP), used as a dimethyl OP structural model. Additionally, the efficacy of oximes K027 and K203 was compared with the efficacy of four oximes (pralidoxime, trimedoxime, obidoxime and HI-6), already used in efficacy experiments and human medicine. To evaluate therapeutic efficacy, groups of Wistar rats were treated with equitoxic doses of oximes (5% LD₅₀, i.m.) and/or atropine (10 mg/kg, i.m.) immediately after s.c. DDVP challenge (4–6 doses). Using the same antidotal protocol, AChE activity was measured in erythrocytes, diaphragm and brain 60 min after s.c. DDVP exposure (75% LD₅₀). The oxime K027 was the most efficacious in reducing the DDVP induced lethal effect in rats, while the oxime K203 was more efficacious than trimedoxime, pralidoxime and HI-6. Significant reactivation of DDVP inhibited AChE was achieved only with oxime K027 or its combination with atropine in erythocytes and the diaphragm. Moreover, the acute i.m. toxicity of oxime K027 in rats was lower than all other tested oximes. The results of this study support previous studies considering the oxime K027 as a promising experimental oxime structure for further testing against structurally-different OP compounds.     

The course of posttraumatic stress symptoms and functional impairment following a disaster: what is the lasting influence of acute versus ongoing traumatic events and stressors?

Purpose

Ongoing traumatic events and stressors, rather than acute sources of trauma, may shape long-term post-disaster mental health. The purpose of this study was to compare the influence of acute hurricane-related exposures and ongoing post-hurricane exposures on the short- and long-term course of posttraumatic stress symptoms (PTSS) and functional impairment (FI).

Methods

A random sample of adults (n = 658) in Galveston and Chambers Counties, Texas, was selected 2–6 months after Hurricane Ike and interviewed 3 times over 18 months. Hurricane-related exposures included traumatic events such as death of a family member due to the hurricane and stressors such as loss/damage to personal property due to the hurricane. Post-hurricane exposures included traumatic events such as sexual assault and stressors such as divorce or serious financial problems.

Results

Experiencing an acute hurricane-related traumatic event or stressor was associated with initial post-hurricane PTSS [RR = 1.92 (95 % CI = 1.13–3.26) and RR = 1.62 (1.36–1.94), respectively] and FI [RR = 1.76; (1.05–2.97) and RR = 1.74 (1.46–2.08)], respectively, and acute hurricane-related stressors were associated with a higher rate of increase in FI over time [RR = 1.09; (1.01–1.19)]. In contrast, ongoing post-hurricane daily stressors were not associated within initial PTSS and FI, but were associated with PTSS and FI at the second and third interviews.

Conclusions

While immediate postdisaster interventions may influence short-term mental health, investment in the prevention of ongoing stressors may be instrumental to manage long-term mental health status.     

Vestibular-evoked myogenic potentials,clinical evaluation,and imaging findings in multiple sclerosis

Vestibular-evoked myogenic potentials (VEMP), short-latency electromyographic responses elicited by acoustic stimuli, evaluate the function of vestibulocollic reflex and may give information about brainstem function. The aim of the present study is to evaluate the potential contribution of VEMP to the diagnosis of multiple sclerosis (MS). Fifty patients with MS and 30 healthy control subjects were included in this study. The frequency of VEMP p1–n1 and n2–p2 waves; mean p1, n1, n2, and p2 latency; and mean p1–n1 and n2–p2 amplitude were determined. The relation between clinical and imaging findings and VEMP parameters was evaluated. The p1–n1 and n2–p2 waves were more frequently absent in MS than in control subjects [p1–n1 wave absent: MS, 25 (25 %) ears; control, 6 (10 %) ears; P ≤ 0.02] [n2–p2 wave absent: MS, 44 (44 %) ears; control, 7 (12 %) ears; P ≤ 0.001]. The mean p1–n1 amplitude was lower in MS than in control subjects (MS, 19.1 ± 7.2 μV; control, 23.3 ± 7.4 μV; P ≤ 0.002). A total of 24/50 (48 %) MS patients had VEMP abnormalities (absent responses and/or prolonged latencies). VEMP abnormalities were more frequent in patients with than without vestibular symptoms (P ≤ 0.02) and with brainstem functional system score (FSS) ≥1 than FSS = 0 (P ≤ 0.02). In patients with MS, absence of p1–n1 wave was more frequent in patients with than without vestibular symptoms [absence of p1–n1 wave: vestibular symptoms, 9 (45 %) ears; no vestibular symptoms, 16 (20 %) ears; P ≤ 0.03] and patients with Expanded Disability Status Scale (EDSS) score ≥5.5 [absence of p1–n1 wave: EDSS ≥5.5, 7 (70 %) ears; EDSS <5.5, 18 (20 %) ears; P ≤ 0.001]. Abnormal VEMP may be noted in MS patients, especially those with vestibular symptoms and greater disability. The VEMP test may complement other studies for diagnosis and follow-up of patients with MS.     

Determinants of External Ventricular Drain Placement and Associated Outcomes in Patients with Spontaneous Intraventricular Hemorrhage

Background

External ventricular drain (EVD) usage in patients with intraventricular hemorrhage (IVH) is variable in current practice and in clinical trials, and its impact on outcome remains controversial. The objective of this study was to identify the clinical predictors of EVD utilization, and associated outcome in adults with spontaneous IVH with or without intracerebral hemorrhage (ICH).

Methods

Retrospective review of 183 consecutive IVH patients admitted to a University Hospital between 2003 and 2010. Clinical and radiographic data were analyzed for associations between EVD placement and mortality, poor outcome, and improvement in Glasgow Coma Scale score (GCS) using multivariate logistic regression models.

Results

Average age was 62 ± 15.6 years, and average ICH and IVH volumes were 35.8 ± 40.9 cc and 19.7 ± 25.3 cc, respectively. Independent predictors of EVD placement within first 5 days of admission were GCS ≤ 8 (OR 11.5; P < 0.001), Graeb score >5 (OR 4.6; P = 0.001), and non-lobar ICH ≤ 30 cc (OR 9.7; P < 0.001). Median GCS increased from 5 (IQR 3–7) 48 h post-EVD (P < 0.001). EVD placement was an independent predictor of reduced mortality (OR 0.31; P = 0.04) and modified Rankin score 0–3 (OR 15.7; P = 0.01) at hospital discharge. In patients with hydrocephalus on presentation, EVD was associated with reduced mortality for patients with GCS > 3 after controlling for ICH and IVH severity (OR 0.02; P = 0.01).

Conclusions

Patients with lower GCS, higher IVH severity, and lower ICH volume are more likely to have an EVD placed. EVD placement is associated with reduced mortality and improved short-term outcomes in patients with IVH after adjusting for known severity factors. EVD use should be protocolized in clinical trials of ICH management where IVH is included.     

Can dietary saturated fat be beneficial in prevention of stroke risk? A meta-analysis

We conducted a meta-analysis to summarize available evidence regarding the relation between saturated fatty acid (SFA) intake and stroke risk. We searched multiple electronic databases through February 2016. Log relative risks (RRs) with 95 % confidence intervals (CIs) of the highest versus the lowest for cohort studies were weighed by the inverse variance method to obtain combined RRs. 15 prospective studies including 476,569 individuals and 11,074 strokes were included. Higher SFA intake was associated with reduced overall stroke risk [RR = 0.89 (95 % CI 0.82–0.96)] and fatal stroke risk [RR = 0.75 (95 % CI 0.59–0.94)]. Subgroup analysis indicated that higher SFA intake was associated with reduced stroke risks for East-Asians [RR = 0.79 (95 % CI 0.69–0.90)], for dose <25 g/day [RR = 0.81 (95 % CI 0.71–0.92)], for males [RR = 0.85 (95 % CI 0.75–0.96)], and for individuals with body mass index (BMI) <24 [RR = 0.75 (95 % CI 0.65–0.87)], but not for non East-Asians, females, and individuals with dose ≥25 g/day and BMI ≥24. This meta-analysis reveals that higher SFA intake is inversely associated with risk of stroke morbidity and mortality with race, sex, and BMI as key factors influencing this risk. There seems to be a threshold of SFA intake for inverse relation of SFA intake with stroke. However, the stroke-reducing or -increasing effects for specific subtypes and specific food sources of SFA can be concealed. Functions of specific subtypes of SFA (e.g. lignoceric acid) and specific food sources of SFA (i.e. plant vs. animal) in relation to stroke need to be clarified in further studies.     

Swirl sign in traumatic acute epidural hematoma: prognostic value and surgical management

The swirl sign is identified as a small area of low attenuation within an intracranial hyperattenuating clot on non-enhanced computed tomography (CT) scans of the brain, which represents active bleeding. The purpose of this study was to evaluate the incidence of the swirl sign among patients with acute epidural hematoma (AEDH) and to identify its prognostic value and impact on surgical treatment. A retrospective review was performed of patients with a diagnosis of traumatic EDH by CT scan who were surgically treated at the Department of Neurosurgery of the First People’s Hospital of Jingmen between January 2010 and January 2014. Patients with combined or open craniocerebral injuries and those who did not undergo surgical treatment were excluded. Of the 147 patients evaluated, 21 (14%) exhibited the swirl sign on non-enhanced CT scans of the brain. Univariate analysis revealed a significant correlation between the occurrence of the swirl sign and preoperative Glasgow coma scale scores, preoperative mydriasis, time from injury to CT scan, and intraoperative hematoma volume. Compared with patients without this sign, those exhibiting the swirl sign had a higher mortality rate (24 vs. 6%, respectively; P = 0.028) and a worse outcome (Glasgow Outcome Scale score ≤ 3: 38 vs. 15%, respectively; P = 0.027) at 3 months. An adjusted analysis showed that the occurrence of the swirl sign was an independent predictor of poor outcome (death: odds ratio (OR) = 4.61; 95% confidence interval (CI): 1.34–15.82; P < 0.05; 3-month Glasgow Outcome Scale score ≤ 3: OR = 3.47; 95% CI: 1.27–9.49; P < 0.05). In conclusion, the occurrence of the swirl sign on the head CT scan of patients with AEDH was found to be significantly associated with poor outcome. Therefore, early identification of this sign and aggressive management with early surgical evacuation is crucial for improving patient outcome.     

Effect of intrathecal pralidoxime administration upon survival of rats exposed to the organophosphate paraoxon

The therapeutic results of systemic administration of pralidoxime (2-PAM) in the treatment of poisoning with organophosphate-type cholinesterase inhibitors are disappointing. It has been hypothesized that this is due to poor entry of 2-PAM into the brain. To test if survival rates can be improved by direct administration of 2-PAM into the cerebrospinal fluid (CSF), the effect of intrathecal 2-PAM injections upon mortality after paraoxon intoxication was examined. Eight groups of rats (n=30 each) were examined, all of which received paraoxon (1 micromol=272 microg, 3 micromol=816 microg, or 5 micromol=1.36 mg) intraperitoneally (i.p.). One group received no further treatment; the other groups were given 50 micromol (=8.63 mg) 2-PAM i.p., 5 micromol (=863 microg) 2-PAM intrathecally and pentobarbital/lidocaine in various combinations. Results were compared with the no treatment group and the control groups that did not receive any paraoxon injections, but were given intrathecal injections of saline or 2-PAM. The relative risk of death was estimated by Cox survival analysis. Mortality was lowest after treatment with a combination of both i.p. and intrathecal 2-PAM plus pentobarbital, and with 2-PAM i.p. alone plus pentobarbital. Both treatments were significantly better than 2-PAM i.p. alone (p相似文献   

In vitro reactivation potency of acetylcholinesterase reactivators — K074 and K075 — to reactivate tabun-inhibited human brain cholinesterases

In this work, two oximes for the treatment of tabun-inhibited acetylcholinesterase (AChE; EC 3.1.1.7), K074 (1,4-bis(4-hydroxyiminomethylpyridinium)butane dibromide) and K075 ((E)-1,4-bis(4-hydroxyiminomethylpyridinium)but-2-en dibromide), were tested in vitro as reactivators of AChE. Comparison was made with currently used AChE reactivators (pralidoxime, HI-6, methoxime and obidoxime). Human brain homogenate was taken as an appropriate source of the cholinesterases. As resulted, oxime K074 appears to be the most potent reactivator of tabun-inhibited AChE, with reactivation potency comparable to that of obidoxime. A second AChE reactivator, K075, does not attain as great a reactivation potency as K074, although its maximal reactivation (17%) was achieved at relevant concentrations for humans.     

Endovascular vs. medical therapy in symptomatic vertebral artery stenosis: a meta-analysis

This meta-analysis aims to compare percutaneous transluminal angioplasty (PTA) to medical treatment (MT) for symptomatic vertebral artery stenosis (SVAS) treatment. We searched PubMed, Springer, Google Scholar, Clinical Trials, Cochrane Central, Chinese National Knowledge Infrastructure, and China Biological Medicine databases. All relevant comparative trials were included. All summary estimates were calculated by random-effect models. Ten comparative trials involving 672 patients were identified. Within 30-day follow-up, there was no significant difference between PTA plus MT and MT alone in vascular death, any stroke, posterior circulation TIA, posterior circulation infarction, and ischemic stroke (all P > 0.05). With a follow-up of more than 1 year, no significant difference was found between PTA plus MT and MT alone in all-cause death (3 vs. 7 %, P = 0.24), vascular death (4 vs. 7 %, P = 0.34), posterior circulation stroke (5 vs. 8 %, P = 0.48), posterior circulation ischemic events (8 vs. 25 %, P = 0.23), posterior circulation TIA (10 vs. 38 %, P = 0.11), posterior circulation infarction (6 vs. 12 %, P = 0.51), vertebral artery occlusion (6 vs. 12 %, P = 0.58), and in secondary long-term events, including any stroke, anterior circulation stroke, hemorrhagic stroke, and myocardial infarction (all P > 0.05), although PTA plus MT could largely reduce the vertebral artery stenosis rate [MD 63.05 %, 95 % CI (32.77–93.34 %), P < 0.01]. Hence, PTA plus MT may be not superior to MT alone for SVAS treatment. Larger randomized trials are needed to verify the optimum therapy for SVAS.     

Patterns of Care Consumption after Compulsory Admission: A Five-Year Follow-Up to the Amsterdam Study of Acute Psychiatry VIII

Significant numbers of involuntary admissions and the fact that compulsory hospitalization is a drastic intervention in a patient’s life justify the introduction of preventive measures. This study looks at the five-year outcome of involuntary admissions after psychiatric emergency consultations in Amsterdam. A cohort of 460 involuntarily admitted patients was investigated prospectively. The annual numbers of involuntary readmissions and the utilization of mental health services were studied, with sociodemographic and clinical characteristics and psychiatric history as predictors. The odds ratios for involuntary readmission during the fourth and fifth follow-up years were 0.71 (95%CI = 0.50–1.01; P = 0.059) and 0.64 (95%CI = 0.45–0.92; P = 0.015), respectively. Readmission was associated with low discontinuity of treatment (Chi2 P ≤ 0.001) and high total consumption of services (Chi2 P ≤ 0.001) during follow-up. It emerged that involuntary readmission could be predicted on the basis of high care consumption five years before inclusion (OR 2.61 CI 1.44–4.73; P 0.002), a history of involuntary admission (OR 1.56 CI = 1.03–2.35; P = 0.034), being older than 44 years at baseline (OR 0.57 CI = 0.39–0.84; P = 0.007), and living alone (OR 1.68 CI = 1.22–02.33; P = 0.002). The risk of involuntary readmission declines after three years. In Amsterdam, low levels of treatment discontinuity and high levels of service use do not seem to reduce this risk for patients with severe and persistent psychiatric disorders. Our findings should be an incentive to explore and reappraise the methods employed in our current system of community mental health care.     

Factors Associated with Thrombolysis Outcome in Ischemic Stroke Patients with Atrial Fibrillation

The outcome of early intravenous thrombolysis for ischemic stroke in patients with atrial fibrillation (AF) is worse than that without thrombosis. How to increase the efficacy of intravenous thrombolysis for AF-related ischemic stroke remains largely unknown. In this study, we investigated factors that influence the effect of intravenous thrombolysis in these patients. Our results showed that thrombolysis was independently associated with a favorable outcome (P < 0.001) and did not influence the mortality of AF-related ischemic stroke, although it increased the risk of hemorrhage within 24 h after treatment. Risk factors for a poor outcome at admission were: heart failure (P = 0.045); high systolic pressure (P = 0.039); high blood glucose (P = 0.030); and a high National Institutes of Health Stroke Scale (NIHSS) score (P < 0.001). Moreover, high systolic pressure at admission (P = 0.007), high blood glucose (P = 0.027), and a high NIHSS score (P < 0.001) were independent risk factors for mortality at 3 months. Besides thrombolysis, a high NIHSS score (P = 0.006) and warfarin taken within 48 h before stroke onset (P = 0.032) were also independent risk factors for symptomatic hemorrhage within 24 h after treatment. Ischemic stroke patients with AF benefited from intravenous thrombolysis with recombinant tissue plasminogen activator within 4.5 h after stroke.     

Efficacy of obidoxime in human organophosphorus poisoning: Determination by neuromuscular transmission studies

Six patients with organophosphorus compound intoxications developed an intermediate syndrome (weakness and fasciculations) and obidoxime was given on eight occasions. The efficacy of the acetylcholinesterase (AChE) reactivator was monitored electrophysiologically by neuromuscular transmission studies using single and repetitive nerve stimulation (20 and 50 Hz) and the activity of the serum (butyryl) cholinesterase (ChE). Dramatic electrophysiologic improvement was seen when obidoxime was given early within 12 h in 3 patients, although evidence of AChE inhibition did not subside completely. When administration of obidoxime was delayed 26 h or more after intoxication on five occasions, electrophysiologic improvement was mild or absent. In one case, 66 h after intoxication with oxydemeton-S-methyl, the neuromuscular block worsened, indicating that aging of the AChE had been completed. The electrophysiologic improvement was always accompanied with better motor function but not necessarily with improvement of the overall clinical status. Serum ChE did not predict the oxime effect at the motor endplate. In humans, the efficacy of oximes in AChE reactivation can be determined rapidly using electrophysiologic studies.© 1995 John Wiley &Sons, Inc.     

Comparative analysis of background EEG activity in childhood absence epilepsy during valproate treatment: a standardized,low-resolution,brain electromagnetic tomography (sLORETA) study

Valproate (VPA) is an antiepileptic drug (AED) used for initial monotherapy in treating childhood absence epilepsy (CAE). EEG might be an alternative approach to explore the effects of AEDs on the central nervous system. We performed a comparative analysis of background EEG activity during VPA treatment by using standardized, low-resolution, brain electromagnetic tomography (sLORETA) to explore the effect of VPA in patients with CAE. In 17 children with CAE, non-parametric statistical analyses using sLORETA were performed to compare the current density distribution of four frequency bands (delta, theta, alpha, and beta) between the untreated and treated condition. Maximum differences in current density were found in the left inferior frontal gyrus for the delta frequency band (log-F-ratio = ?1.390, P > 0.05), the left medial frontal gyrus for the theta frequency band (log-F-ratio = ?0.940, P > 0.05), the left inferior frontal gyrus for the alpha frequency band (log-F-ratio = ?0.590, P > 0.05), and the left anterior cingulate for the beta frequency band (log-F-ratio = ?1.318, P > 0.05). However, none of these differences were significant (threshold log-F-ratio = ±1.888, P < 0.01; threshold log-F-ratio = ±1.722, P < 0.05). Because EEG background is accepted as normal in CAE, VPA would not be expected to significantly change abnormal thalamocortical oscillations on a normal EEG background. Therefore, our results agree with currently accepted concepts but are not consistent with findings in some previous studies.