Dynamic cerebral autoregulation is compromised in ischaemic stroke of undetermined aetiology only in the non-affected hemisphere

Background and purposeTo assess dynamic cerebral autoregulation (CA) in patients with acute ischaemic stroke of undetermined aetiology, within 72 h of stroke onset.Materials and methodsIn 6 patients with ischaemic stroke of undetermined aetiology (aged 66 ± 9 years, National Institutes of Health Stroke Scale [NIHSS] score on admission: 4.0, range: 4–11), selected based on screening of 118 consecutive ischaemic stroke patients and in 14 volunteers (aged 62 ± 10 years), we continuously monitored RR intervals (RRI), mean arterial pressure (MAP) by means of photoplethysmography, mean cerebral blood flow velocity (CBFV) using transcranial Doppler ultrasonography, end-tidal CO₂ (ETCO₂) and respiration during 2-min deep breathing paced at 6 min⁻¹ (0.1 Hz). To assess CA, we evaluated the impact of breathing-induced MAP oscillations on fluctuations of CBFV in the hemispheres with stroke, the non-involved hemispheres and randomly selected hemispheres of controls by applying cross-spectral analysis and calculating coherence, transfer function gain (CBFV–MAP gain) and phase shift angle between the two oscillating signals.ResultsPhase shift angle between MAP and CBFV oscillations showed values >0 and was significantly reduced in the hemispheres without stroke as compared to controls (0.39 ± 0.95 vs. −1.59 ± 0.33 rad, p = 0.015), whereas in the hemispheres with stroke, phase shift angle did not differ significantly from that observed in the control hemispheres. Clinical status of stroke patients significantly improved at discharge from the hospital (NIHSS: 2.0, range: 1–8, p = 0.028).ConclusionsDuring the first days of ischaemic stroke of undetermined aetiology, dynamic cerebral autoregulation is compromised in the non-affected hemisphere, but not in the hemisphere with ischaemic lesion.     

Duration of focal complex,secondarily generalized tonic–clonic,and primarily generalized tonic–clonic seizures — A video-EEG analysis

IntroductionIdentifying seizures with prolonged duration during video-electroencephalographic (EEG) monitoring is of importance to inform clinicians when to start emergency treatment of seizures to prevent status epilepticus. The aims of this study were to assess the clinical and EEG seizure duration (SD) in consecutive patients with epilepsy who underwent prolonged video-EEG monitoring and to identify a seizure type-dependent time point to start emergency treatment based on the likelihood that seizures will not stop spontaneously. Furthermore, we sought to determine predictors of SD and explored the relationship between antiepileptic drug (AED) serum levels and SD.Material and methodsWe retrospectively analyzed 1796 seizures in 200 patients undergoing video-EEG monitoring between January 2006 and March 2008.ResultsFocal simple seizures lasted significantly shorter (clinical SD: 28 s, EEG SD: 42 s) compared with focal complex seizures (clinical SD: 64 s, EEG SD: 62 s), and both seizure types lasted significantly shorter compared with secondarily generalized tonic–clonic seizures (GTCSs; clinical SD: 90 s, EEG SD: 96 s). There was no difference between the duration of the convulsive phase of primary GTCSs (defined as nonfocal) and that of secondarily GTCSs (each 65 s). Cumulative clinical SD (99%) was 7 min in focal complex seizures and 11 min in focal simple seizures. Mixed linear regression model demonstrated that history of status epilepticus (P = 0.034), temporal lobe seizure onset (P = 0.040), and MRI lesions (P = 0.013) were significantly associated with logarithmic EEG SD in focal epilepsies recorded with scalp electrodes. We found significant negative correlations between the AED serum level and the EEG SD in patients treated with monotherapy: carbamazepine (P < 0.001), levetiracetam (P = 0.001), oxcarbazepine (P = 0.001), and valproic acid (P = 0.038) but not with lamotrigine monotherapy and EEG SD.DiscussionBased on the results of this study, we propose 2 min of convulsive seizure activity (irrespective of focal or generalized onset) as a prolonged seizure, which could serve as a time point to consider treatment to prevent status epilepticus. In focal complex seizures, we suggest an upper limit of 7 min, and in focal simple seizures 11 min, as definition of prolonged seizures. History of status epilepticus, temporal seizure onset, and lesional MRI findings are factors associated with significantly longer SD. Negative correlations of carbamazepine, levetiracetam, oxcarbazepine, and valproic acid serum levels and SD suggest a prolonging effect on seizures during withdrawal of these AEDs during video-EEG monitoring sessions.This article is part of a Special Issue entitled “Status Epilepticus”.     

Pallidal low β-low γ phase-amplitude coupling inversely correlates with Parkinson disease symptoms

ObjectiveRecent discoveries suggest that it is most likely the coupling of β oscillations (13–30 Hz) and not merely their power that relates to Parkinson disease (PD) pathophysiology.MethodsWe analyzed power and phase amplitude coupling (PAC) in local field potentials (LFP) recorded from Pallidum after placement of deep brain stimulation (DBS) leads in nineteen PD patients and three patients with dystonia.ResultsWithin GPi, we identified PAC between phase of β and amplitude of high frequency oscillations (200–300 Hz) and distinct β-low γ (40–80 Hz) PAC both modulated by contralateral movement. Resting β-low γ PAC, also present in dystonia patients, inversely correlated with severity of rigidity and bradykinesia (R = −0.44, P = 0.028). These findings were specific to the low β band, suggesting a differential role for the two β sub-bands.ConclusionsPAC is present across distinct frequency bands within the GPi. Given the presence of low β-low γ PAC in dystonia and the inverse correlation with symptom severity, we propose that this PAC may be a normal pallidal signal.SignificanceThis study provides new evidence on the pathophysiological contribution of local pallidal coupling and suggests similar and distinct patterns of coupling within GPi and STN in PD.     

Validation de la batterie rapide de dénomination (BARD) chez 382 témoins et 1004 patients d’une consultation mémoire

IntroductionThe Rapid BAttery of Denomination (BARD) is a short 10-item naming test derived from the 60-item Boston Naming Test. It is easily performed in less than 15 seconds by normal controls independently of age, gender and education (Croisile, 2005, Croisile, 2007, Croisile, 2008). Our aim was to evaluate the BARD in various conditions seen in a memory clinic.Patients and methodsThe BARD was used in 382 normal subjects (165 men and 217 women, aged from 20 to 97 years) and 1004 patients attending a memory clinic. Three groups of 505 patients with Alzheimer's disease (AD) were compared: mild patients (n = 402), moderate patients (n = 84) and moderately severe patients (n = 19). The BARD was also used in 499 patients with a Mini Mental Status (MMSE) ≥ 20: 173 patients with amnestic Mild Cognitive Impairment (aMCI), 56 patients with frontotemporal dementia (FTD), 41 patients with Lewy Body dementia (LBD), 36 patients with nonfluent primary progressive aphasia (NFPPA), 27 patients with semantic dementia (SD), 16 patients with posterior cortical atrophy (PCA), 150 patients with anxiety or depression (ADD).ResultsThe performance of the patients was not affected by age, gender or education. aMCI had a score of 9.97 ± 0.18, ADD a score of 9.97 ± 0.2. A mild anomia was observed in three groups: mild AD (9.78 ± 0.5), FTD (9.79 ± 0.65) et LBD (9.98 ± 0.16). A more pronounced anomia was present in moderate AD (9.10 ± 1.06), moderately severe AD (8.05 ± 1.27), PCA (8.12 ± 3.28) and NFPPA (8.44 ± 1.61). The anomia was severe in SD (5.85 ± 2.46). The 10 items were perfectly named by 98 % of ADD, 96.53 % of aMCI, 82.09 % of mild AD, 87.5 % of FTD patients, 97.56 % of LBD patients, 68.75 % of PCA patients, but only 45.24 % moderate AD, 5.26 % of moderately severe AD, 27.78 % of NFPPA, and 3.7 % of SD. In the patients with MMS ≥ 20, Anova showed that the BARD scores of the ADD, aMCI, mild AD, FTD and LBD groups were significantly greater than the BARD scores of NFPPA, SD and PCA. PCA and NFPPA groups did not differ for BARD scores whereas they were significantly better than SD. A ROC curve comparing the 822 mild anomic patients (AD, FTD, LBD, aMCI, ADD) with the 79 more anomic patients (NFPPA, SD, PCA) showed that for a BARD score of 10, sensitivity was 72.2 %, specificity was 89.2 %, and 87.7 % of the patients were correctly classified.ConclusionThe BARD is a quick and useful tool for identifying naming disorders in a memory clinic. In patients with MMSE ≥ 20, making one error at the BARD is highly abnormal and significantly characteristic of cognitive disorders: the more frequent the errors are, the more probable is the presence of a visual agnosia (PCA), an aphasia (NFPPA), or a semantic disorder (SD).     

Autonomic nervous system functioning associated with psychogenic nonepileptic seizures: Analysis of heart rate variability

ObjectivePsychogenic nonepileptic seizures (PNESs) resemble epileptic seizures but originate from psychogenic rather than organic causes. Patients with PNESs are often unable or unwilling to reflect on underlying emotions. To gain more insight into the internal states of patients during PNES episodes, this study explored the time course of heart rate variability (HRV) measures, which provide information about autonomic nervous system functioning and arousal.MethodsHeart rate variability measures were extracted from double-lead electrocardiography data collected during 1–7 days of video-electroencephalography monitoring of 20 patients with PNESs, in whom a total number of 118 PNESs was recorded. Heart rate (HR) and HRV measures in time and frequency domains (standard deviation of average beat-to-beat intervals (SDANN), root mean square of successive differences (RMSSD), high-frequency (HF) power, low-frequency (LF) power, and very low-frequency (VLF) power) were averaged over consecutive five-minute intervals. Additionally, quantitative analyses of Poincaré plot parameters (SD1, SD2, and SD1/SD2 ratio) were performed.ResultsIn the five-minute interval before PNES, HR significantly (p < 0.05) increased (d = 2.5), whereas SDANN (d = − 0.03) and VLF power (d = − 0.05) significantly decreased. During PNES, significant increases in HF power (d = 0.0006), SD1 (d = 0.031), and SD2 (d = 0.016) were observed. In the five-minute interval immediately following PNES, SDANN (d = 0.046) and VLF power (d = 0.073) significantly increased, and HR (d = − 5.1) and SD1/SD2 ratio (d = − 0.14) decreased, compared to the interval preceding PNES.ConclusionThe results suggest that PNES episodes are preceded by increased sympathetic functioning, which is followed by an increase in parasympathetic functioning during and after PNES. Future research needs to identify the exact nature of the increased arousal that precedes PNES.     

Percutaneous endoscopic lumbar discectomy for lumbar disc herniation

This study aims to compare the advantages and disadvantage of percutaneous endoscopic lumbar discectomy (PELD) and standard discectomy (SD) for the treatment of lumbar intervertebral disc herniation (LDH). We searched in MEDLINE, EMBASE, PubMed, Web of Science and Cochrane databases for relevant trials that compare PELD and SD for the treatment of LDH. The Cochrane Collaboration’s Revman 5.3 software was used for data analyses. This meta-analysis compiled 1301 cases from four random controlled trials and three retrospective studies. Compared with SD, PELD showed a shorter operative time (mean difference (MD) = −18.68, 95% confidence interval (CI): −24.92 to −12.43; p < 0.00001), less blood loss (MD = −64.88, 95% CI: −114.51 to −15.25, p < 0.0001), shorter hospital stay (MD = −3.51, 95% CI: −4.93 to −2.08, p < 0.00001), and shorter mean disability period (MD = −34.34, 95% CI: −53.90 to −14.77, p < 0.006). However, there were no significant differences in the visual analogue scale (VAS) scores at the final follow up (MD = −0.23, 95% CI: −0.53 to 0.07, p = 0.14), Macnab criteria at the final follow up (MD = 1.04, 95% CI: 0.72 to 1.50, p = 0.82), complications (RR = 0.76, 95% CI: 0.40 to 1.43, p = 0.39), recurrence rate (risk ratio (RR) = 1.00, 95% CI: 0.61 to 1.64, p = 1) and reoperation rate (RR = 1.40, 95% CI: 0.90 to 2.16, p = 0.13). In conclusion, despite PELD showing significant benefit in short term outcomes such as hospital course and mean disability period, similar clinical efficacy and long term outcomes were observed when compared to SD. Therefore, we suggest that PELD can be a feasible alternative to the conventional posterior approach for the LDH depending on surgeon preference and indication. High-quality randomized controlled trials with sufficient large sample sizes necessary further confirm these results.     

The survival significance of a measurable enhancing lesion after completing standard treatment for newly diagnosed glioblastoma

The goal of this study was to analyze the survival outcome according to the treatment response after completing standard treatment protocol for newly diagnosed glioblastoma (GBM) and to suggest a patient who should be considered for further treatment. After approving by our Institutional Review Board, 57 patients (38 male, 19 female; median age, 52 years; age range, 16–81 years) with newly diagnosed GBM who completed standard treatment protocol were examined retrospectively. According to the treatment response using the RANO criteria, there were 20 patients with complete response (CR), five patients with partial response (PR), 13 patients with stable disease (SD) and 19 patients with progressive disease (PD) after the completion of standard treatment. Patients (PR + SD + PD) with a measurable enhancing lesion were categorized the MEL group (n = 37). We analyzed the difference of survival outcome between CR group and MEL group. The median progression-free survival (PFS) in the CR group was significantly better than that of the MEL group (18.0 months vs. 3.0 months, p = 0.004). The median overall survival (OS) was also significantly longer in the CR group (25.0 months vs. 15.0 months, p = 0.005). However, there was no significant difference in the survival outcome of the CR group compared with that of the subset of MEL group patients who showed PR or SD. Poor survival outcome was found only in MEL group patients who exhibited progression. Patients with a measurable enhancing lesion showing progression after completion of standard treatment protocol are appropriate candidates for further treatment.     

Cardiovascular and metabolic risk in outpatients with schizoaffective disorder treated with antipsychotics: Results from the CLAMORS study

AimTo assess the coronary heart disease (CHD) risk and prevalence of the metabolic syndrome (MS) in patients with schizoaffective disorder (SD) receiving antipsychotics.MethodsPatients meeting DSM-IV criteria for SD and receiving antipsychotic treatment were recruited in a retrospective, cross-sectional, multicenter study (the CLAMORS study). MS was defined as at least three of the following components: waist circumference greater than 102 cm (men)/greater than 88 cm (women); serum triglycerides greater or equal to 150 mg/dl; HDL cholesterol less than 40 mg/dl (men)/less than 50 mg/dl (women); blood pressure greater or equal to 130/85 mmHg; fasting blood glucose greater or equal to 110 mg/dl. The 10-year CHD risk was assessed by the Systematic coronary risk evaluation (SCORE) (cardiovascular mortality) and Framingham (any cardiovascular event) functions. Clinical severity was assessed using the PANSS and CGI-S scales.ResultsA total of 268 valuable patients with SD (127 men, 48.1%), 41.9 ± 12.3 years (mean ± S.D.), were analyzed. The 10-year overall cardiovascular mortality and CV-event risk were 0.8 ± 1.6 (SCORE) and 6.5 ± 6.8 (Framingham), respectively. A high/very high risk of any CV event (Framingham ≥ 10%) was associated with severity [CGI-S = 3–4; OR: 4.32 (1.15–16.26), P = 0.03)]. MS was present in 26.5% (95%CI: 21.2–31.8) of subjects, without gender differences, but significantly associated with patient's impression of severity: CGI = 3–4; OR = 1.90 (0.83–4.36), and CGI = 5–7; OR = 3.13 (1.06–9.24), P = 0 < 0.001, and age [OR = 1.91 (1.09–3.34), P < 0.024)].ConclusionsCHD risk and MS prevalence were high among patients with SD, being MS prevalence associated with age and severity of disease.     

Associations of working models of the self and other with Cloninger's personality dimensions

The present study examined the associations of working models of the self and other, one of the key concepts of Bowlby's attachment theory, with the seven dimensions of Cloninger's personality model. The subjects were 542 healthy Japanese volunteers. Working models of the self and other were assessed by the Relationship Scales Questionnaire, and the seven dimensions of personality were evaluated by the Temperament and Character Inventory. In the correlation analysis, the self-model was correlated most strongly with self-directedness (SD) (r = 0.50, P < 0.001) and second strongly with harm avoidance (HA) (r = −0.43, P < 0.001), while the other-model was correlated most strongly with cooperativeness (C) (r = 0.43, P < 0.001) and second strongly with reward dependence (RD) (r = 0.41, P < 0.001). In the principal component analysis, the self-model formed a group with SD and HA, while the other-model formed a group with C and RD. The present study suggests that the self-model is reflected in SD and HA, while the other-model is reflected in C and RD.     

Could the beta rebound in the EEG be suitable to realize a “brain switch”?

ObjectivePerforming foot motor imagery is accompanied by a peri-imagery ERD and a post-imagery beta ERS (beta rebound). Our aim was to study whether the post-imagery beta rebound is a suitable feature for a simple “brain switch”. Such a brain switch is a specifically designed brain–computer interface (BCI) with the aim to detect only one predefined brain state (e.g. EEG pattern) in ongoing brain activity.MethodOne EEG (Laplacian) recorded at the vertex during cue-based brisk foot motor imagery was analysed in 5 healthy subjects. The peri-imagery ERD and the post-imagery beta rebound (ERS) were analysed in detail between 6 and 40 Hz and classified with two support vector machines.ResultsThe ERD was detected in ongoing EEG (simulation of asynchronous BCI) with a true positive rate (TPR) of 28.4% ± 13.5 and the beta rebound with a TPR of 59.2% ± 20.3. In single runs with 30 cues each, the TPR for beta rebound detection was 78.6% ± 12.8. The false positive rate was always kept below 10%.ConclusionThe findings suggest that the beta rebound at Cz during foot motor imagery is a relatively stable and reproducible phenomenon detectable in single EEG trials.SignificanceOur results indicate that the beta rebound is a suitable feature to realize a “brain switch” with one single EEG (Laplacian) channel only.     

Serum urate levels are unchanged with continuous positive airway pressure therapy for obstructive sleep apnea: a randomized controlled trial

ObjectiveHyperuricemia is associated with the presence and severity of obstructive sleep apnea (OSA). Previous work has shown that treatment of OSA with continuous positive airway pressure (CPAP) therapy reduces urinary uric acid excretion and serum urate, but there has been no previous randomized controlled investigation on the effects of CPAP therapy on serum urate; we aimed to assess this association.MethodsSerum urate was measured in samples from participants of a previously published randomized controlled trial. Samples were taken at baseline and after 3 months from men with known type 2 diabetes mellitus (T2DM) and newly diagnosed OSA, randomized to receive either therapeutic (n = 19) or placebo (n = 19) CPAP for 3 months.ResultsBoth groups were well matched at baseline, with no significant difference in age, body mass index (BMI), glycosylated hemoglobin (HbA1c), or oxygen desaturation index (ODI). There was no significant difference in therapeutic or placebo CPAP usage. There was no significant difference in urate levels between groups at baseline (362 μmol/L [standard deviation {SD}, 96] vs 413 μmol/L [SD, 91] [reference range, 110–428 μmol/L]) or at 3 months. Baseline urate did not correlate with ODI, BMI, or HbA1c. The mean change in urate at 3 months did not significantly differ between treatment groups (−7.6 μmol/L [SD, 35.9] vs −6.2 μmol/L [SD, 46.2]) (P = .9; [95% confidence interval, −28.7 to +25.9]).ConclusionOur randomized controlled trial has shown no significant reduction in serum urate following 3 months treatment with therapeutic or placebo CPAP.     

Growth hormone treatment in boys with Duchenne muscular dystrophy and glucocorticoid-induced growth failure

This study evaluated efficacy and safety of growth hormone treatment in Duchenne muscular dystrophy boys with glucocorticoid-induced growth failure. We reviewed 39 consecutive boys (average age 11.5 years; 32 ambulatory) treated with growth hormone for 1 year during a four-year period. Boys were on long-term daily deflazacort or prednisone (mean duration 5 ± 2.2 years; dosing regimen prednisone 0.75 mg/kg/day equivalent). Primary outcomes were growth velocity and height-for-age z-scores (height SD) at 1 year. Height velocity increased from 1.3 ± 0.2 to 5.2 ± 0.4 cm/year on growth hormone (p < 0.0001). Pre-growth hormone decline in height SD (−0.5 ± 0.2 SD/year) stabilized at height SD −2.9 ± 0.2 on growth hormone (p < 0.0001). The rate of weight gain was unchanged, at 2.8 ± 0.6 kg/year pre-growth hormone and 2.6 ± 0.7 kg/year at 1 year. Motor function decline was similar pre-growth hormone and at 1 year. Cardiopulmonary function was unchanged. Three experienced side effects. In this first comprehensive report of growth hormone in Duchenne muscular dystrophy, growth hormone improved growth at 1 year, without detrimental effects observed on neuromuscular and cardiopulmonary function.     

Ocular vestibular evoked myogenic potentials to head tap and cervical vestibular evoked myogenic potentials to air-conducted sounds in isolated internuclear ophthalmoplegia

ObjectiveThe central pathways responsible for ocular vestibular evoked myogenic potentials (VEMPs) to forehead tapping remain to be determined. This study aimed to determine whether the medial longitudinal fasciculus (MLF) carries the signals for ocular VEMPs (oVEMPs) in response to this mode of stimulation.MethodsTwelve patients with isolated unilateral internuclear ophthalmoplegia (INO) due to brainstem infarction underwent evaluation of the ocular tilt reaction (ocular torsion and skew deviation), tilt of the subjective visual vertical (SVV), cervical VEMPs (cVEMPs) in response to tone burst sound, and oVEMPs induced by tapping the forehead.ResultsEight (67%) patients showed abnormal oVEMPs that included no wave formation (n = 4) and decreased amplitude (n = 3) in the lesion side, and bilaterally absent responses in the remaining patient. Furthermore, the patients showed diminished oVEMPs responses in the lesion side compared with normal side (6.0 ± 5.6 vs. 11.7 ± 5.5 μV, paired t-test, p = 0.001) and increased IAD_amp(%) of the oVEMPs compared with normal controls (43.6 ± 41.2 vs. 9.1 ± 6.2, t-test, p = 0.018). In contrast, cVEMPs were abnormal in only three (25%) patients, decreased (n = 2) or no response in the lesion side. Eleven (92%) patients showed contraversive ocular tilt reaction or SVV tilt.ConclusionPatients with INO frequently show impaired formation of ipsilesional oVEMPs in response to forehead tapping. The occasional abnormality and decreased amplitude of ipsilesional cVEMPs also suggest a modulatory pathway for the inhibitory sacculocollic reflex descending in the MLF.SignificanceThis study suggests that the MLF contains the fibers for the otolith-ocular reflex from the contralateral ear.     

Six minute walk test in type III spinal muscular atrophy: A 12 month longitudinal study

The aim of our longitudinal multicentric study was to establish the changes on the 6 min walk test (6MWT) in ambulant SMA type III children and adults over a 12 month period. Thirty-eight ambulant type III patients performed the 6MWT at baseline and 12 months after baseline. The distance covered in 6 min ranged between 75 and 510 m (mean 294.91, SD 127) at baseline and between 50 and 611 m (mean 293.41 m, SD 141) at 12 months. The mean change in distance between baseline and 12 months was ?1.46 (SD 50.1; range: ?183 to 131.8 m). The changes were not correlated with age or baseline values (p > .05) even though younger patients reaching puberty, had a relatively higher risk of showing deterioration of more than 30 m compared to older patients. Our findings provide the first longitudinal data using the 6MWT in ambulant SMA patients.     

Sexual dysfunction ın multiple sclerosis: Gender differences

PurposeTo assess the frequency and nature of sexual dysfunction in multiple sclerosis (MS) patients and to investigate the relationships of SD with clinical, demographic and psychosocial factors by comparing MS patients with and without SD.MethodsEighty-nine patients were included, 45 males and 44 females, aging an average of 37.4 ± 8.6 years (range:21–56). We applied Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19) and Arizona Sexual Experiences Scale (ASEX) to all patients. Disability was evaluated with the expanded disability status scale (EDSS).Results60.7% (n = 54) of patients reported SD according to MSISQ scores. Women exhibited significantly higher MSISQ scores than men (42.6 ± 12.9 and 36.6 ± 13.3, respectively; P = 0.034). Women (7.9%) also reported to experience sexual arousal difficulties significantly more than men (1.1%) (P = 0.024) according to ASEX. The patients were classified into three MSISQ-19 subscales, Primary, Secondary and Tertiary SD. The most common reported dimension of SD was secondary (32.5%, n = 41). In this dimension of SD, patients mostly complained of pain-burning, memory-concentration problems and bowel symptoms. A significant relationship was found between Secondary SD and both EDSS score and disease duration (r = 0.34 p = 0.001 and r = 0.21 p = 0.042, respectively). Tertiary SD was also associated with EDSS score (r = 0.23 p = 0.03).ConclusionSexual Dysfunction, a frequent problem for MS patients, is associated with gender. Women reported more SD than men. Secondary SD symptoms were the most common complaints for both men and women. Nonetheless women had more secondary SD symptoms than men. The emotional dimension of SD is related with disability.     

Differential control of vasomotion by angiotensins in the rostral ventrolateral medulla of hypertensive rats

The central and peripheral renin–angiotensin systems are known for playing a key role in cardiovascular control. In the present study, we evaluated the hemodynamic effects produced by nanoinjections of angiotensin II (Ang II) or angiotensin-(1–7) [Ang-(1–7)] into the rostral ventrolateral medulla (RVLM) of adult male normotensive (Wistar—WT) and spontaneously hypertensive rats (SHR). Animals were anesthetized (urethane 1.2 g/kg) and instrumented for recording blood pressure (BP), heart rate (HR) and blood flow (BF) in the femoral, renal or mesenteric arteries. Afterwards, rats were positioned in a stereotaxic and prepared for nanoinjections (100 nl) of saline (NaCl 0.9%), Ang-(1–7) (40 ng) or Ang II (40 ng) into the RVLM. The vascular resistance (VR) was calculated by ΔMAP/ΔBF ratio. In WT, Ang-(1–7) or Ang II caused equipotent pressor effects that were not accompanied by changes in vascular resistance. However, MAP changes were greater in SHR. This strain also showed a concomitant increase in relative vascular resistance (ΔVR/VRbaseline) of renal (0.31 ± 0.07 and 0.3 ± 0.07 vs. 0.02 ± 0.01; Ang-(1–7), Ang II and Saline, respectively) and mesenteric beds (0.3 ± 0.06 and 0.33 ± 0.04 vs. 0.05 ± 0.02; Ang-(1–7), Ang II and saline, respectively). We conclude that Ang II and Ang-(1–7) at the RVLM control the vascular resistance of renal and mesenteric beds during hypertension.     

Resilience and spirituality in patients with depression and their family members: A cross-sectional study

ObjectiveThe degree and quality of resilience in patients with depression have never been investigated in the context of remission status, spirituality/religiosity, and family members' resilience levels, which was addressed in this study.MethodsThis cross-sectional study recruited Japanese outpatients with depressive disorder according to ICD-10 and cohabitant family members who were free from psychiatric diagnoses. Resilience was assessed using the 25-item Resilience Scale (RS). Other assessments included the Montgomery-Asberg Depression Rating Scale (MADRS); the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT) and Kasen et al.'s (2012) scale for spirituality/religiosity; and the Rosenberg Self-Esteem Scale (RSES).ResultsOne hundred outpatients with depression (mean ± SD age, 50.8 ± 14.5 years; 44 men; MADRS total score 9.8 ± 9.0) and 36 healthy family members (mean ± SD age, 56.5 ± 15.0 years; 18 men) were included. Symptom severity, attendance at religious/spiritual services, and self-esteem were significantly associated with RS scores in the patient group. RS total scores were significantly higher in remitted patients compared to non-remitted patients (mean ± SD, 112.3 ± 17.1 vs. 84.8 ± 27.7, p < 0.001). No correlation was found in RS total scores between patients and their family members (p = 0.265), regardless of patients' remission status.ConclusionsResilience may be influenced by individual characteristics rather than familial environment; furthermore, self-esteem or spirituality/religiosity may represent reinforcing elements. While caution is necessary in extrapolating these findings to other patient populations, our results suggest that resilience may be considered a state marker in depression.     

Long-term safety and efficacy of clobazam for Lennox–Gastaut syndrome: Interim results of an open-label extension study

In an ongoing open-label extension (OV-1004), patients with Lennox–Gastaut syndrome who had completed 1 of 2 randomized controlled trials (OV-1002 [Phase II] or OV-1012 [Phase III]) are receiving clobazam at dosages ≤ 2.0 mg/kg/day (≤ 80 mg/day). Of 306 eligible patients from OV-1002 or OV-1012, 267 entered the open-label extension. As of the interim date, July 1, 2010, 213 patients (79.8%) had remained in the trial, and 189 had received clobazam for ≥ 12 months, 128 for ≥ 18 months, and 94 for ≥ 24 months. Median percentage decreases in average weekly rates of drop seizures were 71.1% and 91.6% at Months 3 and 24. Mean modal and mean maximum daily dosages were 0.94 mg/kg and 1.22 mg/kg for those who had received clobazam for ≥ 1 year. The 4 most common adverse events were upper respiratory tract infection (18.4%), fall (14.2%), pneumonia (13.9%), and somnolence (12.7%). Clobazam's adverse event profile was consistent with its profile in controlled trials.     

Ocular and cervical vestibular-evoked myogenic potentials to bone conducted vibration in Ménière’s disease during quiescence vs during acute attacks

ObjectiveTwo indicators of otolithic function were used to measure dynamic otolith function in the same patients both during an acute attack of Ménière’s disease (MD) and in the quiescent period between attacks.MethodsThe early negative component (n10) of the ocular vestibular-evoked myogenic potential (the oVEMP) to brief 500 Hz bone conducted vibration (BCV) stimulation of the forehead, in the midline at the hairline (Fz) was recorded by surface EMG electrodes just beneath both eyes while the patient looked up. It has been proposed that the n10 component of the oVEMP to 500 Hz Fz BCV indicates utricular function. It has been proposed that the early positive component (p13) of the cervical vestibular-evoked myogenic potential (the cVEMP) recorded by surface electrodes on both tensed SCM neck muscles to 500 Hz Fz BCV indicates saccular function.ResultsSixteen healthy control subjects tested on two occasions showed no detectable change in the symmetry of oVEMPs or cVEMPs to 500 Hz Fz BCV. In response to 500 Hz Fz BCV 15 early MD patients tested at both attack and quiescent phases showed a dissociation: there was a significant increase in contralesional of n10 of the oVEMP during the attack compared to quiescence but a significant decrease in the ipsilesional p13 of the cVEMP during the attack compared to quiescence.ConclusionsDuring an MD attack, dynamic utricular function in the affected ear as measured by the n10 of the oVEMP to 500 Hz Fz BCV is enhanced, whereas dynamic saccular function in the affected ear as measured by the p13 of the cVEMP to 500 Hz Fz BCV is not similarly affected.SignificanceThe MD attack appears to affect different otolithic regions differentially.     

Clobazam is efficacious for patients across the spectrum of disease severity of Lennox–Gastaut syndrome: Post hoc analyses of clinical trial results by baseline seizure-frequency quartiles and VNS experience

Lennox–Gastaut syndrome (LGS) severity varies considerably, so the potential impact of differences in baseline severity on patient outcome following treatment is clinically informative. Here, two surrogate indicators of LGS severity (baseline seizure frequency and vagus nerve stimulation [VNS] use) were used in post hoc analyses of both short- and long-term clobazam trials (Phase III OV-1012 [CONTAIN] and open-label extension [OLE] OV-1004). In CONTAIN, 217 patients comprised the modified, intention-to-treat population. Each baseline seizure-frequency quartile had ~ 40 patients, and baseline weekly drop-seizure frequency ranges were as follows: < 10 (Quartile 1), 10–30 (Quartile 2), 32–86 (Quartile 3), and 86–1077 (Quartile 4). Mean percentage decreases in average weekly drop and total seizures were similar for all quartiles. More than 50% of patients in all 4 quartiles demonstrated ≥ 50% decreases in weekly drop- and total-seizure frequency. The percentage of patients achieving 100% reduction in drop seizures was 33% for clobazam-treated patients (vs. 7% for placebo) in Quartile 1. Five percent of clobazam-treated patients in Quartile 4 (most severe LGS) vs. 0% for placebo achieved 100% reduction in drop seizures. A total of 267 of 306 possible patients entered the OLE (61/68 from a Phase II study and 206/238 from Phase III CONTAIN). Each quartile had ~ 66 patients, and baseline weekly drop-seizure ranges were as follows: < 10 (Quartile 1), 10–31 (Quartile 2), 32–110 (Quartile 3), and 111–1147 (Quartile 4). Median percentage decreases in average weekly drop and total seizures were similar between quartiles. Through 5 years of therapy, > 50% of patients in all 4 quartiles demonstrated ≥ 50% decreases in weekly frequency for drop seizures. More than 12% of patients in Quartile 4 achieved 100% reduction in drop seizures from Month 3 through Year 5. For the VNS analyses in CONTAIN, the least-squares mean decreases in average weekly rate of drop seizures (mITT population) were 52% for VNS patients receiving clobazam vs. − 22% for placebo (p < 0.01). For non-VNS patients, these percentages were 53% for clobazam and 26% for placebo (p < 0.01). Moreover, 50% and 54% of clobazam-treated patients in the VNS and non-VNS groups demonstrated ≥ 50% decreases in average weekly drop- and total-seizure frequencies, and 11% and 14% in the two groups achieved drop-seizure freedom, respectively. Analyses using baseline seizure frequency and VNS use as surrogates for disease severity showed that clobazam treatment of patients with less severe or severe LGS was equally efficacious.